D00000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- D0707 26Intraoral periap radio image R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0707 TCIntraoral periap radio image R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0708 Intraoral bite radio image R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0708 26Intraoral bite radio image R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0708 TCIntraoral bite radio image R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0709 Intraoral comp image capture R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0709 26Intraoral comp image capture R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0709 TCIntraoral comp image capture R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0801 3d intraoral scan direct R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0801 263d intraoral scan direct R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0801 TC3d intraoral scan direct R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0802 3d dental scan indirect R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0802 263d dental scan indirect R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0802TC3d dental scan indirect R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0803 3d facial scan direct R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0803 263d facial scan direct R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0803 TC3d facial scan direct R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0804 3d facial scan indirect R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0804 263d facial scan indirect R 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D0804 TC3d facial scan indirect R 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- D0999 Unspecified diagnostic proce R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1110 Dental prophylaxis adult R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1120 Dental prophylaxis child R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1206 Topical fluoride varnish R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1208 Topical app fluorid ex vrnsh R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1301 Immunization counseling R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1310 Nutri counsel-control caries R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1320 Tobacco counseling R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1321 Couns for high risk sub use R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1330 Oral hygiene instructions R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1351 Dental sealant per tooth R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1353 Sealant repair per tooth R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1354 Int caries med app per tooth R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1355 Caries med app per tooth R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1510 Space maintainer fxd unilat R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1516 Fixed bilat space maint, max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1517 Fixed bilat space maint, man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1520 Remove unilat space maintain R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1526 Remove bilat space main, max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1527 Remove bilat space main, man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1551 Recement space maint - max R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1552 Recement space maint - man R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1553 Recement unilat space maint R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1556 Rem fixed unilat space maint R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1557 Remove fixed bilat maint max R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1558 Remove fixed bilat man R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1575 Dist space maint, fixed unil R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1701 Pfizer vacc admin 1st dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1702 Pfizer vacc admin 2nd dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1703 Moderna vacc admin 1st dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1704 Moderna vacc admin 2nd dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1708 Pfizer vacc admin 3rd dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1709 Pfizer vaccine admin booster I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1710 Moderna vacc admin 3rd dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1711 Moderna vacc admin booster I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1713 Pfizer vacc adm ped 1st dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1714 Pfizer vacc adm ped 2nd dose I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1720 Influenza vacc admin I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D1781 Vac admin human pap dose 1 I 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1782 Vac admin human pap dose 2 I 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1783 Vac admin human pap dose 3 I 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D1999 Unspecified preventive proc R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2140 Amalgam one surface permanen R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2150 Amalgam two surfaces permane R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2160 Amalgam three surfaces perma R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2161 Amalgam 4 or > surfaces perm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2330 Resin one surface-anterior R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2331 Resin two surfaces-anterior R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2332 Resin three surfaces-anterio R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2335 Resin 4/> surf or w incis an R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2390 Ant resin-based cmpst crown R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2391 Post 1 srfc resinbased cmpst R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2392 Post 2 srfc resinbased cmpst R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2393 Post 3 srfc resinbased cmpst R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2394 Post >=4srfc resinbase cmpst R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2410 Dental gold foil one surface R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2420 Dental gold foil two surface R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2430 Dental gold foil three surfa R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2510 Dental inlay metalic 1 surf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2520 Dental inlay metallic 2 surf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2530 Dental inlay metl 3/more sur R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2542 Dental onlay metallic 2 surf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2543 Dental onlay metallic 3 surf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2544 Dental onlay metl 4/more sur R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2610 Inlay porcelain/ceramic 1 su R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2620 Inlay porcelain/ceramic 2 su R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2630 Dental onlay porc 3/more sur R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2642 Dental onlay porcelin 2 surf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2643 Dental onlay porcelin 3 surf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2644 Dental onlay porc 4/more sur R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2650 Inlay composite/resin one su R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2651 Inlay composite/resin two su R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2652 Dental inlay resin 3/mre sur R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2662 Dental onlay resin 2 surface R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2663 Dental onlay resin 3 surface R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2664 Dental onlay resin 4/mre sur R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2710 Crown resin-based indirect R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2712 Crown 3/4 resin-based compos R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2720 Crown resin w/ high noble me R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2721 Crown resin w/ base metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2722 Crown resin w/ noble metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2740 Crown porcelain/ceramic R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2750 Crown porcelain w/ h noble m R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2751 Crown porcelain fused base m R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2752 Crown porcelain w/ noble met R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2753 Crown porc fused to titanium R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2780 Crown 3/4 cast hi noble met R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2781 Crown 3/4 cast base metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2782 Crown 3/4 cast noble metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2783 Crown 3/4 porcelain/ceramic R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2790 Crown full cast high noble m R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2791 Crown full cast base metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2792 Crown full cast noble metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2794 Crown-titanium R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2799 Interim crown R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2910 Recement inlay onlay or part R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2915 Recement cast or prefab post R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2920 Re-cement or re-bond crown R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2921 Reattach tooth fragment R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2928 Prefab porc/cer crown perm R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2929 Prefab porc/ceram crown pri R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2930 Prefab stnlss steel crwn pri R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2931 Prefab stnlss steel crown pe R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2932 Prefabricated resin crown R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2933 Prefab stainless steel crown R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2934 Prefab steel crown primary R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2940 Place direct restoration R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2949 Restorative foundation R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D2950 Core build-up incl any pins R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2951 Tooth pin retention R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2952 Post and core cast + crown R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2953 Each addtnl cast post R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2954 Prefab post/core + crown R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2955 Post removal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2956 Indirect rest remov R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2957 Each addtnl prefab post R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2960 Labial veneer resin direct R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2961 Labial veneer resin indirect R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2962 Labial veneer porc indirect R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2971 Add proc construct new crown R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2975 Coping R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2976 Band stabilization per tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2980 Crown repair R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2981 Inlay repair R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2982 Onlay repair R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2983 Veneer repair R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2989 Excavate tooth non-restorabl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2990 Resin infiltration of lesion R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2991 App of hydroxyapatite R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D2999 Dental unspec restorative pr R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3110 Pulp cap direct R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3120 Pulp cap indirect R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3220 Therapeutic pulpotomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3221 Gross pulpal debridement R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3222 Part pulp for apexogenesis R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3230 Pulpal therapy anterior prim R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3240 Pulpal therapy posterior pri R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3310 End thxpy, anterior tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3320 End thxpy, premolar tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3330 End thxpy, molar tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3331 Non-surg tx root canal obs R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3332 Incomplete endodontic tx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3333 Internal root repair R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3346 Retreat root canal anterior R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3347 Retreat root canal premolar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3348 Retreat root canal molar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3351 Apexification/recalc initial R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3352 Apexification/recalc interim R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3353 Apexification/recalc final R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3355 Pulpal regeneration initial R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3356 Pulpal regeneration interim R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3357 Pulpal regeneration complete R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3410 Apicoectomy - anterior R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3421 Root surgery premolar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3425 Root surgery molar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3426 Root surgery ea add root R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3428 Bone graft peri per tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3429 Bone graft peri each addl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3430 Retrograde filling R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3431 Biological materials R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3432 Guided tissue regeneration R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3450 Root amputation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3460 Endodontic endosseous implan R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3470 Intentional replantation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3471 Surg rep root res anterior R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3472 Surg rep root res premolar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3473 Surg rep root res molar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3501 Surg exp root surf anterior R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3502 Surg exp root surf premolar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3503 Surg exp root surf molar R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3910 Isolation- tooth w rubb dam R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3911 Intraorifice barrier R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3920 Tooth splitting R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3921 Decor or submerg erupt tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3950 Canal prep/fitting of dowel R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D3999 Endodontic procedure R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4210 Gingivectomy/plasty 4 or mor R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4211 Gingivectomy/plasty 1 to 3 R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4212 Gingivectomy/plasty rest R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4230 Ana crown exp 4 or> per quad R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4231 Ana crown exp 1-3 per quad R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4240 Gingival flap proc w/ planin R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4241 Gngvl flap w rootplan 1-3 th R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4245 Apically positioned flap R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4249 Crown lengthen hard tissue R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4260 Osseous surgery 4 or more R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4261 Osseous surg 1 to 3 teeth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4263 Bone replce graft first site R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4264 Bone replce graft each add R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4265 Bio mtrls to aid soft/os reg R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4266 Guided tiss regen resorble R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4267 Guided tiss regen nonresorb R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4268 Surgical revision procedure R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4270 Pedicle soft tissue graft pr R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4273 Auto tissue graft 1st tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4274 Mesial/distal wedge proc R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4275 Non-auto graft 1st tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4276 Con tissue w pedicle graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4277 Soft tissue graft firsttooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4278 Soft tissue graft addl tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4283 Auto tissue graft addl tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4285 Non-auto graft addl tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4286 Remove non-resorb barrier R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4322 Splint intra-coronal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4323 Splint extra-coronal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4341 Periodontal scaling & root R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4342 Periodontal scaling 1-3teeth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4346 Scaling gingiv inflammation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4355 Full mouth debridement R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4381 Localized delivery antimicro R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4910 Periodontal maint procedures R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4920 Unscheduled dressing change R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4921 Gingival irrigation per quad R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D4999 Unspecified periodontal proc R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5110 Dentures complete maxillary R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5120 Dentures complete mandible R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5130 Dentures immediat maxillary R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5140 Dentures immediat mandible R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5211 Dentures maxill part resin R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5212 Dentures mand part resin R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5213 Dentures maxill part metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5214 Dentures mandibl part metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5221 Immed max part denture resin R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5222 Immed man part denture resin R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5223 Immed max part dent metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5224 Immed mand part dent metal R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5225 Maxillary part denture flex R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5226 Mandibular part denture flex R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5227 Immed max part denture R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5228 Immed mand part denture R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5282 Remove unil part denture,max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5283 Remove unil part denture,man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5284 Rem unilat dent flex base R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5286 Rem unilat dent 1 pc resin R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5410 Dentures adjust cmplt maxil R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5411 Dentures adjust cmplt mand R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5421 Dentures adjust part maxill R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5422 Dentures adjust part mandbl R 0.00 0.00 0.00 0.00 0.00 0.005XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5511 Rep broke comp dent base man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5512 Rep broke comp dent base max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5520 Replace denture teeth complt R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5611 Rep resin part dent base man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5612 Rep resin part dent base max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5621 Rep cast part frame man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5622 Rep cast part frame max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5630 Rep partial denture clasp R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5640 Replace part denture teeth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5650 Add tooth to partial denture R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5660 Add clasp to partial denture R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5670 Replc tth&acrlc on mtl frmwk R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5671 Replc tth&acrlc mandibular R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5710 Dentures rebase cmplt maxil R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5711 Dentures rebase cmplt mand R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5720 Dentures rebase part maxill R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5721 Dentures rebase part mandbl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5725 Rebase hybrid prosthesis R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5730 Denture reln cmplt max dir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5731 Denture reln cmplt mand dir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5740 Denture reln part max dir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5741 Denture reln part mand dir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5750 Denture reln cmplt max indir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5751 Denture reln cmplt mand ind R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5760 Denture reln part max indir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5761 Denture reln part mand indir R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5765 Liner compl/partial rem dent R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5810 Denture interm cmplt maxill R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5811 Denture interm cmplt mandbl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5820 Denture interm part maxill R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5821 Denture interm part mandbl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5850 Denture tiss conditn maxill R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5851 Denture tiss condtin mandbl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5862 Precision attachment R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5863 Overdenture complete max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5864 Overdenture partial max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5865 Overdenture complete mandib R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5866 Overdenture partial mandib R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5867 Replacement of precision att R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5875 Prosthesis modification R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5876 Add metal sub to acrylc dent R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5877 Dup of complt dent-maxill R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5878 Dup of complt dent-mandib R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5899 Removable prosthodontic proc R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5909 Max guid prothes w/ flange R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5911 Facial moulage sectional R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00010009 33.4009 090 99 0.00 0.00 0.00
- D5912 Facial moulage complete R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5913 Nasal prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5914 Auricular prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5915 Orbital prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5916 Ocular prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5919 Facial prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5922 Nasal septal prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5923 Ocular prosthesis interim R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5924 Cranial prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5925 Facial augmentation implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5926 Replacement nasal prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5927 Auricular replacement R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5928 Orbital replacement R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5929 Facial replacement R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5930 Max guid prothes w/o flange R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5931 Surgical obturator R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5932 Postsurgical obturator R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5933 Refitting of obturator R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5934 Mandibular flange prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5935 Mandibular denture prosth R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5936 Temp obturator prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5937 Trismus appliance R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5938 Resct proth max comp remov R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5939 Resct proth mand comp remov R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5940 Resct proth max part remov R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5941 Resct proth mand part remov R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5942 Proth max implt sup remv R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5943 Proth mandib implt sup remv R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5944 Max implt sup remv part R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5945 Mand implt sup remv part R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5946 Max implt sup fix R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5947 Mand implt sup fix R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5948 Max implt sup fix part R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5949 Mand implt sup fix part R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D5951 Feeding aid R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5952 Pediatric speech aid R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5953 Adult speech aid R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5954 Superimposed prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5955 Palatal lift prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5958 Intraoral con def inter plt R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5959 Intraoral con def mod palat R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5960 Modify speech aid prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5982 Surgical stent R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5983 Radiation applicator R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5984 Radiation shield R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5985 Radiation cone locator R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5986 Fluoride applicator R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5987 Commissure splint R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5988 Surgical splint R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5991 Vesiculobullous disease carr R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5992 Adjust max prost appliance R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5993 Main/clean max prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5995 Peri medicament w/seal, max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5996 Peri medicament w/seal, mand R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D5999 Maxillofacial prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6010 Odontics endosteal implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6011 Second stage implant surgery R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6012 Endosteal implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6013 Surgical place mini implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6040 Odontics eposteal implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6049 Scale implt peri-implt inflm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6050 Odontics transosteal implnt R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6051 Interim implant abutment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6055 Implant connecting bar R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6056 Prefabricated abutment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6057 Custom abutment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6058 Abutment supported crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6059 Abutment supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6060 Abutment supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6061 Abutment supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6062 Abutment supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6063 Abutment supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6064 Abutment supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6065 Implant supported crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6066 Implant supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6067 Implant supported mtl crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6068 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6069 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6070 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6071 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6072 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6073 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6074 Abutment supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6075 Implant supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6076 Implant supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6077 Implant supported retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6080 Implant maintenance R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6081 Scale & debride, single imp R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6082 Imp crown porc to base alloy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6083 Imp crown porc to noble allo R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6084 Imp crown porc to titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6085 Interim implant crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6086 Imp crown base alloys R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6087 Implant crown noble alloys R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6088 Imp crown titanium alloys R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6089 Access/retorq implant screw R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6090 Repair implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6091 Repl semi/precision attach R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6092 Recement supp crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6093 Recement supp part denture R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6094 Abut support crown titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6096 Remove broken imp ret screw R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6097 Abut crown porc to titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6098 Imp retain porc to base allo R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6099 Imp retainer for fpd R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6100 Surg removal of implant body R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6101 Debridement of a periimplant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6102 Debridement & contouring R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6103 Bone graft repair perimplant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6104 Bone graft time of implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6105 Remove implant body R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6106 Tissue regen resorbable R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6107 Tissue regen non-resorbable R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6110 Implnt/abut remov dent max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6111 Implnt/abut remov dent mand R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6112 Imp/abut rem dent part max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6113 Imp/abut rem dent part mand R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6114 Implnt/abut fixed dent max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6115 Implnt/abut fixed dent mand R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6116 Imp/abut fixed dent part max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6117 Imp/abut fixed dent part man R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6118 Imp/abut int fixed dent man R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6119 Int/abut int fixed dent max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6120 Imp retain porc to titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6121 Retain metal fpd base alloys R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6122 Retain metal fpd noble alloy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6123 Retain metal fpd titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6180 Implnt maint proced R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6190 Radio/surgical implant index R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6191 Semi precision abutment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6192 Semi precision attachment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6193 Replace implnt screw R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6194 Abut support retainer titani R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6195 Abut retain porc to titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6196 Remv of ind rest on implt R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6197 Replace material prosthesis R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6198 Remove interim implant R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6199 Implant procedure R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6205 Pontic-indirect resin based R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6210 Prosthodont high noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6211 Bridge base metal cast R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6212 Bridge noble metal cast R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6214 Pontic titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6240 Bridge porcelain high noble R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6241 Bridge porcelain base metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6242 Bridge porcelain nobel metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6243 Pontic porcelain to titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6245 Bridge porcelain/ceramic R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6250 Bridge resin w/high noble R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6251 Bridge resin base metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6252 Bridge resin w/noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6253 Interim pontic R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6280 Implt maint procd remv implt R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6545 Dental retainr cast metl R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6548 Porcelain/ceramic retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6549 Resin retainer R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6600 Porcelain/ceramic inlay 2srf R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6601 Porc/ceram inlay >= 3 surfac R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6602 Cst hgh nble mtl inlay 2 srf R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6603 Cst hgh nble mtl inlay >=3sr R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6604 Cst bse mtl inlay 2 surfaces R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6605 Cst bse mtl inlay >= 3 surfa R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6606 Cast noble metal inlay 2 sur R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6607 Cst noble mtl inlay >=3 surf R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6608 Onlay porc/crmc 2 surfaces R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6609 Onlay porc/crmc >=3 surfaces R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6610 Onlay cst hgh nbl mtl 2 srfc R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6611 Onlay cst hgh nbl mtl >=3srf R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6612 Onlay cst base mtl 2 surface R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6613 Onlay cst base mtl >=3 surfa R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6614 Onlay cst nbl mtl 2 surfaces R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6615 Onlay cst nbl mtl >=3 surfac R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6624 Inlay titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6634 Onlay titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6710 Crown-indirect resin based R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6720 Retain crown resin w hi nble R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6721 Crown resin w/base metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6722 Crown resin w/noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6740 Crown porcelain/ceramic R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6750 Crown porcelain high noble R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6751 Crown porcelain base metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6752 Crown porcelain noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6753 Retain crown porc to titaniu R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6780 Crown 3/4 high noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6781 Crown 3/4 cast based metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6782 Crown 3/4 cast noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6783 Crown 3/4 porcelain/ceramic R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6784 Retainer crown 3/4 titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6790 Crown full high noble metal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6791 Crown full base metal cast R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6792 Crown full noble metal cast R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6793 Interim retainer crown R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6794 Crown titanium R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D6920 Dental connector bar R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6930 Recement/bond part denture R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6940 Stress breaker R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6950 Precision attachment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6980 Fixed partial repair R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6985 Pediatric partial denture fx R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D6999 Fixed prosthodontic proc R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7111 Extraction coronal remnants R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7140 Extraction erupted tooth/exr R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7210 Rem imp tooth w mucoper flp R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7220 Impact tooth remov soft tiss R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7230 Impact tooth remov part bony R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7240 Impact tooth remov comp bony R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7241 Impact tooth rem bony w/comp R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7250 Tooth root removal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7251 Coronectomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7252 Part extract for implant R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7259 Nerve dissection R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7260 Oral antral fistula closure R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7261 Primary closure sinus perf R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7270 Tooth reimplantation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7272 Tooth transplantation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7280 Exposure of unerupted tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7282 Mobilize erupted/malpos toot R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7283 Place device impacted tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7284 Exc biopsy of saliv glands R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7285 Biopsy of oral tissue hard R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7286 Biopsy of oral tissue soft R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7287 Exfoliative cytolog collect R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7288 Brush biopsy R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7290 Repositioning of teeth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7291 Transseptal fiberotomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7292 Screw retained plate R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7293 Temp anchorage dev w flap R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7294 Temp anchorage dev w/o flap R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7295 Bone harvest,auto graft proc R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7296 Corticotomy, 1-3 teeth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7297 Corticotomy, 4 or more teeth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7298 Remove screw retained plate R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7299 Rem anchorage device w/flap R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7300 Rem anchorage dev w/o flap R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7310 Alveoplasty w/ extraction R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7311 Alveoloplasty w/extract 1-3 R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7320 Alveoplasty w/o extraction R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7321 Alveoloplasty not w/extracts R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7340 Vestibuloplasty ridge extens R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7350 Vestibuloplasty exten graft R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7410 Rad exc lesion up to 1.25 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7411 Excision benign lesion>1.25c R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7412 Excision benign lesion compl R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7413 Excision malig lesion<=1.25c R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7414 Excision malig lesion>1.25cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7415 Excision malig les complicat R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7440 Malig tumor exc to 1.25 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7441 Malig tumor > 1.25 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7450 Rem odontogen cyst to 1.25cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7451 Rem odontogen cyst > 1.25 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7460 Rem nonodonto cyst to 1.25cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7461 Rem nonodonto cyst > 1.25 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7465 Lesion destruction R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7471 Rem exostosis any site R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7472 Removal of torus palatinus R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7473 Remove torus mandibularis R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7485 Surg reduct osseoustuberosit R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7490 Maxilla or mandible resectio R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7509 Marsupialization odon cyst R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7510 I&d absc intraoral soft tiss R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7511 Incision/drain abscess intra R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7520 I&d abscess extraoral R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7521 Incision/drain abscess extra R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7530 Removal fb skin/areolar tiss R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7540 Removal of fb reaction R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7550 Removal of sloughed off bone R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7560 Maxillary sinusotomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7610 Maxilla open reduct simple R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7620 Clsd reduct simpl maxilla fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7630 Open red simpl mandible fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7640 Clsd red simpl mandible fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7650 Open red simp malar/zygom fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7660 Clsd red simp malar/zygom fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7670 Closd rductn splint alveolus R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7671 Alveolus open reduction R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7680 Reduct simple facial bone fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7710 Maxilla open reduct compound R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7720 Clsd reduct compd maxilla fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7730 Open reduct compd mandble fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7740 Clsd reduct compd mandble fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7750 Open red comp malar/zygma fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7760 Clsd red comp malar/zygma fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7770 Open reduc compd alveolus fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7771 Alveolus clsd reduc stblz te R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7780 Reduct compnd facial bone fx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7810 Tmj open reduct-dislocation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7820 Closed tmp manipulation R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7830 Tmj manipulation under anest R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7840 Removal of tmj condyle R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7850 Tmj meniscectomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7852 Tmj repair of joint disc R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7854 Tmj excisn of joint membrane R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7856 Tmj cutting of a muscle R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7858 Tmj reconstruction R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7860 Tmj cutting into joint R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7865 Tmj reshaping components R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7870 Tmj aspiration joint fluid R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7871 Lysis + lavage w catheters R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7872 Tmj diagnostic arthroscopy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7873 Tmj arthroscopy lysis adhesn R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7874 Tmj arthroscopy disc reposit R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7875 Tmj arthroscopy synovectomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7876 Tmj arthroscopy discectomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7877 Tmj arthroscopy debridement R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7880 Occlusal orthotic appliance R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7881 Occ orthotic device adjust R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7899 Tmj unspecified therapy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7910 Dent sutur recent wnd to 5cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7911 Dental suture wound to 5 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7912 Suture complicate wnd > 5 cm R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7920 Dental skin graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7921 Collect & appl blood product R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7922 Place intra-socket bio dress R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7939 Indexing for osteotomy R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7940 Reshaping bone orthognathic R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7941 Bone cutting ramus closed R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7943 Cutting ramus open w/graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7944 Bone cutting segmented R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7945 Bone cutting body mandible R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7946 Reconstruction maxilla total R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7947 Reconstruct maxilla segment R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7948 Reconstruct midface no graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7949 Reconstruct midface w/graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7950 Mandible graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7951 Sinus aug w bone or bone sub R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7952 Sinus augmentation vertical R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7953 Bone replacement graft R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7955 Repair maxillofacial defects R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7956 Tiss regen edent resorb R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7957 Tiss regen edent nonresorb R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D7961 Buccal/labial frenectomy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7962 Lingual frenectomy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7963 Frenuloplasty R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7970 Excision hyperplastic tissue R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7971 Excision pericoronal gingiva R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7972 Surg redct fibrous tuberosit R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7979 Non-surgical sialolithotomy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7980 Surgical sialolithotomy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7981 Excision of salivary gland R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7982 Sialodochoplasty R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7983 Closure of salivary fistula R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7990 Emergency tracheotomy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7991 Dental coronoidectomy R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7993 Surg place craniofacial impl R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7994 Surg place zygomatic impl R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7995 Synthetic graft facial bones R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7996 Implant mandible for augment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7997 Appliance removal R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7998 Intraoral place of fix dev R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D7999 Oral surgery procedure R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D8010 Limited dental tx primary R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8020 Limited dental tx transition R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8030 Limited dental tx adolescent R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8040 Limited dental tx adult R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8070 Compre dental tx transition R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8080 Compre dental tx adolescent R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8090 Compre dental tx adult R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8091 Compre ortho treat w surg R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8210 Orthodontic rem appliance tx R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8220 Fixed appliance therapy habt R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8660 Preorthodontic tx visit R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8670 Periodic orthodontc tx visit R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8671 Periodic orth treat w surg R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8680 Orthodontic retention R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8681 Removable retainer adjust R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8695 Remove fixed ortho appliance R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8696 Rep of ortho appliance max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8697 Rep of ortho appliance man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8698 Recement fixed retainer max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8699 Recement fixed retainer man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8701 Repair fixed retainer max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8702 Repair of fixed retainer man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8703 Replace broken retainer max R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8704 Replace broken retainer man R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D8999 Orthodontic procedure R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9110 Palliative tx dental pain R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9120 Fix partial denture section R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9128 Photobio therpy-first 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9129 Photobio therpy-sub 15 mins I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9130 Temporomandibular joint dysf R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9210 Dent anesthesia w/o surgery R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9211 Regional block anesthesia R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9212 Trigeminal block anesthesia R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9215 Local anesthesia R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9219 Eval mod/deep sed/gen anest R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9222 Deep anest, 1st 15 min R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9223 General anesth ea addl 15 mi R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9224 Gen anes adv air-15 min R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9225 Gen anes adv air-sub 15 min R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9230 Analgesia R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9239 Iv mod sedation, 1st 15 min R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9243 Iv sedation ea addl 15m R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9244 Office min sed drug enteral R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9245 Admin mod sedation-enteral R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9246 Mod sedation noniv-15 min R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9247 Mod sedation noniv-sub15min R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9310 Dental consultation R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9311 Consult w/med hlth care prof R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9410 Dental house call R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9420 Hospital/asc call R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9430 Office visit during hours R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9440 Office visit after hours R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9450 Case presentation tx plan R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9610 Dent therapeutic drug inject R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9612 Thera par drugs 2 or > admin R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9613 Infiltration thera drug R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9630 Drugs/meds disp for home use R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9910 Dent appl desensitizing med R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9911 Appl desensitizing resin R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9912 Pre-visit patient screening R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9913 Admin of neuromod R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9914 Admin of dermal fill R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9920 Behavior management R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9930 Treatment of complications R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9932 Clean & inspect rem dent max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9933 Clean & inspect rem dent man R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9934 Clean rem part denture max R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9935 Clean rem part denture mand R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9936 Clean occ guard I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9938 Fab removable appliance R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9939 Placemnt removable appliance R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9941 Fabrication athletic guard R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9942 Repair/reline occlusal guard R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9943 Occlusal guard adjustment R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9944 Occ guard, hard, full arch R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9945 Occ guard, soft, full arch R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9946 Occ guard, hard, part arch R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9947 Sleep apnea appliance N 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9948 Adjust sleep apnea appliance N 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9949 Repair sleep apnea appliance N 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9950 Occlusion analysis R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9951 Limited occlusal adjustment R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9952 Complete occlusal adjustment R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9953 Reline sleep apnea appliance N 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9954 Fab/del oral appliance thxpy N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9955 Oral app thxpy titration vis R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9956 Admin home sleep apnea test R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9957 Screening sleep disorders R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9959 Unspec sleep ap proc R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9961 Dup/copy patient's records R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9970 Enamel microabrasion R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9971 Odontoplasty per tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9972 Extrnl bleaching per arch R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9973 Extrnl bleaching per tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9974 Intrnl bleaching per tooth R 0.00 0.00 0.00 0.00 0.00 0.009YYY.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9975 External bleaching home app R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9985 Sales tax I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9986 Missed appointment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9987 Cancelled appointment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- D9990 Trans or sign language svcs R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9991 Case mgmt, appt barriers R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9992 Case mgmt, care coordination R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9993 Case mgmt, interviewing R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9994 Case mgmt, pt education R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9995 Teledentistry real-time R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9996 Teledentistry dent review R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9997 Dent case mgmt special needs R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- D9999 Adjunctive procedure R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00G0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- G0008 Admin influenza virus vac X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0009 Admin pneumococcal vaccine X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0010 Admin hepatitis b vaccine X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0011 Hiv prep counsel, md 15-30m A 0.45 0.39 0.16 0.04 0.88 0.650XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0012 Injection of hiv prep drug A 0.17 0.28 0.28NA 0.01 0.46 0.465XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0013 Hiv prep counsel, clin staff A 0.18 0.54 0.04 0.01 0.73 0.230XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0017 Crisis psychotherapy 60m A 4.70 1.79 0.40 0.05 6.54 5.150XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0018 Crisis psychotherapy add 30m A 2.25 0.87 0.21 0.03 3.15 2.490ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0019 Comm hlth intg svs sdoh 60mn A 1.00 1.51 0.25 0.07 2.58 1.320XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0022 Comm hlth intg svs add 30 m A 0.70 0.87 0.17 0.05 1.62 0.920ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0023 Pin service 60m per month A 1.00 1.54 0.26 0.07 2.61 1.330XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0024 Pin srv add 30 min pr m A 0.70 0.88 0.18 0.05 1.63 0.930ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0027 Semen analysis X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0029 No tob scr/cess int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0030 Pt scr tob & cess int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0031 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0032 2+ antipsy schiz M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0033 2+ benzo seiz M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0034 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0035 Pt ed pos 23 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0036 Pt/ptn decln assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0037 Pt not able to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0038 Clin pt no ref M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0039 Pt no ref, rn spec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0040 Pt phys/occ therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0041 Pt/ptn decln referral M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0042 Ref to therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0043 Pt mech pros ht valv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0044 Pt mitral stenosis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0045 Mrs 90 days post stk M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0046 No mrs 90 days post stk M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0047 Ped blunt hd traum M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0048 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0049 Main hemo in-cntr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0050 Pt w/ lmted life expec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0051 Pt hospice mnth M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0052 Pt peri dialysis dur mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0053 Adv rheum pt care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0054 Strk cr prev pos outcme mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0055 Adv care heart dx mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0057 Best pct pt safety em mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0058 Imprv care le jnt repr mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0059 Pt sfty pos exp w aneth mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0060 Allergy/immunology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0061 Anesthesiology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0062 Audiology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0063 Cardiology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0064 Cert nurse midwife ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0065 Chiropractic ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0066 Clinical social work ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0067 Dentistry ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0068 Adm iv infusion drug in home X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0069 Adm sq infusion drug in home X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0070 Adm of chemo drug in home X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0076 Care manag h vst new pt 20 m A 1.01 0.43 0.43NA 0.04 1.48 1.480XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0077 Care manag h vst new pt 30 m A 1.52 0.64 0.64NA 0.07 2.23 2.230XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0078 Care manag h vst new pt 45 m A 2.53 0.95 0.95NA 0.12 3.60 3.600XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0079 Care manag h vst new pt 60 m A 3.38 1.36 1.36NA 0.16 4.90 4.900XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0080 Care manag h vst new pt 75 m A 4.09 2.16 2.16NA 0.25 6.50 6.500XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0081 Care man h v ext pt 20 mi A 1.00 0.44 0.44NA 0.04 1.48 1.480XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0082 Care man h v ext pt 30 m A 1.56 0.79 0.79NA 0.07 2.42 2.420XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0083 Care man h v ext pt 45 m A 2.33 1.36 1.36NA 0.16 3.85 3.850XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0084 Care man h v ext pt 60 m A 3.28 1.94 1.94NA 0.24 5.46 5.460XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0085 Care man h v ext pt 75 m A 4.09 2.16 2.16NA 0.25 6.50 6.500XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0086 Care man home care plan 30 m A 1.25 0.86 0.86NA 0.10 2.21 2.210XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0087 Care man home care plan 60 m A 1.80 1.15 1.15NA 0.14 3.09 3.090XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0088 Adm iv drug 1st home visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0089 Adm subq drug 1st home visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0090 Adm iv chemo 1st home visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0101 Ca screen;pelvic/breast exam A 0.44 0.68 0.23 0.07 1.19 0.740XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0102 Prostate ca screening; dre A 0.18 0.54 0.04 0.01 0.73 0.230XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0103 Psa screening X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0104 Ca screen;flexi sigmoidscope A 0.82 5.50 0.67 0.11 6.43 1.600000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0105 Colorectal scrn; hi risk ind A 3.18 7.73 1.34 0.41 11.32 4.930000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G010553Colorectal scrn; hi risk ind A 1.59 3.87 0.67 0.20 5.66 2.460000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0108 Diab manage trn per indiv A 0.90 0.73 0.73NA 0.04 1.67 1.670XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0109 Diab manage trn ind/group A 0.25 0.22 0.22NA 0.01 0.48 0.480XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0117 Glaucoma scrn hgh risk direc T 0.44 1.47 1.47NA 0.02 1.93 1.930XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0118 Glaucoma scrn hgh risk direc T 0.17 1.03 1.03NA 0.01 1.21 1.210XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0121 Colon ca scrn not hi rsk ind A 3.18 7.73 1.34 0.42 11.33 4.940000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G012153Colon ca scrn not hi rsk ind A 1.59 3.87 0.67 0.21 5.67 2.470000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0123 Screen cerv/vag thin layer X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0124 Screen c/v thin layer by md A 0.25 0.46 0.46 0.01 0.72 0.720XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0127 Trim nail(s) R 0.17 0.53 0.02 0.01 0.71 0.200000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0128 Corf skilled nursing service R 0.00 0.32 0.32NA 0.01 0.33 0.333XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0129 Php/iop ot service X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0130 Single energy x-ray study A 0.21 0.96 0.96NA 0.02 1.19 1.191XXX.00.00.00000009 33.4009 090 99 3.27 3.27 0.05
- G013026Single energy x-ray study A 0.21 0.11 0.11 0.01 0.33 0.331XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0130TCSingle energy x-ray study A 0.00 0.85 0.85NA 0.01 0.86 0.861XXX.00.00.00000009 33.4009 010 99 3.16 3.16 0.04
- G0136 Adm of pa/n assess 5-15 m A 0.18 0.41 0.05 0.01 0.60 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0137 Inten outpt svs,min 9 pr 7 d X 0.00 0.00 0.00 0.00 0.00 0.009ZZZ.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0138 Iv cipaglucosidase alfa-atga A 0.21 5.62 5.62NA 0.05 5.88 5.880XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0140 Nav srv peer sup 60 min pr m A 1.00 1.60 0.26 0.07 2.67 1.330XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0141 Scr c/v cyto,autosys and md A 0.25 0.46 0.46 0.01 0.72 0.720XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0143 Scr c/v cyto,thinlayer,rescr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0144 Scr c/v cyto,thinlayer,rescr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0145 Scr c/v cyto,thinlayer,rescr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0146 Nav srv peer sup add 30 pr m A 0.70 0.86 0.17 0.04 1.60 0.910ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0147 Scr c/v cyto, automated sys X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0148 Scr c/v cyto, autosys, rescr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0151 Hhcp-serv of pt,ea 15 min X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0152 Hhcp-serv of ot,ea 15 min X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0153 Hhcp-svs of s/l path,ea 15mn X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0155 Hhcp-svs of csw,ea 15 min X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0156 Hhcp-svs of aide,ea 15 min X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0157 Hhc pt assistant ea 15 E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0158 Hhc ot assistant ea 15 E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0159 Hhc pt maint ea 15 min E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0160 Hhc occup therapy ea 15 E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0161 Hhc slp ea 15 min E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0162 Hhc rn e&m plan svs, 15 min E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0166 Extrnl counterpulse, per tx A 0.00 3.04 3.04NA 0.04 3.08 3.085XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0168 Wound closure by adhesive A 0.30 2.79 0.05 0.07 3.16 0.420000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0175 Opps service,sched team conf X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0176 Opps/php/iop; activity thrpy X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0177 Opps/php/iop; train & educ X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0179 Md recertification hha pt A 0.44 0.86 0.86NA 0.03 1.33 1.330XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0180 Md certification hha patient A 0.65 1.00 1.00NA 0.05 1.70 1.700XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0181 Home health care supervision A 1.73 1.44 1.44NA 0.12 3.29 3.290XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0182 Hospice care supervision A 1.73 1.40 1.40NA 0.12 3.25 3.250XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0183 Software meas of cardiac vol C 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0186 Dstry eye lesn,fdr vssl tech C 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00210119 33.4009 090 99 0.00 0.00 0.00
- G0219 Pet img wholbod melano nonco N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G021926Pet img wholbod melano nonco N 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0219TCPet img wholbod melano nonco N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 010 99 0.00 0.00 0.00
- G0235 Pet not otherwise specified N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G023526Pet not otherwise specified N 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0235TCPet not otherwise specified N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 010 99 0.00 0.00 0.00
- G0237 Therapeutic procd strg endur A 0.00 0.37 0.37NA 0.01 0.38 0.385XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0238 Oth resp proc, indiv A 0.00 0.33 0.33NA 0.01 0.34 0.345XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0239 Oth resp proc, group A 0.00 0.42 0.42NA 0.01 0.43 0.435XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0245 Initial foot exam pt lops R 0.86 1.06 0.14 0.04 1.96 1.040XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0246 Followup eval of foot pt lop R 0.44 0.70 0.06 0.02 1.16 0.520XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0247 Routine footcare pt w lops R 0.49 1.91 0.06 0.02 2.42 0.570ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0248 Demonstrate use home inr mon R 0.00 3.11 3.11NA 0.05 3.16 3.163XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- G0249 Provide inr test mater/equip R 0.00 1.96 1.96NA 0.01 1.97 1.973XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- G0250 Md inr test revie inter mgmt R 0.18 0.08 0.08NA 0.01 0.27 0.272XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0252 Pet imaging initial dx N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G025226Pet imaging initial dx N+ 1.46 0.64 0.64 0.04 2.14 2.141XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0252TCPet imaging initial dx N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0255 Current percep threshold tst N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G025526Current percep threshold tst N 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0255TCCurrent percep threshold tst N 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00999999 33.4009 010 99 0.00 0.00 0.00
- G0257 Unsched dialysis esrd pt hos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0259 Inject for sacroiliac joint E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0260 Inj for sacroiliac jt anesth E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0268 Removal of impacted wax md A 0.59 0.84 0.15 0.08 1.51 0.820000.00.00.00221009 33.4009 090 99 0.00 0.00 0.00
- G0269 Occlusive device in vein art B 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0270 Mnt subs tx for change dx A 0.45 0.49 0.20 0.01 0.95 0.660XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0271 Group mnt 2 or more 30 mins A 0.25 0.25 0.11 0.01 0.51 0.370XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0276 Pild/placebo control clin tr R 6.99 3.03NA 3.03 0.72 10.74 10.740000.00.00.00222109 33.4009 090 99 0.00 0.00 0.00
- G0277 Hbot, full body chamber, 30m A 0.00 5.76 5.76NA 0.04 5.80 5.803XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0278 Iliac art angio,cardiac cath A 0.24 0.05NA 0.05 0.06 0.35 0.350ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0279 Tomosynthesis, mammo A 0.59 0.59 0.59NA 0.03 1.21 1.211ZZZ.00.00.00029009 33.4009 090 99 0.00 0.00 0.00
- G027926Tomosynthesis, mammo A 0.59 0.21 0.21 0.03 0.83 0.831ZZZ.00.00.00029009 33.4009 090 99 0.00 0.00 0.00
- G0279TCTomosynthesis, mammo A 0.00 0.38 0.38NA 0.00 0.38 0.381ZZZ.00.00.00029009 33.4009 090 99 0.00 0.00 0.00
- G0281 Elec stim unattend for press A 0.18 0.16 0.16NA 0.01 0.35 0.357XXX.00.00.00500009 33.4009 090 99 0.00 0.00 0.00
- G0282 Elect stim wound care not pd N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0283 Elec stim other than wound A 0.18 0.19 0.19NA 0.01 0.38 0.387XXX.00.00.00500009 33.4009 090 99 0.00 0.00 0.00
- G0288 Recon, cta for surg plan A 0.00 1.31 1.31NA 0.07 1.38 1.383XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- G0289 Arthro, loose body + chondro A 1.44 0.45NA 0.45 0.29 2.18 2.180ZZZ.00.00.00010009 33.4009 090 99 0.00 0.00 0.00
- G0293 Non-cov surg proc,clin trial E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0294 Non-cov proc, clinical trial E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0295 Electromagnetic therapy onc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0296 Visit to determ ldct elig A 0.52 0.31 0.12 0.03 0.86 0.670XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0299 Hhs/hospice of rn ea 15 min X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0300 Hhs/hospice of lpn ea 15 min X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0302 Pre-op service lvrs complete X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0303 Pre-op service lvrs 10-15dos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0304 Pre-op service lvrs 1-9 dos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0305 Post op service lvrs min 6 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0306 Cbc/diffwbc w/o platelet X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0307 Cbc without platelet X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0310 Immunize counsel 5-15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0311 Immunize counsel 16-30 mins I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0312 Immunize couns < 21yr 5-15 m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0313 Immunize couns < 21yr 6-30 m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0314 Counsel immune <21 16-30 m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0315 Counsel immune <21 5-15 m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0316 Prolong inpt eval add15 m A 0.61 0.38 0.17 0.05 1.04 0.830ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0317 Prolong nursin fac eval 15m A 0.61 0.36 0.16 0.04 1.01 0.810ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0318 Prolong home eval add 15m A 0.61 0.36 0.16 0.05 1.02 0.820ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0320 Two-way audio and video hhs X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0321 Audio-only hhs X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0322 Home h physio data collec tr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0323 Care manage beh svs 20mins A 0.93 0.76 0.16 0.04 1.73 1.130XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0327 Colon ca scrn;bld-bsd biomrk X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0328 Fecal blood scrn immunoassay X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0329 Electromagntic tx for ulcers A 0.06 0.25 0.25NA 0.01 0.32 0.327XXX.00.00.00500009 33.4009 090 99 0.00 0.00 0.00
- G0330 Facility svs dental rehab X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0333 Dispense fee initial 30 day X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0337 Hospice evaluation preelecti X+ 1.42 0.62 0.31 0.08 2.12 1.819XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0339 Robot lin-radsurg com, first C 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0340 Robt lin-radsurg fractx 2-5 C 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0341 Percutaneous islet celltrans A 6.81 39.52 0.80 0.89 47.22 8.500000.00.00.00200109 33.4009 090 99 0.00 0.00 0.00
- G0342 Laparoscopy islet cell trans A 11.62 6.79NA 6.79 3.10 21.51 21.510090.09.81.10202109 33.4009 090 99 0.00 0.00 0.00
- G0343 Laparotomy islet cell transp A 19.35 10.38NA 10.38 5.15 34.88 34.880090.09.81.10202109 33.4009 090 99 0.00 0.00 0.00
- G0372 Md service required for pmd A 0.17 0.10 0.05 0.01 0.28 0.230XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0378 Hospital observation per hr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0379 Direct refer hospital observ X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0380 Lev 1 hosp type b ed visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0381 Lev 2 hosp type b ed visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0382 Lev 3 hosp type b ed visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0383 Lev 4 hosp type b ed visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0384 Lev 5 hosp type b ed visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0390 Trauma respons w/hosp criti X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0396 Alcohol/subs interv 15-30mn A 0.65 0.40 0.16 0.06 1.11 0.870XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0397 Alcohol/subs interv >30 min A 1.30 0.65 0.28 0.07 2.02 1.650XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0398 Home sleep test/type 2 porta C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G039826Home sleep test/type 2 porta C 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0398TCHome sleep test/type 2 porta C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0399 Home sleep test/type 3 porta C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G039926Home sleep test/type 3 porta C 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0399TCHome sleep test/type 3 porta C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0400 Home sleep test/type 4 porta C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G040026Home sleep test/type 4 porta C 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0400TCHome sleep test/type 4 porta C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0402 Initial preventive exam A 2.60 2.46 0.65 0.17 5.23 3.420XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0403 Ekg for initial prevent exam A 0.17 0.27 0.27NA 0.02 0.46 0.464XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0404 Ekg tracing for initial prev A 0.00 0.20 0.20NA 0.01 0.21 0.213XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0405 Ekg interpret & report preve A 0.17 0.07 0.07 0.01 0.25 0.252XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0406 Inpt/tele follow up 15 A 0.76 0.24NA 0.24 0.08 1.08 1.080XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0407 Inpt/tele follow up 25 A 1.39 0.40NA 0.40 0.12 1.91 1.910XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0408 Inpt/tele follow up 35 A 2.00 0.62NA 0.62 0.18 2.80 2.800XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0409 Corf related serv 15 mins ea R 0.00 0.71 0.71NA 0.01 0.72 0.729XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0410 Grp psych php/iop 45-50 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0411 Interactive grp psyc php/iop X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0412 Open tx iliac spine uni/bil A 10.19 7.67NA 7.67 2.17 20.03 20.030090.10.69.21202209 33.4009 090 99 0.00 0.00 0.00
- G0413 Pelvic ring fracture uni/bil A 15.34 10.68NA 10.68 3.26 29.28 29.280090.10.69.21202209 33.4009 090 99 0.00 0.00 0.00
- G0414 Pelvic ring fx treat int fix A 14.28 10.35NA 10.35 3.04 27.67 27.670090.10.69.21202209 33.4009 090 99 0.00 0.00 0.00
- G0415 Open tx post pelvic fxcture A 20.41 12.26NA 12.26 4.43 37.10 37.100090.10.69.21202209 33.4009 090 99 0.00 0.00 0.00
- G0416 Prostate biopsy, any mthd A 3.51 7.06 7.06NA 0.11 10.68 10.681XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G041626Prostate biopsy, any mthd A 3.51 1.44 1.44 0.06 5.01 5.011XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0416TCProstate biopsy, any mthd A 0.00 5.62 5.62NA 0.05 5.67 5.671XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0420 Ed svc ckd ind per session A 2.12 1.15 1.15NA 0.13 3.40 3.400XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0421 Ed svc ckd grp per session A 0.50 0.29 0.29NA 0.03 0.82 0.820XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0422 Intens cardiac rehab w/exerc A 2.05 1.77 1.77 0.12 3.94 3.940XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0423 Intens cardiac rehab no exer A 2.05 1.77 1.77 0.12 3.94 3.940XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0425 Inpt/ed teleconsult30 A 1.92 0.41NA 0.41 0.19 2.52 2.520XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0426 Inpt/ed teleconsult50 A 2.61 0.67NA 0.67 0.23 3.51 3.510XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0427 Inpt/ed teleconsult70 A 3.86 0.90NA 0.90 0.28 5.04 5.040XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0428 Collagen meniscus implant N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0429 Dermal filler injection(s) A 1.16 1.69 0.39 0.13 2.98 1.680000.00.00.00200009 33.4009 090 99 0.00 0.00 0.00
- G0432 Eia hiv-1/hiv-2 screen X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0433 Elisa hiv-1/hiv-2 screen X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0435 Oral hiv-1/hiv-2 screen X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0438 Ppps, initial visit A 2.60 2.45 2.45NA 0.17 5.22 5.220XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0439 Ppps, subseq visit A 1.92 2.07 2.07NA 0.13 4.12 4.120XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0442 Annual alcohol screen 15 min A 0.18 0.37 0.05 0.01 0.56 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0443 Brief alcohol misuse counsel A 0.60 0.39 0.15 0.04 1.03 0.790XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0444 Depression screen annual A 0.18 0.37 0.05 0.01 0.56 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0445 High inten beh couns std 30m A 0.60 0.39 0.16 0.04 1.03 0.800XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0446 Intens behave ther cardio dx A 0.60 0.38 0.15 0.04 1.02 0.790XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0447 Behavior counsel obesity 15m A 0.60 0.38 0.15 0.04 1.02 0.790XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0448 Place perm pacing cardiovert E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0451 Devlopment test interpt&rep A 0.00 0.36 0.36NA 0.01 0.37 0.375XXX.00.00.00000009 33.4009 040 99 0.00 0.00 0.00
- G0452 Molecular pathology interpr A 0.91 0.47 0.47NA 0.02 1.40 1.401XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G045226Molecular pathology interpr A 0.91 0.39 0.39 0.01 1.31 1.311XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0452TCMolecular pathology interpr A 0.00 0.08 0.08NA 0.01 0.09 0.091XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0453 Cont intraop neuro monitor A 0.60 0.17NA 0.17 0.05 0.82 0.820XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0454 Md document visit by npp A 0.18 0.08 0.04 0.01 0.27 0.230XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0455 Fecal microbiota prep instil A 1.31 2.93 0.39 0.14 4.38 1.840000.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0458 Ldr prostate brachy comp rat E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0459 Telehealth inpt pharm mgmt A 0.95 0.18NA 0.18 0.06 1.19 1.190XXX.00.00.00009009 33.4009 090 99 0.00 0.00 0.00
- G0460 Autolog prp not diab ulcer C 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0463 Hospital outpt clinic visit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0465 Autolog prp diab wound ulcer A 1.78 29.91 0.58 0.15 31.84 2.510000.00.00.00201009 33.4009 090 99 0.00 0.00 0.00
- G0466 Fqhc visit new patient X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0467 Fqhc visit, estab pt X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0468 Fqhc visit, ippe or awv X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0469 Fqhc visit, mh new pt X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0470 Fqhc visit, mh estab pt X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0471 Ven blood coll snf/hha X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0472 Hep c screen high risk/other X 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0473 Group behave couns 2-10 A 0.23 0.14 0.06 0.01 0.38 0.309XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0475 Hiv combination assay X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0476 Hpv combo assay ca screen X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0480 Drug test def 1-7 classes X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0481 Drug test def 8-14 classes X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0482 Drug test def 15-21 classes X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0483 Drug test def 22+ classes X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0490 Home visit rn, lpn by rhc/fq X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0491 Dialysis acu kidney no esrd X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0492 Md/oth eval acut kid no esrd X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0493 Rn care ea 15 min hh/hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0494 Lpn care ea 15min hh/hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0495 Rn care train/edu in hh X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0496 Lpn care train/edu in hh X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0498 Chemo extend iv infus w/pump C 0.00 0.00 0.00 0.00 0.00 0.005YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0499 Hepb screen high risk indiv X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0500 Mod sedat endo service >5yrs A 0.10 1.86 0.03 0.03 1.99 0.169XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0501 Resource-inten svc during ov B 0.00 0.00 0.00 0.00 0.00 0.000ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0506 Comp asses care plan ccm svc A 0.87 1.06 0.22 0.06 1.99 1.150ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0508 Crit care telehea consult 60 A 4.00 1.17NA 1.17 0.36 5.53 5.530XXX.00.00.00009009 33.4009 090 99 0.00 0.00 0.00
- G0509 Crit care telehea consult 50 A 3.86 1.06NA 1.06 0.36 5.28 5.280XXX.00.00.00009009 33.4009 090 99 0.00 0.00 0.00
- G0513 Prolong prev svcs, first 30m A 1.17 0.70 0.28 0.07 1.94 1.520ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0514 Prolong prev svcs, addl 30m A 1.17 0.70 0.28 0.07 1.94 1.520ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0516 Insert drug del implant, >=4 A 1.77 3.32 0.62 0.15 5.24 2.540000.00.00.00200009 33.4009 090 99 0.00 0.00 0.00
- G0517 Remove drug implant A 2.05 3.71 0.68 0.18 5.94 2.910000.00.00.00200009 33.4009 090 99 0.00 0.00 0.00
- G0518 Remove w insert drug implant A 3.46 5.68 0.98 0.29 9.43 4.730000.00.00.00200009 33.4009 090 99 0.00 0.00 0.00
- G0519 New pt-cg dyad dem low cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0520 New pt-cg dyad dem mod cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0521 New pt-cg dyad dem hig cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0522 Mgt nw pt dementia low cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0523 Mgt nw pt dem mod-high cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0524 Est pt-cg dyad dem low cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0525 Est pt-cg dyad dem mod cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0526 Est pt-cg dyad dem hig cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0527 Mgt est pt dmentia low cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0528 Mgt est pt dem mod-hi cmplx X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0529 In home respite care, 4 hr u X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0530 Adult daycare center, 8 hr u X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0531 Fclty-based respite, 24 hr u X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0532 Take home supp nasal spray X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0533 Buprenorphone inj weekly X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0534 Coordinated care/or referral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0535 Pt navigat svs direct/ref X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0536 Peer recover support svs X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0537 Risk ascvd tst once pr 12 mo A 0.18 0.41 0.05 0.01 0.60 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0538 Ascvd rsk mng clin stf pr mo A 0.18 0.32 0.05 0.01 0.51 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0539 Initial care training 30 m A 1.00 0.58 0.18 0.01 1.59 1.190XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0540 Train for caregiver add 15 A 0.54 0.24 0.09 0.00 0.78 0.630ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0541 No pt prsnt train initial 30 A 1.00 0.58 0.18 0.01 1.59 1.190XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0542 No pt prsnt train add 15 A 0.54 0.24 0.09 0.00 0.78 0.630ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0543 Group train w/o patient A 0.23 0.42 0.04 0.01 0.66 0.280XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0544 Post d/c phone follow up A 0.98 0.95 0.24 0.07 2.00 1.290XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0545 Inherent visit to inpt A 0.89 0.49 0.25 0.07 1.45 1.210ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0546 Phone/internet ehr assess A 0.35 0.18 0.09 0.04 0.57 0.480XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0547 Phone/internet svs 11-20 m A 0.70 0.36 0.19 0.07 1.13 0.960XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0548 Phone/inter svs 21-30 m A 1.05 0.56 0.29 0.09 1.70 1.430XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0549 Phone/inter for treat>31m A 1.40 0.77 0.38 0.12 2.29 1.900XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0550 Phone/inter for dx/treat >5m A 0.70 0.30 0.15 0.05 1.05 0.900XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0551 Phn/intr svs fr dx treat 30m A 0.70 0.35 0.18 0.05 1.10 0.930XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0552 Supply of digital device C 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0553 Monthly tx for dmht 20mins A 0.62 0.97 0.13 0.03 1.62 0.780XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0554 Add 20 m of monthly tx A 0.61 0.60 0.12 0.03 1.24 0.760ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0555 Replacment pt electronic sys C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00001009 33.4009 010 99 0.00 0.00 0.00
- G0556 Adv prim care mgmt lvl 1 A 0.25 0.22 0.06 0.02 0.49 0.330XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0557 Adv prim care mgmt lvl 2 A 0.77 0.79 0.19 0.05 1.61 1.010XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0558 Adv prim care mgmt lvl 3 A 1.67 1.72 0.39 0.12 3.51 2.180XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0559 Unrelat prac follow up visit A 0.16 0.10 0.05 0.03 0.29 0.240ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0560 Safety plan interven A 1.09 0.17 0.08 0.01 1.27 1.180XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0561 Temp tube delivery, unil C 0.00 0.00 0.00 0.00 0.00 0.000ZZZ.00.00.00011009 33.4009 090 99 0.00 0.00 0.00
- G0562 Complex simulation w/pet-ct C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G056226Complex simulation w/pet-ct C 0.00 0.00 0.00 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0562TCComplex simulation w/pet-ct C 0.00 0.00 0.00NA 0.00 0.00 0.001XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0563 Sbrt w/positron emission del C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0566 3d bn img algor drvd fr mri C 0.00 0.00 0.00NA 0.00 0.00 0.001000.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0566263d bn img algor drvd fr mri C 0.00 0.00 0.00 0.00 0.00 0.001000.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0566TC3d bn img algor drvd fr mri C 0.00 0.00 0.00NA 0.00 0.00 0.001000.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- G0567 Screening hep c detect X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0568 Int psych care mng, 1 cal mo A 1.88 2.81 0.42 0.15 4.84 2.450ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0569 Subs psych care mng, subs mo A 2.05 2.17 0.49 0.15 4.37 2.690ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0570 Care manage serv, pr cal mo A 0.93 0.74 0.17 0.06 1.73 1.160ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G0571 Intraop nerve cryoablation A 1.36 0.40 0.21 0.20 1.96 1.770ZZZ.00.00.00001009 33.4009 090 99 0.00 0.00 0.00
- G0659 Drug test def simple all cl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0660 TEAM Remote E/M new pt 10mins X+ 0.93 1.25 0.23 0.07 2.25 1.239XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0661 TEAM Remote E/M new pt 20mins X+ 0.93 1.25 0.23 0.07 2.25 1.239XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0662 TEAM Remote E/M new pt 30mins X+ 1.60 1.76 0.38 0.16 3.52 2.149XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0663 TEAM Remote E/M new pt 45mins X+ 2.60 2.47 0.66 0.24 5.31 3.509XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0664 TEAM Remote E/M new pt 60mins X+ 3.50 3.23 0.94 0.36 7.09 4.809XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0665 TEAM Remote E/M est. pt 10mins X+ 0.70 1.02 0.17 0.06 1.78 0.939XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0666 TEAM Remote E/M est. pt 15mins X+ 1.30 1.46 0.33 0.09 2.85 1.729XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0667 TEAM Remote E/M est. pt 25mins X+ 1.92 2.00 0.47 0.14 4.06 2.539XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0668 TEAM Remote E/M est. pt 40mins X+ 2.80 2.75 0.75 0.21 5.76 3.769XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0680 Cr art clc art vlv clc w rpt C 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0681 App of non-sheet skin sub C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0682 App of non-sheet skin sub add C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0683 App of non-sheet skin sub g C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0684 App non-sheet skin sb g addl C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0913 Improve visual funct M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0914 Survey not complete M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0915 No improve visual funct M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0916 Satisfy with care M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0917 Care survey not complete M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G0918 No satisfy with care M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G1025 Pt mnth 1 mcp prov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G1026 Pt hemo > 3mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G1027 Pt hemo < 3mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G1028 Take home supply 8mg per 0.1 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2000 Blinded conv. tx mdd clin tr R 0.00 0.00 0.00 0.00 0.00 0.000YYY.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2001 Post d/c h vst new pt 20 m A 1.01 0.43 0.43NA 0.04 1.48 1.480XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2002 Post-d/c h vst new pt 30 m A 1.52 0.64 0.64NA 0.07 2.23 2.230XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2003 Post-d/c h vst new pt 45 m A 2.53 0.95 0.95NA 0.12 3.60 3.600XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2004 Post-d/c h vst new pt 60 m A 3.38 1.36 1.36NA 0.16 4.90 4.900XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2005 Post-d/c h vst new pt 75 m A 4.09 2.16 2.16NA 0.25 6.50 6.500XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2006 Post-d/c h vst ext pt 20 m A 1.00 0.44 0.44NA 0.04 1.48 1.480XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2007 Post-d/c h vst ext pt 30 m A 1.56 0.79 0.79NA 0.07 2.42 2.420XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2008 Post-d/c h vst ext pt 45 m A 2.33 1.36 1.36NA 0.16 3.85 3.850XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2009 Post-d/c h vst ext pt 60 m A 3.28 1.94 1.94NA 0.24 5.46 5.460XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2010 Remot image submit by pt A 0.18 0.20 0.05 0.01 0.39 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2011 Alcohol/sub misuse assess A 0.33 0.16 0.08 0.03 0.52 0.440XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2013 Post-d/c h vst ext pt 75 m A 4.09 2.16 2.16NA 0.25 6.50 6.500XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2014 Post-d/c care plan overs 30m A 1.25 0.86 0.86NA 0.10 2.21 2.210XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2015 Post-d/c care plan overs 60m A 1.80 1.15 1.15NA 0.14 3.09 3.090XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2020 Hi inten serv for sip model X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2021 Hea care pract tx in place X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2022 Benef refuses service, mod X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2025 Dis site tele svcs rhc/fqhc X+ 1.44 1.38 1.38 0.10 2.92 2.920XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2067 Med assist tx meth wk X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2068 Med assist tx bupre oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2069 Med assist tx inject X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2073 Med tx naltrexone X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2074 Med assist tx no drug X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2075 Med tx meds nos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2076 Intake act w/med exam X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2077 Periodic assessment X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2078 Take-home meth X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2079 Take-hom buprenorphine X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2080 Add 30 mins counsel X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2081 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2082 Visit esketamine 56m or less A 0.70 27.75 0.16 0.07 28.52 0.930XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2083 Visit esketamine, > 56m A 0.70 39.83 0.16 0.07 40.60 0.930XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2086 Off base opioid tx 70min A 8.36 5.73 1.88 0.62 14.71 10.860XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2087 Off base opioid tx, 60 m A 8.19 4.53 1.59 0.55 13.27 10.330XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2088 Off base opioid tx, add30 A 0.82 0.95 0.15 0.05 1.82 1.020ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2090 Pt 66+ frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2091 Pt 66+ frailty and adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2092 Ace arb arni M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2093 Med doc rsn no ace arn arni M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2094 Pt rsn no ace arn arni M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2096 No rsn ace arb arni M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2097 Dx uri 3d after other dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2098 Pt 66+ frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2099 Pt 66+ frailty and adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2100 Pt 66+ frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2101 Pt 66+ frailty and adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2105 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2106 Pt 66+ frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2107 Pt 66+ frailty and adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2112 Pred<=5 mg ra glu <6m M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2113 Pred>5 mg >6m, no chg da M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2115 Pt 66-80 frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2116 Pt 66-80 frailty and adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2118 Pt 81+ frailty M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2121 Psy dep anx ap and icd asse M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2122 Psy/dep/anx/apandicd noasse M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2125 Pt 81+ frailty M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2126 Pt 66-80 frailty and adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2127 Pt 66-80 frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2128 No aspirin med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2129 No bp outpt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2136 Bk pain vas 6-20wk <= 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2137 Bk pain vas 6-20wk > 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2138 Bk pain vas 9-15mo <= 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2139 Bk pain vas 9-15mo > 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2140 Leg pain vas 6-20wk <= 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2141 Leg pain vas 6-20wk > 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2142 Fs odi 9-15mo postop<= 22 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2143 Fs odi 9-15mo > 22 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2144 Fs odi 6-20wk postop <= 22 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2145 Fsodi 6-20wk >22 or chg 30pt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2146 Leg pain vas 9-15mo <= 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2147 Leg pain vas 9-15mo > 3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2148 Mpm used M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2149 No mpm med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2150 No mpm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2151 Dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2152 Res change sc >=0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2167 Res change sc < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2168 Svs by pt in home health E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2169 Svs by ot in home health E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2172 Tx for opioid use demo proj X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2173 Uri w comorb 12m oth dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2174 Uri new rx antibiotic 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2175 Pt comorb dx 12m of epi M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2176 Outpt ed obs w inpt admit M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2177 Bronch w rx antibx 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2178 Pt not elig low neuro ex M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2179 Med doc rsn no low ex M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2180 Inelig footwr eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2181 Bmi not doc medrsn ptref M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2182 Pt 1st biolog antirheum M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2183 Doc pt unable comm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2184 No caregiver M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2185 Caregiver dem trained M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2186 Pt ref app rsrcs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2187 Clin ind img hd trauma M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2188 Pt 50 yrs w/clin ind hd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2189 Img hd abnml neuro exam M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2190 Ind img hd rad neck M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2191 Ind img hd pos hd ache M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2192 >55 yrs temp hd ache M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2193 <6yr new onset hd ache M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2194 New hdache ped pt dis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2195 Occip hdache child M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2196 Screen unhlthy etoh use M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2197 Screen hlthy etoh use M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2199 Not scrn etoh no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2200 Unhlthy etoh rcvd couns M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2202 No rsn no brief couns M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2204 Pt 45-85 w/ scope M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2205 Preg drng adjv trtmt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2206 Adjv trtmt chemo her2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2207 Rsn no trtmt chem her2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2208 No trtmt chemo and her2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2209 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2210 No neck fs prom no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2211 Complex e/m visit add on A 0.33 0.17 0.08 0.02 0.52 0.430ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2212 Prolong outpt/office vis A 0.61 0.36 0.16 0.05 1.02 0.820XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2213 Initiat med assist tx in er A 1.27 0.58 0.22 0.14 1.99 1.630ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2214 Init/sub psych care m 1st 30 A 0.77 0.99 0.18 0.06 1.82 1.010XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2215 Home supply nasal naloxone X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2216 Home supply inject naloxon X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G2250 Remot img sub by pt, non e/m A 0.18 0.20 0.05 0.01 0.39 0.240XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2251 Brief chkin, 5-10, non-e/m A 0.25 0.16 0.06 0.01 0.42 0.320XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G2252 Brief chkin by md/qhp, 11-20 A 0.50 0.31 0.13 0.04 0.85 0.670XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G3002 Chronic pain mgmt 30 mins A 1.45 1.01 0.36 0.12 2.58 1.930XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G3003 Chronic pain mgmt addl 15m A 0.50 0.40 0.13 0.05 0.95 0.680ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G4000 Dermatology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4001 Diagnostic rad ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4002 Ep cardio ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4003 Emergency med ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4004 Endocrinology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4005 Family medicine ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4006 Gastroenterology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4007 General surgery ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4008 Geriatrics ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4009 Hospitalists ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4010 Infectious disease ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4011 Internal medicine ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4012 Interventional rad ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4013 Mntal/behav/psych hlth ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4014 Nephrology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4015 Neurology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4016 Neurosurgical ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4017 Nutrition/dietician ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4018 Ob/gyn ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4019 Oncology/hema ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4020 Ophthalmology/optometry ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4021 Orthopedic surgery ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4022 Otolaryngology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4023 Pathology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4024 Pediatrics ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4025 Physical medicine ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4026 Phys/occ therapy ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4027 Plastic surgery ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4028 Podiatry ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4029 Preventive medicine ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4030 Pulmonology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4031 Radiation oncology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4032 Rheumatology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4033 Skilled nursing facility ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4034 Speech language path ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4035 Thoracic surgery ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4036 Urgent care ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4037 Urology ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G4038 Vascular surgery ss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8395 Lvef>=40% doc normal or mild M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8396 Lvef not performed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8397 Dil macula/fundus exam/w doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8399 Pt w/dxa results document M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8400 Pt w/dxa no results doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8404 Low extemity neur exam docum M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8405 Low extemity neur not perfor M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8410 Eval on foot documented M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8415 Eval on foot not performed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8416 Pt inelig footwear evaluatio M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8417 Calc bmi abv up param f/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8418 Calc bmi blw low param f/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8419 Calc bmi out nrm param nof/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8420 Calc bmi norm parameters M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8421 Bmi not calculated M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8427 Docrev cur meds by elig clin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8428 Cur meds not document M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8430 Doc med rsn no medrec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8431 Pos clin depres scrn f/u doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8432 Dep scr not doc, rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8433 Scr for dep not cpt doc rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8450 Beta-bloc rx pt w/abn lvef M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8451 Pt w/abn lvef inelig b-bloc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8452 Pt w/abn lvef b-bloc no rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8465 High risk recurrence pro ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8473 Ace/arb thxpy rx'd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8474 Ace/arb not rx'd; doc reas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8475 Ace/arb thxpy not rx'd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8476 Bp sys <140 and dias <90 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8477 Bp sys>=140 and/or dias >=90 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8478 Bp not performed/doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8510 Scr dep neg, no plan reqd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8511 Scr dep pos, no plan doc rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8535 Eld maltreatment not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8536 No doc elder mal scrn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8539 Doc funct and care plan M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8540 Foa not doc as being perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8541 No doc cur funct assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8542 Doc funct no deficiencies M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8543 Cur funct asses; no care pln M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8559 Pt ref doc oto eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8560 Pt hx act drain prev 90 days I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8561 Pt inelig for ref oto eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8562 Pt no hx act drain 90 d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8563 Pt no ref oto reas no spec I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8564 Pt ref oto eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8565 Ver doc hear loss I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8566 Pt inelig ref oto eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8567 Pt no doc hear loss I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8568 Pt no ref otolo no spec I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8569 Prol intubation req M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8570 No prol intub req M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8575 Postop ren fail M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8576 No postop ren fail M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8577 Reop req bld grft oth M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8578 No reop req bld grft oth M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8598 Asa/antiplat ther used M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8599 No asa/antiplat ther use rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8600 Tpa initi w/in 4.5 hr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8601 No elig tpa init w/in 4.5 hr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8602 No tpa init w/in 4.5 hr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8633 Pharm ther osteo rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8635 No pharm ther osteo rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8647 Rafscrs ki scor >= 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8648 Rafscrs ki scor < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8650 Rafs crs ki no scor no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8651 Rafscrs hi scor >=0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8652 Rafscrs hi scor < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8654 Rafs crs hi no scor no surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8655 Rafscrs llfai scor >= 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8656 Rafscrs llfai scor < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8658 Rafscrs llfai no scor + surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8659 Rafscrs lbi scor >= 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8660 Rafscrs lbi scor < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8661 Rafscrs lbi no scor M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8662 Rafs crs lbi no scor no surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8663 Rafscrs si scor >= 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8664 Rafscrs si scor < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8666 Rafs crs si no scor no surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8667 Rafscrs ewh scor >= 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8668 Rafscrs ewh scor < 0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8670 Rafs crs ewh no scor no surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8694 Lvef <=40% M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8708 Antibiotic not pres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8709 Uri ep compete diag M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8710 Pt pres antibiotic M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8711 Pres antibx on/within 3 day M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8712 Not pres antibiotic M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8721 Pt, pn, hist grade doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8722 Med reas pt, pn, not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8723 Spec sit not prim tumor M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8724 Pt, pn, hist grade not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8733 Doc pos elder mal scrn plan M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8734 Doc neg eld req M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8735 Eld mal scrn pos no plan M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8749 No signs melanoma M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8752 Sys bp less 140 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8753 Sys bp > or = 140 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8754 Dias bp less 90 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8755 Dias bp > or = 90 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8756 No bp measure doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8783 Bp scrn perf rec interval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8785 Bp scrn no perf at interval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8797 Specimen site not esophagus M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8798 Specimen site not prostate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8806 Perf ultrsnd to lct preg doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8807 No ta tv ultrasnd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8808 Ultrasound not perf, rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8815 Doc reas no statin therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8816 Statin med pres at disch M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8817 Doc reas no statin med disch M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8826 Pt disch home day #2 evar M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8833 Pt not disch home day#2 evar M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8834 Pt disch home day #2 cea M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8838 Not disch home by day #2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8839 Sleep apnea assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8840 Doc reas no sleep apnea M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8841 No sleep apnea assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8842 Ahi rdi rei doc win 2mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8843 Doc reas no ahi rdi rei M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8844 No ahi rdi rei ini dx no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8845 Pos airway press prescribed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8846 Mod or severe osa M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8849 Doc reas no pos air press M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8850 No pap prescribed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8851 Adhere tx assess at lst ann M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8854 Reas no adhere therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8855 Ther not assessed annually M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8856 Ref for oto eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8857 No elig ref for oto eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8858 Not ref for oto eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8863 No assess bone loss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8864 Pneumococcal vaccine admin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8865 Doc med reas no pneumococcal M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8866 Doc pt reas no pneumococcal M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8867 No pneumococcal admin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8869 Doc immune hep b antitnf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8875 Breast cancer dx min invsive M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8876 Doc reas no min inv dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8877 No brst cncr dx min invasive M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8878 Sent lymph node biopsy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8880 Sen lym p node biop not perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8881 Brst cncr stage > t1n0m0 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8882 No sent lymph node biopsy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8907 Pt doc no events on discharg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8908 Pt doc w burn prior to d/c X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8909 Pt doc no burn prior to d/c X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8910 Pt doc to have fall in asc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8911 Pt doc no fall in asc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8912 Pt doc with wrong event X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8913 Pt doc no wrong event X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8914 Pt trans to hosp post d/c X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8915 Pt not trans to hosp at d/c X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8916 Pt w iv ab given on time X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8917 Pt w iv ab not given on time X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8918 Pt w/o preop order iv ab pro X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8923 Lvef <= 40% or lvsd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8924 Spir res doc fev1/fvc<70% M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8934 Lvef <=40% or dep lv sys fcn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8935 Rx ace or arb therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8936 Pt not eligible ace/arb M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8937 No rx ace/arb therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8942 Doc fcn/care plan w/30 days M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8944 Ajcc mel cnr stg 0 - iic M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8946 Mibm but no dx of breast ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8950 Pre-htn or htn doc, f/u indc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8952 Pre-htn/htn, no f/u, not gvn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8955 Most recent assess vol mgmt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8956 Pt rcv hedia outpt dyls fac M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8958 Assess vol mgmt not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8961 Csit lowrisk surg pts preop M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8962 Csit on pt any reas 30 days M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8967 Warf or other fda drug presc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8968 Doc med not presb M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8969 Doc pt rsn no presc warf/fda M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G8970 No rsk fac or 1 mod risk te M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9001 Mccd, initial rate X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9002 Mccd,maintenance rate X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9003 Mccd, risk adj hi, initial X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9004 Mccd, risk adj lo, initial X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9005 Mccd, risk adj, maintenance X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9006 Mccd, home monitoring X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9007 Mccd, sch team conf X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9008 Mccd,phys coor-care ovrsght X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9009 Mccd, risk adj, level 3 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9010 Mccd, risk adj, level 4 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9011 Mccd, risk adj, level 5 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9012 Other specified case mgmt X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9013 Esrd demo bundle level i N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9014 Esrd demo bundle-level ii N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9016 Demo-smoking cessation coun N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9050 Oncology work-up evaluation I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9051 Oncology tx decision-mgmt I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9052 Onc surveillance for disease I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9053 Onc expectant management pt I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9054 Onc supervision palliative I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9055 Onc visit unspecified nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9056 Onc prac mgmt adheres guide I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9057 Onc pract mgmt differs trial I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9058 Onc prac mgmt disagree w/gui I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9059 Onc prac mgmt pt opt alterna I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9060 Onc prac mgmt dif pt comorb I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9061 Onc prac cond noadd by guide I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9062 Onc prac guide differs nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9063 Onc dx nsclc stgi no progres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9064 Onc dx nsclc stg2 no progres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9065 Onc dx nsclc stg3a no progre M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9066 Onc dx nsclc stg3b-4 metasta M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9067 Onc dx nsclc dx unknown nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9068 Onc dx sclc/nsclc limited M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9069 Onc dx sclc/nsclc ext at dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9070 Onc dx sclc/nsclc ext unknwn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9071 Onc dx brst stg1-2b hr,nopro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9072 Onc dx brst stg1-2 noprogres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9073 Onc dx brst stg3-hr, no pro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9074 Onc dx brst stg3-noprogress M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9075 Onc dx brst metastic/ recur M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9077 Onc dx prostate t1no progres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9078 Onc dx prostate t2no progres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9079 Onc dx prostate t3b-t4noprog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9080 Onc dx prostate w/rise psa M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9083 Onc dx prostate unknwn nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9084 Onc dx colon t1-3,n1-2,no pr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9085 Onc dx colon t4, n0 w/o prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9086 Onc dx colon t1-4 no dx prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9087 Onc dx colon metas evid dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9088 Onc dx colon metas noevid dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9089 Onc dx colon extent unknown M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9090 Onc dx rectal t1-2 no progr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9091 Onc dx rectal t3 n0 no prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9092 Onc dx rectal t1-3,n1-2noprg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9093 Onc dx rectal t4,n,m0 no prg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9094 Onc dx rectal m1 w/mets prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9095 Onc dx rectal extent unknwn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9096 Onc dx esophag t1-t3 noprog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9097 Onc dx esophageal t4 no prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9098 Onc dx esophageal mets recur M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9099 Onc dx esophageal unknown M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9100 Onc dx gastric no recurrence M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9101 Onc dx gastric p r1-r2noprog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9102 Onc dx gastric unresectable M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9103 Onc dx gastric recurrent M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9104 Onc dx gastric unknown nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9105 Onc dx pancreatc p r0 res no M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9106 Onc dx pancreatc p r1/r2 no M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9107 Onc dx pancreatic unresectab M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9108 Onc dx pancreatic unknwn nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9109 Onc dx head/neck t1-t2no prg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9110 Onc dx head/neck t3-4 noprog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9111 Onc dx head/neck m1 mets rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9112 Onc dx head/neck ext unknown M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9113 Onc dx ovarian stg1a-b no pr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9114 Onc dx ovarian stg1a-b or 2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9115 Onc dx ovarian stg3/4 noprog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9116 Onc dx ovarian recurrence M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9117 Onc dx ovarian unknown nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9123 Onc dx cml chronic phase M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9124 Onc dx cml acceler phase M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9125 Onc dx cml blast phase M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9126 Onc dx cml remission M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9128 Onc dx multi myeloma stage i M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9129 Onc dx mult myeloma stg2 hig M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9130 Onc dx multi myeloma unknown M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9131 Onc dx brst unknown nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9132 Onc dx prostate mets no cast M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9133 Onc dx prostate clinical met M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9134 Onc nhlstg 1-2 no relap no M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9135 Onc dx nhl stg 3-4 not relap M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9136 Onc dx nhl trans to lg bcell M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9137 Onc dx nhl relapse/refractor M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9138 Onc dx nhl stg unknown M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9139 Onc dx cml dx status unknown M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9140 Frontier extended stay demo X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9143 Warfarin respon genetic test X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9147 Outpt iv insulin tx any mea N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9148 Medical home level 1 R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9149 Medical home level ii R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9150 Medical home level iii R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9151 Mapcp demo state R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9152 Mapcp demo community R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9153 Mapcp demo physician R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9156 Evaluation for wheelchair R 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9157 Transesoph doppl cardiac mon A 2.15 0.32NA 0.32 0.18 2.65 2.652XXX.00.00.00999009 33.4009 090 99 0.00 0.00 0.00
- G9187 Bpci home visit A 0.18 1.32 1.32NA 0.03 1.53 1.530XXX.00.00.00009999 33.4009 090 99 0.00 0.00 0.00
- G9188 Beta not given no reason M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9189 Beta pres or already taking M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9190 Medical reason for no beta M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9191 Pt reason for no beta M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9212 Doc of dsm-iv init eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9213 No doc of dsm-iv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9223 Pjp proph ordered cd4 low M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9225 Norsn no foot exam M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9226 3 comp foot exam completed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9227 Foa doc, care plan not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9228 Gc chl syp documented M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9230 Norsn for gc chl syp test M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9231 Doc esrd dia trans preg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9242 Doc viral load >=200 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9243 Doc viral load <200 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9246 No enc or enc/vir ld 90days M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9247 2 enc enc/vir ld 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9254 Doc pt dischg >2d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9255 Pt dc home 2nd po day M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9273 Sys<140 and dia<90 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9274 Bp out of nrml limits M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9275 Doc of non tobacco user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9276 Doc of tobacco user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9277 Doc daily aspirin or contra M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9278 Doc no daily aspirin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9279 Pne scrn done doc vac done M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9280 Pne not given norsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9281 Pne scrn done doc not ind M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9282 Doc medrsn no histo type M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9283 Hist type doc on report M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9284 No hist type doc on report M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9285 Site not small cell lung ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9286 Antibio rx w in 10d of sympt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9287 No antibio w in 10d of sympt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9288 Doc medrsn no hist type rpt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9289 Doc type nsm lung ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9290 No doc type nsm lung ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9291 Not nsm lung ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9292 Medrsn no pt category M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9293 No pt category on report M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9294 Pt cat and thck on report M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9295 Non cutaneous loc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9296 Doc share dec prior proc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9297 No doc share dec prior proc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9298 Eval risk vte card 30d prior M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9299 No eval risk vte card prior M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9305 No interv req for leak M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9306 Interv req for leak M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9307 No ret for surg w in 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9308 Unpl ret or w/compl w/in 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9309 No unplnd hosp readm in 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9310 Unplnd hosp readm in 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9311 No surg site infection M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9312 Surgical site infection M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9313 Amoxic not presc as 1st line M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9314 Norsn not first line amox M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9315 Amox w/wo clav rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9316 Doc comm risk calc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9317 No doc comm risk calc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9318 Image std nomenclature M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9319 Image not std nomenclature M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9321 Prev ct nuc med cnt doc 12mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9322 No cnt ct nuc med doc 12mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9341 Srch for ct w in 12 mos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9342 No srch for ct in 12mo norsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9344 Sysrsn no dicom srch M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9345 Follow up pulm nod M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9347 No follow up pulm nod norsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9351 Doc >1 sinus ct w 90d dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9352 Not >1 sinus ct w 90d dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9353 Medrsn >1 sinus ct w 90d dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9354 1 or no ct sinus w/in 90d dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9355 No early ind/delivery M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9356 Early ind/delivery M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9357 Pp eval/edu perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9358 Pp eval/edu not perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9361 Doc rsn elect c-sec/induct M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9364 Sinus caus bac inx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9367 >= 2 same hi-rsk med ord M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9368 >= 2 same hi-rsk med not ord M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9380 Off assis eol iss M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9382 No off assis eol M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9383 Recd scrn hcv infec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9384 Doc med rsn no hcv scrn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9385 Doc pt reas not rec hcv srn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9386 Scrn hcv infec not recd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9393 Ini phq9 >9 remiss <5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9394 Dx bipol, death, nhres, hosp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9395 Ini phq9 >9 no remiss >=5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9396 Ini phq9 >9 not assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9408 Card tamp w/in 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9409 No card tamp e/in 30d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9410 Admit w/in 180d req remov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9411 No admit w/in 180d req remov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9412 Admit w/in 180d req surg rev M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9413 No admit req surg rev M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9414 1dose menig vac btwn 10 & 13 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9415 No 1dose meni vac btwn 10&13 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9416 Pt 1 tdap betw 10-13 yrs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9417 Pt not 1 tdap betw 10-13 yrs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9418 Lungcx bx rpt docs class M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9419 Med reas not incl histo type M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9420 Spec site no lung M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9421 Lung cx bx rpt no doc class M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9422 Rpt doc class histo type M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9423 Med reas rpt no histo type M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9424 Site no lung or lung cx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9425 Spec rpt no doc class histo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9426 Impr med time edarr pain med M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9427 No impro med time pain med M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9428 Patho rpt incl pt ctg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9429 Doc med rsn no pt cat M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9430 Spec site no cutaneous M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9431 Patho rpt no pt ctg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9432 Asth controlled M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9434 Asth not controlled M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9452 Doc med reas no hcv test M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9455 Abd imag w/us, ct or mri M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9456 Doc med pt reas no hcc scrn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9457 Pt no abd img no doc rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9468 No recd cortico>=10mg/d >60d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9470 No rec cortico>60d 1rx 600mg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9471 W/in 2yr dxa not order M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9473 Chap services at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9474 Diet counsel at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9475 Other counselor at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9476 Volun service at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9477 Care coord at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9478 Othe therapist at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9479 Pharmacist at hospice X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9480 Admission to mccm X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9481 Remote e/m new pt 10mins A 0.48 0.00 0.00 0.06 0.54 0.540XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9482 Remote e/m new pt 20mins A 0.93 0.00 0.00 0.07 1.00 1.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9483 Remote e/m new pt 30mins A 1.42 0.00 0.00 0.16 1.58 1.580XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9484 Remote e/m new pt 45mins A 2.43 0.00 0.00 0.24 2.67 2.670XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9485 Remote e/m new pt 60mins A 3.17 0.00 0.00 0.36 3.53 3.530XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9486 Remote e/m est. pt 10mins A 0.48 0.00 0.00 0.06 0.54 0.540XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9487 Remote e/m est. pt 15mins A 0.97 0.00 0.00 0.09 1.06 1.060XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9488 Remote e/m est. pt 25mins A 1.50 0.00 0.00 0.14 1.64 1.640XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9489 Remote e/m est. pt 40mins A 2.11 0.00 0.00 0.21 2.32 2.320XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9490 Cmmi mod home visit A 0.18 1.32 1.32NA 0.03 1.53 1.530XXX.00.00.00009999 33.4009 090 99 0.00 0.00 0.00
- G9497 Rec inst no smoke day surg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9498 Abx reg prescribed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9500 Rad expos ind/exp tm doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9501 Rad expos ind/exp tm no doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9502 Med reas no perf foot exam M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9504 Doc rsn hep b stat not asses M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9505 Abx pres w/in 10 dys of symp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9507 Doc reas on statin or contra M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9508 Doc pt not on statin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9509 Adit mdd dys rem 12 mnths M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9510 Remis12m not phq-9 score <5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9511 Idx evt dte phq>9 doc 12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9512 Indiv pdc > 0.8 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9513 Indiv pdc not > 0.8 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9514 Req ret or w/in 90d of surg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9515 No reas, no ret or w/in 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9516 Impr vis acuit w/in 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9517 No impr vis acuit w/in 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9518 Doc active inj drug use M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9519 Final ref +/- 1.0 w/in 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9520 Refract not +/- 1.0 w/in 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9521 Er and ip hosp <2 in 12 mos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9522 Er/ip hosp =/>2 in 12 mos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9529 Minor blunt trauma w/head ct M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9530 Pt mbht hd ct ord ec prov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9531 Pt doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9533 Indic for head ct not valid M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9537 Img hd clin trial M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9539 Intent pot remv time placemt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9540 Pt alive 3 mos post proc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9541 Filter rem 3 mon plmt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9542 Doc reass appr remo filt 3ms M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9543 Doc 2x re-assess filt remov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9544 No filt remov w/in 3mos plcm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9547 Cys ren les or adren M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9548 No f/u rec image study M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9549 Doc med rsn for f/u imag M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9550 Imag rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9551 Imag no les M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9552 Inc thyr node <1.0 in rpt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9553 Prior thyroid dise dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9554 Ct/cta/mri/a chst foll rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9555 Doc med rsn for follup image M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9556 Ct/cta/mri/a no follup imag M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9557 Ct/cta/mri/a no thyr <1.0cm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9580 Door to punc time <2hrs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9582 Door to punc time >2hr, nrg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9593 Low pecarn ped head trauma M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9594 Pt mbht hd ct ord ec prov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9595 Doc shnt/tum/coag M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9597 No low pecarn ped head traum M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9598 Aor ane 5.5-5.9 cm max diam M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9599 Aor ane >=6.0 cm max diam M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9603 Pt surv improv bsline tx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9605 Surv score no improv w/tx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9606 Intraop cyst eval trac inj M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9607 Doc med rsn not perf cystosc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9608 Intraop cyst eval not done M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9609 Doc order anti-plat M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9610 Doc md rsn no antipla M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9611 No doc order anti-plat rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9621 Scr unheal etoh w/counsel M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9622 No unheal etoh user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9624 Pt not scrn or no counseling M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9625 Pt bl srg 30 day pst srg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9626 Med rsn no rpt bladder inj M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9627 Pt no bl srg 30 day pst srg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9628 Pt bwli srg 30 day pst srg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9629 Med rsn no rpt bowel inj M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9630 Pt no bwli srg 30 day srg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9637 Doc >1 dose reduc tech M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9638 No doc >1 dose reduc tech M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9642 Current smoker M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9643 Elective surgery M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9644 No smok b/4 anes day of surg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9645 Had smoke b/4 anes day surg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9646 Pt w/90d mrs 0-2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9648 Pt w/90d mrs >2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9649 Psor as doc spc bm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9651 Psor as doc no spc bm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9654 Mon anesth care M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9655 Toc tool incl key elem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9656 Pt trans from anest to pacu M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9658 Toc tool incl elem not used M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9659 >=86y scr colo nomed rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9660 Doc med rsn colo pt >= 86y M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9661 Pt >= 86 w/ hi risk M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9662 Prior dx/active clin ascvd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9663 Fast/dir ldl >= 190 mg/dl M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9664 Taking statin or rec'd order M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9665 No statin/no order statin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9674 Pt w/clin ascvd dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9675 Pt w/fast/dir lab ldl-c >190 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9676 40-75y w/type 1/2 w/ldl-c rs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9679 Acute care pneumonia X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9680 Acute care congestive heart X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9681 Acute care chronic obstruct X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9682 Acute care skin infection X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9683 Acute fluid/electro disorder X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9684 Acute care urinary tract inf X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9685 Acute nursing facility care A 3.50 0.90 0.90 0.29 4.69 4.690XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9687 Hospice anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9688 Pt w/hosp anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9689 Inpt elect carotid intervent M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9690 Pt in hos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9691 Pt hosp dur msmt period M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9692 Hosp recd by pt dur msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9693 Pt use hosp during msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9694 Hosp srv used pt in msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9695 Long act inhal bronchdil pre M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9696 Med rsn no presc bronchdil M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9698 Sys rsn no presc bronchdil M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9699 Long inhal bronchdil no pres M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9700 Pt is w/hosp during msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9702 Pt use hosp during msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9703 Anbx 30 prior to episode M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9704 Ajcc br ca stg i: t1 mic/t1a M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9705 Ajcc br ca stg ib M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9706 Low recur prost ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9708 Bilat mast/hx bi /unilat mas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9709 Hosp srv used pt in msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9710 Pt prov hosp srv msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9711 Pt hx tot col or colon ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9712 Doc med rsn presc anbx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9713 Pt use hosp during msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9714 Pt is w/hosp during msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9716 Bmi doc onl fup not cmpltd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9717 Doc pt dx bipol M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9719 Pt not ambul/immob/wc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9720 Hospice anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9721 Pt not ambul/immob/wc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9722 Doc hx renal fail or cr+ >=4 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9723 Hosp recd by pt dur msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9724 Pt w/doc use anticoag mst yr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9726 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9727 Pt unable cmplt lepf prom M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9728 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9729 Pt unbl cmplt lepf prom M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9730 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9731 Pt unbl cmplt lepf prom M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9732 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9733 Pt unbl cmplt lb fs prom M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9734 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9735 Pt unbl cmplt shld fs prom M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9736 Refused to participate M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9737 Pt unbl cmplt ewh fs prom M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9740 Hosp srv to pt dur msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9741 Pt w/hosp anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9744 Pt not eli d/t act dig htn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9745 Doc rsn no hbp scrn or f/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9746 Mit sten, valve or trans af M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9752 Urgent surgery M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9753 Doc no dicom, ct other fac M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9754 Incid pulm nodule M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9755 Doc med rsn no fllw up M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9756 Surg proc w/silicone oil M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9757 Surg proc w/silicone oil M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9758 Pt in hos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9761 Pt w/hosp anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9762 Pt had >= 2-3 hpv vaccines M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9763 Pt not have 2-3 hpv vaccines M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9764 Pt treatd w/oral syst or bio M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9765 Doc pat declined therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9766 Cva stroke dx tx transf fac M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9767 Hosp new dx cva consid evst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9768 Pt w/hosp anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9769 Bn den 2yr/got ost med/ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9770 Perip nerve block M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9771 Anes end, 1 temp >35.5(95.9) M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9772 Doc med rsn no temp >= 35.5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9773 1 bod temp >=35.5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9775 Recd 2 anti-emet pre/intraop M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9776 Doc med rsn no proph antiem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9777 Pt no antiemet pre/intraop M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9779 Pts breastfeeding M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9780 Pts dx w/rhabdomyolysis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9781 Doc rsn no statin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9782 Hx dx fam/pure hypercholes M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9784 Path/derm prov 2nd biop opin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9785 Path report sent M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9786 Path report not sent M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9787 Pt alive M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9788 Most rct bp </= 130/80 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9789 Record bp ip, er, urg/self M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9790 Most rct bp >/= 130/80 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9791 Most rct tob stat free M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9792 Most rct tob stat not free M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9793 Pt on daily asa/antiplat M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9794 Doc med rsn no daily aspirin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9795 Pt no daily asa/antiplat M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9796 Pt currently on statin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9797 Pt not currently on statin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9805 Pt w/hosp anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9806 Pt recd cerv cyto/hpv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9807 Pt no recd cerv cyto/hpv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9812 Pt died during inpt/30d aft M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9813 Pt not died w/in 30d of proc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9818 Doc sex activity M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9819 Pt w/hosp anytime msmt per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9820 Doc chlam scr test w/follow M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9821 No doc chlam scr ts w/follow M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9822 Endo abl proc yr prev ind dt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9823 Endo smpl/hyst bx res doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9824 Endo smpl/hyst bx res no doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9830 Her-2 pos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9831 Ajcc stg brt ca dx ii or iii M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9832 Br ca stg = 1 t stg = t1c M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9838 Pt met dis at dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9839 Anti-egfr mon anti ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9840 Gene testing performed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9841 Gene testing not performed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9842 Pt met dis at dx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9843 Kras or nras gene mutation M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9844 Pt no recd anti-egfr ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9845 Pt recd anti-egfr ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9846 Pt died from cancer M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9847 Pt recd chemo last 14d life M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9848 Pt no chemo last 14d life M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9858 Pt enroll hospice M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9859 Pt died from cancer M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9860 Pt less 3d hospice M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9861 Pt more than 3d hospice M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9862 Doc rsn no 10 yr follow M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9868 Cmmi asyntelehealth <10min A 0.80 0.00 0.00 0.00 0.80 0.809XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9869 Cmmi asyntelehealth 10-20min A 1.07 0.00 0.00 0.00 1.07 1.079XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9870 Cmmi asyntelehealth >20min A 1.34 0.00 0.00 0.00 1.34 1.349XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9871 Bhv couns dm prev, onln 60 m X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9873 1 em core session X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9874 4 em core sessions X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9875 9 em core sessions X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9876 2 em core ms mo 7-9 no wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9877 2 em core ms mo 10-12 no wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9878 2 em core ms mo 7-9 wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9879 2 em core ms mo 10-12 wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9880 Em 5 percent wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9881 Em 9 percent wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9882 2 em ongoing ms mo 13-15 wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9883 2 em ongoing ms mo 16-18 wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9884 2 em ongoing ms mo 19-21 wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9885 2 em ongoing ms mo 22-24 wl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9886 In-person attendance g code X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9887 Distance learning attendance X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9888 5% wl maintnd from bsline wt X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9890 Em bridge payment X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9891 Em session reporting X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9894 Adr dep thrpy prescribed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9895 Doc med rsn no adr dep thrpy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9896 Doc pt rsn no adr dep thrpy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9897 Pt nt prsc adr dep thrpy rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9898 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9899 Scrn mam perf rslts doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9900 Scrn mam perf rslts not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9901 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9902 Pt scrn tbco and id as user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9903 Pt scrn tbco id as non user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9905 No pt tbco scrn rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9906 Pt recv tbco cess interv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9908 No pt tbco cess interv rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9910 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9911 Node neg pre/post syst ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9912 Hbv status assesed and int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9913 No hbv status assesd and int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9914 Pt initiated anti-tnf agent M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9915 No documntd hbv results rcd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9916 Funct status past 12 months M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9917 Adv dem crgvr limited M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9918 No funct stat perf, rsn nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9919 Scrn nd pos nd prov of rec I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9920 Scrning perf and negative I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9922 Sfty cncrns scrn nd mit recs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9923 Safty cncrns scrn and neg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9925 No scrn prov rsn nos M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9926 Sfty cncrns scrn but no recs M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9928 No warf or fda drug presc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9929 Trs/rev af M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9930 Com care M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9931 No chad or chad scr 0 or 1 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9938 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9939 Same path/derm perf biopsy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9940 Doc reas no statin therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9943 Bk pn nt msr vas scl pre/pst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9945 Pt w/cancer scoliosis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9946 Bk pain no vas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9949 Leg pain no vas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9954 Pt >2 rsk fac post-op vomit M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9955 Inhlnt anesth only for induc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9956 Combo thrpy of >= 2 prophly M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9957 Doc med rsn no combo thrpy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9958 No combo prohpyl thrp for pt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9959 Systemic antimicro not presc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9960 Med rsn sys antimi nt rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9961 Systemic antimicro presc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9962 Embolization doc separatly M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9963 Embolization not doc separat M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9964 Pt recv >=1 well-chld visit M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9965 No well-chld vist recv by pt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9968 Pt refrd 2 pvdr/spclst in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9969 Pvdr rfrd pt rprt rcvd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9970 Pvdr rfrd pt no rprt rcvd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9978 Remote e/m new pt 10mins A 0.48 1.02 0.17 0.06 1.56 0.710XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9979 Remote e/m new pt 20mins A 0.93 1.25 0.23 0.07 2.25 1.230XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9980 Remote e/m new pt 30 mins A 1.42 1.76 0.38 0.16 3.34 1.960XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9981 Remote e/m new pt 45mins A 2.43 2.47 0.66 0.24 5.14 3.330XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9982 Remote e/m new pt 60mins A 3.17 3.23 0.94 0.36 6.76 4.470XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9983 Remote e/m est. pt 10mins A 0.48 1.02 0.17 0.06 1.56 0.710XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9984 Remote e/m est. pt 15mins A 0.97 1.46 0.33 0.09 2.52 1.390XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9985 Remote e/m est. pt 25mins A 1.50 2.00 0.47 0.14 3.64 2.110XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9986 Remote e/m est. pt 40mins A 2.11 2.75 0.75 0.21 5.07 3.070XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- G9987 Bpci advanced in home visit A 0.18 1.32 1.32 0.03 1.53 1.530XXX.00.00.00009999 33.4009 090 99 0.00 0.00 0.00
- G9988 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9992 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9993 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9994 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9996 Doc pt pal or hospice M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9997 Doc pt preg dur msrmt pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9998 Doc med rsn <3 colon M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- G9999 Doc sys rsn <3 colon M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- GXXX1 Bhv couns dm prev, onln 60 m X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00H0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- H0001 Alcohol and/or drug assess I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0002 Alcohol and/or drug screenin I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0003 Alcohol and/or drug screenin I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0004 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0005 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0006 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0007 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0008 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0009 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0010 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0011 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0012 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0013 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0014 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0015 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0016 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0017 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0018 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0019 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0020 Alcohol and/or drug services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0021 Alcohol and/or drug training I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0022 Alcohol and/or drug interven I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0023 Alcohol and/or drug outreach I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0024 Alcohol and/or drug preventi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0025 Alcohol and/or drug preventi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0026 Alcohol and/or drug preventi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0027 Alcohol and/or drug preventi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0028 Alcohol and/or drug preventi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0029 Alcohol and/or drug preventi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0030 Alcohol and/or drug hotline I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0031 Mh health assess by non-md I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0032 Mh svc plan dev by non-md I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0033 Oral med adm direct observe I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0034 Med trng & support per 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0035 Mh partial hosp tx under 24h I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0036 Comm psy face-face per 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0037 Comm psy sup tx pgm per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0038 Self-help/peer svc per 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0039 Asser com tx face-face/15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0040 Assert comm tx pgm per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0041 Fos c chld non-ther per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0042 Fos c chld non-ther per mon I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0043 Supported housing, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0044 Supported housing, per month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0045 Respite not-in-home per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0046 Mental health service, nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0047 Alcohol/drug abuse svc nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0048 Spec coll non-blood:a/d test I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0049 Alcohol/drug screening I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0050 Alcohol/drug service 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0051 Traditional healing service I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0052 Mmip mental health and care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H0053 Ht mental health and care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1000 Prenatal care atrisk assessm I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1001 Antepartum management I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1002 Carecoordination prenatal I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1003 Prenatal at risk education I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1004 Follow up home visit/prental I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1005 Prenatalcare enhanced srv pk I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1010 Nonmed family planning ed I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H1011 Family assessment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2000 Comp multidisipln evaluation I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2001 Rehabilitation program 1/2 d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2010 Comprehensive med svc 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2011 Crisis interven svc, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2012 Behav hlth day treat, per hr I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2013 Psych hlth fac svc, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2014 Skills train and dev, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2015 Comp comm supp svc, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2016 Comp comm supp svc, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2017 Psysoc rehab svc, per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2018 Psysoc rehab svc, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2019 Ther behav svc, per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2020 Ther behav svc, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2021 Com wrap-around sv, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2022 Com wrap-around sv, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2023 Supported employ, per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2024 Supported employ, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2025 Supp maint employ, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2026 Supp maint employ, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2027 Psychoed svc, per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2028 Sex offend tx svc, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2029 Sex offend tx svc, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2030 Mh clubhouse svc, per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2031 Mh clubhouse svc, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2032 Activity therapy, per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2033 Multisys ther/juvenile 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2034 A/d halfway house, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2035 A/d tx program, per hour I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2036 A/d tx program, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2037 Dev delay prev dp ch, 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2038 Skill train and dev/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2040 Coord specialty care, month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- H2041 Coord special care encounter I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00J000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- J0013 Esketamine, nasal spray N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0120 Tetracyclin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0121 Inj., omadacycline, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0122 Inj., eravacycline, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0129 Abatacept injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0130 Abciximab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0131 Inj, acetaminophen (nos) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0132 Acetylcysteine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0133 Acyclovir injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0134 Inj acetaminophen -fresenius E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0136 Inj, acetaminophen (b braun) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0137 Inj, acetaminophen (hikma) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0138 Inj acetaminoph 10mg/ibu 3mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0139 Inj, adalimumab, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0153 Adenosine inj 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0162 Inj epinephrine (fresenius) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0163 Epinephrine in nacl (endo) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0164 Epinephrine in nacl (baxter) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0165 Inj epinephrine nos 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0166 Inj epinephrine (bpi) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0167 Inj epinephrine (hospira) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0168 Epinephrine (intl med sys) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0169 Inj epinephrine (adrenalin) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0174 Lecanemab-irmb, for iv inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0175 Inj, donanemab-azbt, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0177 Inj, aflibercept hd, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0178 Aflibercept injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0179 Inj, brolucizumab-dbll, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0180 Agalsidase beta injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0184 Inj, amisulpride, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0185 Inj., aprepitant, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0202 Injection, alemtuzumab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0206 Inj allopurinol sodium 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0207 Amifostine E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0208 Inj, pedmark, 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0209 Inj, sod thiosulfate (hope) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0210 Methyldopate hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0211 Inj, nithiodote, 3mg / 125mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0216 Inj, alfentanil hcl, 500mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0217 Inj velmanase alfa-tycv 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0218 Inj olipudase alfa-rpcp 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0219 Inj aval alfa-nqpt 4mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0220 Alglucosidase alfa injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0221 Lumizyme injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0222 Inj., patisiran, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0223 Inj givosiran 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0224 Inj. lumasiran, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0225 Inj, vutrisiran, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0248 Inj, remdesivir, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0256 Alpha 1 proteinase inhibitor E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0257 Glassia injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0270 Alprostadil for injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0275 Alprostadil urethral suppos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0278 Amikacin sulfate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0280 Aminophyllin 250 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0281 Inj aminocaproic acid 1 gram E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0282 Amiodarone hcl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0283 Inj, amiodarone (nexterone) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0285 Amphotericin b E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0287 Amphotericin b lipid complex E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0289 Amphotericin b liposome inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0290 Ampicillin 500 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0291 Inj., plazomicin, 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0295 Ampicillin sulbactam 1.5 gm E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0300 Amobarbital 125 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0330 Succinycholine chloride inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0348 Anidulafungin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0349 Inj, rezafungin, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0360 Hydralazine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0364 Apomorphine hydrochloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0390 Chloroquine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0391 Inj, artesunate, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0400 Aripiprazole injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0401 Inj, abilify maintena, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0402 Inj, abilify asimtufii, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0456 Azithromycin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0457 Injection, aztreonam, 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0458 Aztreonam/avibactam 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0461 Atropine sulfate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0462 Atropine sulf, nte, 0.01 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0463 Inj atropine (fresenius te) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0470 Dimecaprol injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0475 Baclofen 10 mg injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0476 Baclofen intrathecal trial E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0480 Basiliximab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0485 Belatacept injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0490 Belimumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0491 Inj anifrolumab-fnia 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0500 Dicyclomine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0515 Inj benztropine mesylate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0517 Inj., benralizumab, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0520 Bethanechol chloride inject E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0525 Inj cefotetan disodium 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0558 Peng benzathine/procaine inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0561 Penicillin g benzathine inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0565 Inj, bezlotoxumab, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0567 Inj., cerliponase alfa 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0570 Buprenorphine implant 74.2mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0571 Buprenorphine oral 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0572 Bupren/nal up to 3mg bupreno E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0573 Bupren/nal 3.1 to 6mg bupren E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0574 Bupren/nal 6.1 to 10mg bupre E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0575 Bupren/nal over 10mg bupreno E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0577 Inj, brixadi, 7 days or less E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0578 Inj brixadi, more than 7 day E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0582 Bivalirudin (endo) 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0583 Bivalirudin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0584 Injection, burosumab-twza 1m E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0585 Injection,onabotulinumtoxina E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0586 Abobotulinumtoxina E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0587 Inj, rimabotulinumtoxinb E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0588 Incobotulinumtoxin a E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0589 Inj daxibotulinumtoxina-lanm E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0591 Inj deoxycholic acid, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0592 Buprenorphine hydrochloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0593 Inj., lanadelumab-flyo, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0594 Busulfan injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0595 Butorphanol tartrate 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0596 Injection, ruconest E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0597 C-1 esterase, berinert E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0598 C-1 esterase, cinryze E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0599 Inj., haegarda 10 units E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0600 Edetate calcium disodium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0601 Sevelamer carbonate 20 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0602 Sevelamer carbonate pdr 20mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0603 Sevelamer hydrochloride 20mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0604 Cinacalcet, esrd on dialysis E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0605 Sucroferric oxyhydroxide 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0606 Inj, etelcalcetide, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0607 Lanthanum carbonate oral 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0608 Lanthanum carbonate pwdr 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0609 Ferric citrate orl 3 mg iron E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0612 Inj, calcium gluconate, nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0613 Calcium glucon (wg critical) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0614 Inj, treosulfan, 50 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0615 Calcium acetate, oral, 23 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0616 Inj metoprolol tartrate 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0618 Inj, calcium chloride, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0620 Calcium glycer & lact/10 ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0630 Calcitonin salmon injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0636 Inj calcitriol per 0.1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0637 Caspofungin acetate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0638 Canakinumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0640 Leucovorin calcium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0641 Inj levoleucovorin nos 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0642 Injection, khapzory, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0650 Inj, levothyroxine nos 10mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0651 Inj, levothyroxine, freskabi E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0652 Inj, levothyroxine, hikma E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0654 Inj, liothyronine, 1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0665 Inj, bupivacaine, nos, 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0666 Inj, bupivacaine liposome E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0668 Instill, bupivac and meloxic E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0670 Inj mepivacaine hcl/10 ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0675 Inj, carboprost, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0681 Inj ceftobipole medocarl 3mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0687 Inj cefazolin (wg crit care) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0688 Inj cefazolin sodium, hikma E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0689 Inj cefazolin sodium, baxter E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0690 Cefazolin sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0691 Inj lefamulin 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0692 Cefepime hcl for injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0694 Cefoxitin sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0695 Inj ceftolozane tazobactam E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0696 Ceftriaxone sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0697 Sterile cefuroxime injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0698 Cefotaxime sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0699 Inj, cefiderocol, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0701 Inj. cefepime hcl (baxter) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0702 Betamethasone acet&sod phosp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0703 Inj, cefepime hcl (b braun) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0706 Caffeine citrate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0712 Ceftaroline fosamil inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0713 Inj ceftazidime per 500 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0714 Ceftazidime and avibactam E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0716 Centruroides immune f(ab) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0717 Certolizumab pegol inj 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0720 Chloramphenicol sodium injec E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0725 Chorionic gonadotropin/1000u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0735 Clonidine hydrochloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0736 Inj, clindamycin phosp 300mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0737 Inj, clindamycin (baxter) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0738 Hiv prep, inj, lenacapavir X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0739 Hiv prep, inj, cabotegravir X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0740 Cidofovir injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0741 Inj, cabote rilpivir 2mg 3mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0742 Inj imip 4 cilas 4 releb 2mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0743 Cilastatin sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0744 Ciprofloxacin iv E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0745 Inj codeine phosphate /30 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0750 Hiv prep, ftc/tdf 200/300mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0751 Hiv prep, ftc/taf 200/25mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0752 Hiv prep, oral lenacapavir X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0759 Inj, clevidipine, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0770 Colistimethate sodium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0775 Collagenase, clost hist inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0780 Prochlorperazine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0791 Inj crizanlizumab-tmca 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0799 Hiv prep, fda approved, noc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0801 Inj. acthar gel to 40 units E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0802 Inj. (ani), up to 40 units E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0834 Inj., cosyntropin, 0.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0840 Crotalidae poly immune fab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0841 Inj crotalidae im f(ab')2 eq E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0850 Cytomegalovirus imm iv /vial E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0870 Injection, imetelstat, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0872 Daptomycin (xellia) unrefrig E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0873 Inj daptomycin (xellia) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0874 Inj, daptomycin (baxter) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0875 Injection, dalbavancin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0877 Inj, daptomycin (hospira) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0878 Daptomycin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0879 Difelikefalin, esrd on dialy E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0881 Darbepoetin alfa, non-esrd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0882 Darbepoetin alfa, esrd use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0883 Argatroban nonesrd use 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0884 Argatroban esrd dialysis 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0885 Epoetin alfa, non-esrd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0887 Epoetin beta esrd use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0888 Epoetin beta non esrd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0890 Peginesatide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0891 Argatroban nonesrd (accord) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0892 Argatroban dialysis (accord) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0893 Inj, decitabine (sun pharma) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0894 Decitabine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0895 Deferoxamine mesylate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0896 Inj luspatercept-aamt 0.25mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0897 Denosumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0898 Argatroban nonesrd (auromed) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0899 Argatroban dialysis, auromed E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0901 Vadadustat oral 1mg for esrd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0911 Inst tauro 1.35mg/hep 100u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J0945 Brompheniramine maleate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1000 Depo-estradiol cypionate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1010 Inj, methylpred acetate 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1050 Medroxyprogesterone acetate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1071 Inj testosterone cypionate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1072 Inj, testosterone, azmiro E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1073 Testosterone pellet 75 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1095 Injection, dexamethasone 9% E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1096 Dexametha opth insert 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1097 Phenylep ketorolac opth soln E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1098 Articaine ophthalmi 8% 0.4ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1100 Dexamethasone sodium phos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1105 Dexmedetomidine film, 1 mcg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1110 Inj dihydroergotamine mesylt E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1120 Acetazolamid sodium injectio E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1130 Inj diclofenac sodium 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1160 Digoxin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1162 Digoxin immune fab (ovine) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1163 Inj, diltiazem hcl, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1164 Inj diltiazem in 0.72% nacl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1165 Phenytoin sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1171 Inj, hydromorphone, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1180 Dyphylline injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1190 Dexrazoxane hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1200 Diphenhydramine hcl injectio E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1201 Inj. cetirizine hcl 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1202 Miglustat oral 65 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1203 Inj, cipaglucosidase, 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1205 Chlorothiazide sodium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1212 Dimethyl sulfoxide 50% 50 ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1230 Methadone injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1240 Dimenhydrinate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1245 Dipyridamole injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1250 Inj dobutamine hcl/250 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1260 Dolasetron mesylate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1265 Dopamine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1270 Injection, doxercalciferol E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1271 Inj doxycycline hyclate 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1290 Ecallantide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1299 Inj, eculizumab, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1301 Injection, edaravone, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1302 Inj, sutimlimab-jome, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1303 Inj., ravulizumab-cwvz 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1304 Inj tofersen intrathec 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1305 Inj, evinacumab-dgnb, 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1306 Injection, inclisiran, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1307 Inj, crovalimab-akkz, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1308 Inj, famotidine, 0.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1320 Amitriptyline injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1322 Elosulfase alfa, injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1323 Inj, elranatamab-bcmm, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1324 Enfuvirtide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1325 Epoprostenol injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1326 Inj, zolbetuximab-clzb, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1327 Eptifibatide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1335 Ertapenem injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1364 Erythro lactobionate /500 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1370 Inj, esomeprazole sod, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1380 Estradiol valerate 10 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1410 Inj estrogen conjugate 25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1411 Inj, hemgenix, per tx dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1412 Inj roctavian ml 2x10^13vc g E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1413 Inj delandistrogene mox rokl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1414 Inj, beqvez, per tx dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1426 Injection, casimersen, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1427 Inj. viltolarsen E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1428 Inj, eteplirsen, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1429 Inj golodirsen 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1430 Ethanolamine oleate 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1434 Inj, focinvez, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1435 Injection estrone per 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1436 Etidronate disodium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1437 Inj. fe derisomaltose 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1438 Etanercept injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1439 Inj ferric carboxymaltos 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1440 Fecal microbiota jslm 1 ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1442 Inj filgrastim excl biosimil E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1447 Inj tbo filgrastim 1 microg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1448 Injection, trilaciclib, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1449 Inj eflapegrastim-xnst 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1450 Fluconazole E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1451 Fomepizole, 15 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1453 Fosaprepitant injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1454 Inj fosnetupitant, palonoset E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1455 Foscarnet sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1456 Inj, fosaprepitant (teva) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1458 Galsulfase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1459 Inj ivig privigen 500 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1460 Gamma globulin 1 cc inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1551 Inj cutaquig 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1552 Inj, alyglo, 500 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1553 Inj yimmugo 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1554 Inj. asceniv E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1555 Inj cuvitru, 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1556 Inj, imm glob bivigam, 500mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1557 Gammaplex injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1558 Inj. xembify, 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1559 Hizentra injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1560 Gamma globulin > 10 cc inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1561 Gamunex-c/gammaked E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1566 Immune globulin, powder E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1568 Octagam injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1569 Gammagard liquid injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1570 Ganciclovir sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1571 Hepagam b im injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1572 Flebogamma injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1573 Hepagam b intravenous, inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1574 Inj, ganciclovir (exela) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1575 Hyqvia 100mg immuneglobulin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1576 Inj, panzyga, 500 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1580 Garamycin gentamicin inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1595 Injection glatiramer acetate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1596 Inj, glycopyrrolate, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1597 Inj glycopyrrolate, glyrx-pf E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1598 Inj glycopyrrolate fres kabi E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1599 Ivig non-lyophilized, nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1600 Gold sodium thiomaleate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1602 Golimumab for iv use 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1610 Glucagon hydrochloride/1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1611 Inj glucagon hcl, fresenius E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1612 Inj glucagon (gvoke) 0.01 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1626 Granisetron hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1627 Inj, granisetron, xr, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1628 Inj., guselkumab, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1630 Haloperidol injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1631 Haloperidol decanoate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1632 Inj., brexanolone, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1640 Hemin, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1642 Inj heparin sodium per 10 u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1643 Inj heparin, pfizer, 1000u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1644 Inj heparin sodium per 1000u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1645 Dalteparin sodium E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1650 Inj enoxaparin sodium E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1652 Fondaparinux sodium E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1670 Tetanus immune globulin inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1675 Histrelin acetate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1700 Hydrocortisone acetate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1720 Hydrocortisone sodium succ i E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1726 Makena, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1729 Inj hydroxyprogst capoat nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1730 Diazoxide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1736 Inj meloxicam (delova) 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1737 Inj meloxicam (azurity) 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1738 Inj. meloxicam 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1740 Ibandronate sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1741 Ibuprofen injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1742 Ibutilide fumarate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1743 Idursulfase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1744 Icatibant injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1745 Infliximab not biosimil 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1746 Inj., ibalizumab-uiyk, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1747 Inj, spesolimab-sbzo, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1748 Inj, zymfentra, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1749 Inj, iloprost, 0.1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1750 Inj iron dextran E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1756 Iron sucrose injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1786 Imuglucerase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1790 Droperidol injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1800 Propranolol injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1805 Inj, esmolol hcl, 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1806 Inj esmolol hcl wg crit care E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1807 Inj, ethacrynate sod, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1808 Inj, folic acid, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1809 Inj, fosdenopterin, 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1811 Fiasp for insulin pump use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1812 Inj. insulin (fiasp) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1813 Lyumjev for insulin pump use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1814 Inj. insulin (lyumjev) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1815 Insulin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1817 Insulin for insulin pump use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1823 Inj. inebilizumab-cdon, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1826 Interferon beta-1a inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1830 Interferon beta-1b / .25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1833 Injection, isavuconazonium E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1834 Inj, isoniazid, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1835 Itraconazole injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1836 Inj, metronidazole, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1837 Inj, posaconazole, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1885 Ketorolac tromethamine inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1920 Inj, labetalol hcl, 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1921 Inj labetalol hcl hikma, 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1930 Lanreotide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1931 Laronidase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1932 Inj, lanreotide, (cipla) 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1938 Inj, furosemide, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1939 Inj, bumetanide, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1941 Inj, furoscix, 20 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1943 Inj., aristada initio, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1944 Aripiprazole lauroxil 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1950 Leuprolide acetate /3.75 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1951 Inj fensolvi 0.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1952 Leuprolide inj, camcevi, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1953 Levetiracetam injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1954 Inj leu acet lutr dpt 7.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1955 Inj levocarnitine per 1 gm E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1956 Levofloxacin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1960 Levorphanol tartrate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1961 Inj lenacapavir (hiv tx) 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1980 Hyoscyamine sulfate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J1990 Chlordiazepoxide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2002 Inj, lidocaine in d5w, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2003 Inj, lidocaine hcl, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2004 Inj, lidocaine w epinephrine E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2010 Lincomycin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2020 Linezolid injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2021 Inj, linezolid (hospira) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2060 Lorazepam injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2062 Loxapine for inhalation 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2151 Inj, mannitol, 250 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2170 Mecasermin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2175 Meperidine hydrochl /100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2180 Meperidine/promethazine inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2182 Injection, mepolizumab, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2183 Inj meropenem (wg crit care) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2184 Inj, meropenem (b. braun) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2185 Meropenem E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2186 Inj., meropenem, vaborbactam E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2210 Methylergonovin maleate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2212 Methylnaltrexone injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2246 Inj, micafungin (baxter) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2247 Inj, micafungin (par pharm) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2248 Micafungin sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2249 Inj, remimazolam, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2250 Inj midazolam hydrochloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2251 Inj midazolam in 0.9% nacl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2252 Inj midazolam in 0.8% nacl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2253 Inj midazolam (seizalam) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2260 Inj milrinone lactate / 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2265 Minocycline hydrochloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2267 Inj, mirikizumab-mrkz, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2270 Morphine sulfate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2272 Inj, morphine (fresenius) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2274 Inj morphine pf epid ithc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2277 Inj, motixafortide, 0.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2278 Ziconotide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2280 Inj, moxifloxacin 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2281 Inj moxifloxacin (fres kabi) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2290 Inj, nafcillin sodium, 20 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2291 Inj, nafcillin (baxter) 20mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2300 Inj nalbuphine hydrochloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2305 Inj, nitroglycerin, 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2312 Inj naloxone hcl nos, 0.01mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2313 Inj, naloxone (zimhi) 0.01mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2315 Naltrexone, depot form E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2320 Nandrolone decanoate 50 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2323 Natalizumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2325 Nesiritide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2326 Inj, nusinersen, 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2327 Inj risankizumab-rzaa 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2329 Inj ublituximab-xiiy, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2350 Injection, ocrelizumab, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2351 Inj ocrelizumab 1mg hya-ocsq E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2353 Octreotide injection, depot E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2354 Octreotide inj, non-depot E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2355 Oprelvekin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2356 Inj tezepelumab-ekko, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2357 Omalizumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2358 Olanzapine long-acting inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2359 Inj. olanzapine, 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2360 Orphenadrine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2371 Inj phenylephrine hcl 20 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2372 Inj, biorphen, 20 micrograms E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2373 Inj, immphentiv, 20 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2401 Chloroprocaine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2402 Chloroprocaine (clorotekal) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2403 Chloroprocaine opht gel, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2404 Inj, nicardipine 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2405 Ondansetron hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2406 Injection, oritavancin 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2407 Injection, oritavancin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2410 Oxymorphone hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2425 Palifermin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2426 Inj, invega sustenna, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2427 Inj, invega hafyera/trinza E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2428 Inj, erzofri, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2430 Pamidronate disodium /30 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2440 Papaverin hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2460 Oxytetracycline injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2468 Inj, palonosetron (posfrea) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2469 Palonosetron hcl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2470 Inj pantoprazole sodium 40mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2471 Inj pantoprazole(hikma) 40mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2472 Inj, pantoprazole sodium chl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2501 Paricalcitol E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2502 Inj, pasireotide long acting E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2506 Inj pegfilgrast ex bio 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2507 Pegloticase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2508 Pegunigalsidase alfa-iwxj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2510 Penicillin g procaine inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2515 Pentobarbital sodium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2516 Inj, pentamidine isethionate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2540 Penicillin g potassium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2543 Piperacillin/tazobactam E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2545 Pentamidine non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2547 Injection, peramivir E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2550 Promethazine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2560 Phenobarbital sodium inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2561 Inj, sezaby, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2562 Plerixafor injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2590 Oxytocin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2596 Vasopressin (long grove) 1 u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2597 Inj desmopressin acetate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2598 Inj, vasopressin, 1 unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2599 Inj vasopressin (am reg) 1 u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2601 Inj, vasopressin (baxter) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2650 Prednisolone acetate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2670 Totazoline hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2675 Inj progesterone per 50 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2679 Inj fluphenazine hcl 1.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2680 Fluphenazine decanoate 25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2690 Procainamide hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2700 Oxacillin sodium injeciton E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2704 Inj, propofol, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2710 Neostigmine methylslfte inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2711 Inj neostigmin/glycopyrrolat E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2720 Inj protamine sulfate/10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2724 Protein c concentrate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2725 Inj protirelin per 250 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2730 Pralidoxime chloride inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2760 Phentolaine mesylate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2765 Metoclopramide hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2770 Quinupristin/dalfopristin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2777 Inj, faricimab-svoa, 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2778 Ranibizumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2779 Inj, susvimo 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2781 Inj, pegcetacoplan, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2782 Inj avacincaptad pegol 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2783 Rasburicase E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2785 Regadenoson injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2786 Injection, reslizumab, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2787 Riboflavin 5'phos opth<=3ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2788 Rho d immune globulin 50 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2790 Rho d immune globulin inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2791 Rhophylac injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2792 Rho(d) immune globulin h, sd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2793 Rilonacept injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2794 Inj risperdal consta, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2795 Ropivacaine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2797 Inj., rolapitant, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2798 Inj., perseris, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2799 Inj, uzedy, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2800 Methocarbamol injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2801 Inj, rykindo, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2802 Inj, romiplostim 1 microgram E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2804 Inj, rifampin, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2805 Sincalide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2810 Inj theophylline per 40 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2820 Sargramostim injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2840 Inj sebelipase alfa 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2850 Inj secretin synthetic human E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2860 Injection, siltuximab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2865 Inj sulfameth/trim 5 mg/1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2916 Na ferric gluconate complex E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2919 Inj, methylpred sod succ 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2941 Somatropin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2950 Promazine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2993 Reteplase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2997 Alteplase recombinant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J2998 Inj plasminogen tvmh 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3000 Streptomycin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3010 Fentanyl citrate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3030 Sumatriptan succinate / 6 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3031 Inj., fremanezumab-vfrm 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3032 Inj. eptinezumab-jjmr 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3055 Inj talquetamab-tgvs 0.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3060 Inj, taliglucerase alfa 10 u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3070 Pentazocine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3090 Inj tedizolid phosphate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3095 Telavancin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3101 Tenecteplase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3105 Terbutaline sulfate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3110 Teriparatide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3111 Inj. romosozumab-aqqg 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3121 Inj testostero enanthate 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3145 Testosterone undecanoate 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3230 Chlorpromazine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3240 Thyrotropin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3241 Inj. teprotumumab-trbw 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3243 Tigecycline injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3244 Inj. tigecycline (accord) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3245 Inj., tildrakizumab, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3246 Tirofiban hcl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3247 Inj secukinumab intrav 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3250 Trimethobenzamide hcl inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3260 Tobramycin sulfate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3262 Tocilizumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3263 Inj, toripalimab-tpzi, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3265 Injection torsemide 10 mg/ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3285 Treprostinil injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3290 Inj, tranexamic acid 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3291 Tranexamic acid in sod chlor N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3299 Inj xipere 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3300 Triamcinolone a inj prs-free E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3301 Triamcinolone acet inj nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3302 Triamcinolone diacetate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3303 Triamcinolone hexacetonl inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3304 Inj triamcinolone ace xr 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3315 Triptorelin pamoate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3316 Inj., triptorelin xr 3.75 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3350 Urea injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3357 Ustekinumab sub cu inj, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3358 Ustekinumab, iv inject, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3360 Diazepam injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3373 Inj, vancomycin hcl, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3374 Inj, vancomycin (mylan) 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3375 Inj vancomycin (xellia) 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3376 Inj vancomycin (hikma) 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3379 Inj, valproate sod, 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3380 Inj vedolizumab iv 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3385 Velaglucerase alfa E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3387 Inj elivaldogene autotemecel E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3389 Topi adm prad zami per treat E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3391 Inj, atidarsagene autotemcel E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3392 Inj, exagamglogene autotem E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3393 Inj, betibeglogene autotemce E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3394 Inj, lovotibeglogene autotem E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3396 Verteporfin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3397 Inj., vestronidase alfa-vjbk E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3398 Inj luxturna 1 billion vec g E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3399 Inj onase abepar-xioi treat E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3401 Vyjuvek 5x10^9pfu/ml, 0.1 ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3402 Inj. remestemcel-l-rknd/ td E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3403 Revakinagene, per implant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3404 Inj zopapogene per ther dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3410 Hydroxyzine hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3411 Thiamine hcl 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3415 Pyridoxine hcl 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3420 Vitamin b12 injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3424 Inj hydroxocobalamin iv 25mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3425 Hydroxocobalamin im 10mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3430 Vitamin k phytonadione inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3465 Injection, voriconazole E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3470 Hyaluronidase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3471 Ovine, up to 999 usp units E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3472 Ovine, 1000 usp units E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3473 Hyaluronidase recombinant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3475 Inj magnesium sulfate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3480 Inj potassium chloride E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3485 Zidovudine E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3486 Ziprasidone mesylate E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3489 Zoledronic acid 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3490 Drugs unclassified injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3520 Edetate disodium per 150 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3530 Nasal vaccine inhalation E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3535 Metered dose inhaler drug N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3570 Laetrile amygdalin vit b17 N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3590 Unclassified biologics E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J3591 Esrd on dialysi drug/bio noc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7030 Normal saline solution infus E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7040 Normal saline solution infus E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7042 5% dextrose/normal saline E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7050 Normal saline solution infus E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7060 5% dextrose/water E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7070 D5w infusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7100 Dextran 40 infusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7110 Dextran 75 infusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7120 Ringers lactate infusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7121 5% dextrose in lac ringers E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7131 Hypertonic saline sol E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7165 Inj, human-lans, per i.u E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7168 Prothrombin complex kcentra E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7169 Inj andexxa, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7170 Inj., emicizumab-kxwh 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7171 Inj, adzynma, 10 iu E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7172 Inj marstacim-hncq, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7173 Inj. concizumab-mtci, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7174 Injection fitusiran 0.04 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7175 Inj, factor x, (human), 1iu E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7177 Inj., fibryga, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7178 Inj human fibrinogen con nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7179 Vonvendi inj 1 iu vwf:rco E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7180 Factor xiii anti-hem factor E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7181 Factor xiii recomb a-subunit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7182 Factor viii recomb novoeight E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7183 Wilate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7185 Xyntha inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7186 Antihemophilic viii/vwf comp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7187 Humate-p, inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7188 Factor viii recomb obizur E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7189 Factor viia recomb novoseven E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7190 Factor viii X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7191 Factor viii (porcine) X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7192 Factor viii recombinant nos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7193 Factor ix non-recombinant X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7194 Factor ix complex X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7195 Factor ix recombinant nos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7196 Antithrombin recombinant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7197 Antithrombin iii injection X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7198 Anti-inhibitor X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7199 Hemophilia clot factor noc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7200 Factor ix recombinan rixubis E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7201 Factor ix alprolix recomb E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7202 Factor ix idelvion inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7203 Factor ix recomb gly rebinyn E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7204 Inj recombin esperoct per iu E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7205 Factor viii fc fusion recomb E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7207 Factor viii pegylated recomb E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7208 Inj. jivi 1 iu E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7209 Factor viii nuwiq recomb 1iu E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7210 Inj, afstyla, 1 i.u. E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7211 Inj, kovaltry, 1 i.u. E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7212 Factor viia recomb sevenfact E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7213 Inj, ixinity, 1 i.u. E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7214 Altuviiio per factor viii iu E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7294 Seg acet and eth estr yearly N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7295 Eth estr and eton monthly N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7296 Kyleena, 19.5 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7297 Liletta, 52 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7298 Mirena, 52 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7299 Intraut copp cont (miudella) N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7300 Intra copp contra (paragard) N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7301 Skyla, 13.5 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7304 Contraceptive hormone patch N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7306 Levonorgestrel implant sys I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7307 Etonogestrel implant system I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7308 Aminolevulinic acid hcl top E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7311 Inj., retisert, 0.01 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7312 Dexamethasone intra implant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7313 Inj., iluvien, 0.01 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7314 Inj., yutiq, 0.01 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7315 Ophthalmic mitomycin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7316 Inj, ocriplasmin, 0.125 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7318 Inj, durolane 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7320 Genvisc 850, inj, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7321 Hyalgan supartz visco-3 dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7322 Hyaluronan, hymo or hymo one E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7323 Euflexxa inj per dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7324 Orthovisc inj per dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7325 Synvisc or synvisc-one E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7326 Gel-one E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7327 Monovisc inj per dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7328 Gelsyn-3 injection 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7329 Inj, trivisc 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7330 Cultured chondrocytes implnt E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7331 Synojoynt, inj., 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7332 Inj., triluron, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7336 Capsaicin 8% patch E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7340 Carbidopa levodopa ent 100ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7342 Ciprofloxacin otic susp 6 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7345 Aminolevulinic acid, 10% gel E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7351 Inj bimatoprost itc imp1mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7352 Afamelanotide implant, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7353 Anacaulase-bcdb 8.8% gel 1 g E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7354 Cantharidin top, applicator E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7355 Inj travoprost intra impl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7356 Inj foscarb/foslevodopa 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7402 Mometasone sinus sinuva E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7500 Azathioprine oral 50mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7501 Azathioprine parenteral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7502 Cyclosporine oral 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7503 Tacrol envarsus ex rel oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7504 Lymphocyte immune globulin X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7507 Tacrolimus imme rel oral 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7508 Tacrol astagraf ex rel oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7509 Methylprednisolone oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7510 Prednisolone oral per 5 mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7511 Antithymocyte globuln rabbit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7512 Prednisone ir or dr oral 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7514 Mycophenol (myhibbin) 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7515 Cyclosporine oral 25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7516 Inj, cyclosporine 250mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7517 Mycophenolate mofetil oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7518 Mycophenolic acid E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7519 Inj. mycophenolate mofetil E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7520 Sirolimus, oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7521 Tacrolim granules oral susp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7525 Tacrolimus injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7527 Oral everolimus E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7528 Mycophen mofetil for susp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7599 Immunosuppressive drug noc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7601 Ensifentrine inh 3 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7604 Acetylcysteine comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7605 Arformoterol non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7606 Formoterol fumarate, inh E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7607 Levalbuterol comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7608 Acetylcysteine non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7609 Albuterol comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7610 Albuterol comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7611 Albuterol non-comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7612 Levalbuterol non-comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7613 Albuterol non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7614 Levalbuterol non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7615 Levalbuterol comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7620 Albuterol ipratrop non-comp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7622 Beclomethasone comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7624 Betamethasone comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7626 Budesonide non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7627 Budesonide comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7628 Bitolterol mesylate comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7629 Bitolterol mesylate comp unt E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7631 Cromolyn sodium noncomp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7632 Cromolyn sodium comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7633 Budesonide non-comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7634 Budesonide comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7635 Atropine comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7636 Atropine comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7637 Dexamethasone comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7638 Dexamethasone comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7639 Dornase alfa non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7640 Formoterol comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7641 Flunisolide comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7642 Glycopyrrolate comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7643 Glycopyrrolate comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7644 Ipratropium bromide non-comp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7645 Ipratropium bromide comp E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7647 Isoetharine comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7648 Isoetharine non-comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7649 Isoetharine non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7650 Isoetharine comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7657 Isoproterenol comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7658 Isoproterenol non-comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7659 Isoproterenol non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7660 Isoproterenol comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7665 Mannitol for inhaler E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7667 Metaproterenol comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7668 Metaproterenol non-comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7669 Metaproterenol non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7670 Metaproterenol comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7674 Methacholine chloride, neb E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7676 Pentamidine comp unit dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7677 Revefenacin inh non-com 1mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7680 Terbutaline sulf comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7681 Terbutaline sulf comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7682 Tobramycin non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7683 Triamcinolone comp con E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7684 Triamcinolone comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7685 Tobramycin comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7686 Treprostinil, non-comp unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7699 Inhalation solution for dme E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7799 Non-inhalation drug for dme E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J7999 Compounded drug, noc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8498 Antiemetic rectal/supp nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8499 Oral prescrip drug non chemo N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8501 Oral aprepitant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8502 Inj, aponvie, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8510 Oral busulfan E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8515 Cabergoline, oral 0.25mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8522 Capecitabine, oral, 50 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8530 Cyclophosphamide oral 25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8540 Oral dexamethasone E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8541 Oral, hemady, 0.25 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8560 Etoposide oral 50 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8565 Gefitinib oral I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8597 Antiemetic drug oral nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8600 Melphalan oral 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8610 Methotrexate oral 2.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8611 Oral methotrexate (jylamvo) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8612 Oral methotrexate (xatmep) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8655 Oral netupitant, palonosetro E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8670 Rolapitant, oral, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8700 Temozolomide E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8705 Topotecan oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J8999 Oral prescription drug chemo E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9000 Doxorubicin hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9003 Leupro inj, camcevi etm, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9011 Datopotamab deruxtecan, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9015 Aldesleukin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9017 Arsenic trioxide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9021 Inj, aspara, rylaze, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9022 Inj, atezolizumab,10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9023 Injection, avelumab, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9024 Inj atezolizumb 5mg hya-tqjs E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9025 Azacitidine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9026 Inj, tarlatamab-dlle, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9027 Clofarabine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9028 Inj, nogapendekin pmln, 1mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9029 Instill adstiladrin, tx dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9030 Bcg live intravesical 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9032 Injection, belinostat, 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9033 Inj, bendamustine hcl, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9034 Inj., bendeka 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9035 Bevacizumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9036 Inj. belrapzo/bendamustine E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9038 Inj axatilimab-csfr 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9039 Injection, blinatumomab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9040 Bleomycin sulfate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9041 Injection, bortezomib, 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9042 Brentuximab vedotin inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9043 Cabazitaxel injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9045 Carboplatin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9046 Inj, bortezomib, dr. reddy's E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9047 Injection, carfilzomib, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9048 Inj, bortezomib freseniuskab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9049 Inj, bortezomib, hospira E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9050 Carmustine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9051 Inj, bortezomib (maia) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9052 Inj, carmustine (accord) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9054 Inj bortezomib boruzu 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9055 Cetuximab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9056 Inj, vivimusta, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9057 Inj., copanlisib, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9060 Cisplatin 10 mg injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9061 Inj, amivantamab-vmjw E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9063 Inj, elahere, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9064 Inj, cabazitaxel (sandoz) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9065 Inj cladribine per 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9071 Inj cyclophosphamd auromedic E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9072 Inj cyclophos frindovyx 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9073 Inj cyclophos dr reddys 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9074 Inj, cyclophosphamd, sandoz E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9075 Inj, cyclophosphamide, nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9076 Inj, cyclophos (baxter) 5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9100 Cytarabine hcl 100 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9118 Inj. calaspargase pegol-mknl E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9119 Inj., cemiplimab-rwlc, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9120 Dactinomycin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9130 Dacarbazine 100 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9144 Daratumumab, hyaluronidase E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9145 Injection, daratumumab 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9150 Daunorubicin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9153 Inj daunorubicin, cytarabine E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9155 Degarelix injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9161 Inj denileuk difti-cxdl 1mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9171 Docetaxel injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9172 Docetaxel (docivyx), 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9173 Inj., durvalumab, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9174 Inj, docetaxel (beizray) 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9175 Elliotts b solution per ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9176 Injection, elotuzumab, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9177 Inj enfort vedo-ejfv 0.25mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9178 Inj, epirubicin hcl, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9179 Eribulin mesylate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9181 Etoposide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9183 Gemcitabine intravesical sys E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9184 Inj gemcitabin (avyxa) 200mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9185 Fludarabine phosphate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9190 Fluorouracil injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9196 Inj gemcitabine hcl (accord) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9198 Inj. infugem, 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9200 Floxuridine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9201 In gemcitabine hcl nos 200mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9202 Goserelin acetate implant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9203 Gemtuzumab ozogamicin 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9204 Inj mogamulizumab-kpkc, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9205 Inj irinotecan liposome 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9206 Irinotecan injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9207 Ixabepilone injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9208 Ifosfamide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9209 Mesna injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9210 Inj., emapalumab-lzsg, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9211 Idarubicin hcl injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9213 Interferon alfa-2a inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9214 Interferon alfa-2b inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9215 Interferon alfa-n3 inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9216 Interferon gamma 1-b inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9217 Leuprolide acetate suspnsion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9218 Leuprolide acetate injeciton E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9219 Leuprolide acetate implant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9220 Indigotindisulfonate sod 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9223 Inj. lurbinectedin, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9225 Vantas implant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9226 Supprelin la implant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9227 Inj. isatuximab-irfc 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9228 Ipilimumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9229 Inj inotuzumab ozogam 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9230 Mechlorethamine hcl inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9245 Inj melpha hydroch nos 50 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9246 Inj., evomela, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9248 Inj melphalan (hepzato) 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9249 Inj, melphalan (apotex) 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9255 Inj, methotrexate (accord) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9256 Inj, nipocalimab-aahu, 3 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9260 Inj methotrexate sodium 50mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9261 Nelarabine injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9262 Inj, omacetaxine mep, 0.01mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9263 Oxaliplatin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9264 Paclitaxel protein bound E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9266 Pegaspargase injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9267 Paclitaxel injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9268 Pentostatin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9269 Inj. tagraxofusp-erzs 10 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9271 Inj pembrolizumab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9272 Inj, dostarlimab-gxly, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9273 Inj tisotu vedotin-tftv, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9274 Inj, tebentafusp-tebn, 1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9275 Inj cosibelimab-ipdl, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9276 Inj zanidatamab-hrii, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9277 Pembrolizumab 1mg berahyalur E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9278 Inj, carboplatin (avyxa) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9280 Mitomycin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9281 Mitomycin instillation E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9282 Mitomycin intravesical inst E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9285 Inj, olaratumab, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9286 Inj glofitamab gxbm, 2.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9289 Inj nivolumab 2 mg hyaluron E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9292 Inj, pemetrexed dipotassium E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9293 Mitoxantrone hydrochl / 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9294 Inj pemetrexed, hospira 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9295 Injection, necitumumab, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9296 Inj pemetrexed (accord) 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9297 Inj pemetrexed (sandoz) 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9298 Inj nivol relatlimab 3mg/1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9299 Injection, nivolumab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9301 Obinutuzumab inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9302 Ofatumumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9303 Panitumumab injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9304 Inj. pemetrexed, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9305 Inj. pemetrexed nos 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9306 Injection, pertuzumab, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9307 Pralatrexate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9308 Injection, ramucirumab E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9309 Inj, polatuzumab vedotin 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9311 Inj rituximab, hyaluronidase E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9312 Inj., rituximab, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9313 Inj., lumoxiti, 0.01 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9314 Inj pemetrexed (teva) 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9316 Pertuzu, trastuzu, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9317 Sacituzumab govitecan-hziy E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9318 Inj romidepsin non-lyo 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9319 Inj romidepsin lyophil 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9320 Streptozocin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9321 Inj epcoritamab-bysp 0.16 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9322 Inj pemetrexed (bluepoint) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9323 Inj pemetrexed ditromethamin E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9324 Inj, pemrydi rtu, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9325 Inj talimogene laherparepvec E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9326 Telisotuzumab vedotin-tllv E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9328 Temozolomide injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9329 Inj, tislelizumab-jsgr E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9330 Temsirolimus injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9331 Inj sirolimus prot part 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9332 Inj efgartigimod 2mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9333 Inj rozanolixizum-noli 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9334 Inj efgart-alfa 2mg hya-qvfc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9341 Inj thiotepa (tepylute) 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9342 Inj thiotepa nos 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9345 Inj, retifanlimab-dlwr, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9347 Inj, tremelimumab-actl, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9348 Inj. naxitamab-gqgk, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9349 Inj., tafasitamab-cxix E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9350 Inj mosunetuzumab-axgb, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9351 Topotecan injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9352 Injection trabectedin 0.1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9353 Inj. margetuximab-cmkb, 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9354 Inj, ado-trastuzumab emt 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9355 Inj trastuzumab excl biosimi E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9356 Inj. herceptin hylecta, 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9357 Valrubicin injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9358 Inj fam-trastu deru-nxki 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9359 Inj lon tesirin-lpyl 0.075mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9360 Vinblastine sulfate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9361 Inj, efbemalenograstim alfa- E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9370 Vincristine sulfate 1 mg inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9376 Inj pozelimab-bbfg, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9380 Inj teclistamab cqyv 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9381 Inj teplizumab mzwv 5 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9382 Inj zenocutuzumab-zbco 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9390 Vinorelbine tartrate inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9393 Inj, fulvestrant (teva) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9394 Inj, fulvestrant (fresenius) E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9395 Injection, fulvestrant E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9400 Inj, ziv-aflibercept, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9600 Porfimer sodium injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9601 Inj linvoseltamab-gcpt 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- J9999 Chemotherapy drug E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00M0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- M0001 Advancing cancer care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0002 Opt care kidney hlth mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0004 Qual care neurologic cnd mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0005 Value in primary care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0010 Eom meos payment X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0075 Cellular therapy N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0076 Prolotherapy N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0100 Intragastric hypothermia N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0201 Pne flu hepb cov home admin X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0224 Pemivibart infusion X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0233 Intra inf, toci, first dose X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0234 Intra inf, toci, second dos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0235 Intrav inf, mon anti, fir do X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0236 Intrav inf, mon anti, sec do X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0237 Intrav inf, toci, first dose X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0238 Intrav inf, toci, second dos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0249 Adm tocilizu covid-19 1st X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0250 Adm tocilizu covid-19 2nd X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0300 Iv chelationtherapy N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M0301 Fabric wrapping of aneurysm N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1003 Tb scr 12 mo pri fst bio dz M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1004 Doc med rsn no srn tb M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1005 Tb scr no perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1006 Dz not ases, no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1007 >=50% total pt outpt ra enct M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1008 <50% total pt outpt ra encts M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1009 Dc eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1010 Dc eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1011 Dc eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1012 Dc eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1013 Dc eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1014 Dc epi care doc medrec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1016 Pt dx meop or sur steri M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1018 Pt dx hst cr pt sk lg cr scr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1019 Adl pt mj dep ds rs 12 phq<5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1020 Adl pt mj dep ds no rs 12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1021 Pt uc in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1027 Img head (ct or mri) obtnd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1028 Doc of pt prm hda dx and otr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1029 Doc sysm rsn img hd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1032 Adt tkng pharmthry for oud M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1034 Adt 180 dys pharmthry oud M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1035 Adt pd out mat pr 180 dys tx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1036 Adt no 180 dys pharmthry oud M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1037 Pt dx lum sp reg cacr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1038 Pt dx lum sp reg fract M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1039 Pt dx lum sp reg inf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1040 Pt dx lum idi or cong scol M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1041 Pt cr ft inf lm or pt id sl M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1043 Fs no odi 9-15mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1045 Fs oks 9-15mo >= 37 >= 71 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1046 Fs oks 9-15mo < 37 < 71 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1049 Fs wth scr no odi pre and p M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1051 Pt w/cancer scoliosis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1052 Lg pn not meas w/ vas 1yr po M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1054 Pt uc in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1055 Aspirin used M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1056 Presc antico med in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1057 Aspirin not used, no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1058 Pt prm nurs hm res in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1059 Pt no prm nurs hm res in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1060 Pt died in pp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1067 Hspc pt prv time meam per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1068 Pt not ambulatory M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1069 Pt scr ft fall rsk M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1070 Pt not scrn fut fall no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1106 Start eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1107 Docu dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1108 Oc ni pt home prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1109 Oc ni pt dc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1110 Oc not p pt selfdc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1111 Start eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1112 Docu dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1113 Oc ni pt home prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1114 Oc ni pt dc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1115 Oc ni pt selfdc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1116 Start eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1117 Docu dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1118 Oc ni pt home prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1119 Oc ni pt dc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1120 Oc ni pt selfdc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1121 Start eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1122 Docu dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1123 Oc ni pt home prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1124 Oc ni pt dc 1-2 vis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1125 Oc ni pt selfdc 1-2 vis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1126 Start eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1127 Docu dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1128 Oc ni pt home prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1129 Oc ni pt dc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1130 Oc ni pt selfdc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1131 Docu dx degen neuro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1132 Oc ni pt home prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1133 Oc ni pt dc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1134 Oc ni pt selfdc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1135 Start eoc doc med rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1141 Fs no oks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1142 Emerge cases M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1143 Ni rehab med chiro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1146 Ongoing care not ind M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1147 Care not poss med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1148 Pt self dschg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1149 No neck fs prom incap M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1150 Lvef <=40% or mod/sev l vsf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1151 Pt w/ hx trnsplt or lvad M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1152 Pt w/ hx trnsplt or lvad M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1153 Pt w/ dx osteo doe M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1159 Hospc serv dur meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1160 Pt anphx due to mengb bef 13 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1161 Pt anphx due to dtp bef 13 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1162 Pt enceph due to dtp bef 13 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1163 Pt anphx due to hpv bef 13 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1164 Pt w/ dementia any time M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1165 Pt use hspc dur meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1166 Path rpt tis spec wle/reexc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1167 Hspc dur meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1168 Pt recd flu vax 7/1-6/30 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1169 Doc med rsn no flu vax M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1170 Pt w/o flu vax 7/1-6/30 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1171 Pt recd 1 td/tdap 9yrs prior M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1172 Doc med rsn no td/tdap M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1173 Pt no rec td/tdap 9yrs prior M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1174 Pt w/ 2 hzv 10/2017 - mp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1175 Doc med rsn no hzv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1176 No 2 hzv 10/2017-meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1177 Pt recd pcv on/aft 19 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1178 Doc med rsn no pcv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1179 No pcv recd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1180 Pt imm ckpt inhib therapy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1181 Gr 2 or> dia or gr2 or> col M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1182 Not elg pre ex ibd/uc/crohn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1183 Doc imm ckpt inhib hld M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1184 Doc med rsn no cst/ist rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1185 Imm ckpt inhib not hld no rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1186 Pt w/ rx for hspc/plltv care M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1187 Pt w/ esrd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1188 Pt w/ ckd stg 5 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1189 Doc khe pef w/efgr/uacr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1190 Doc khe not pef w/efgr/uacr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1191 Hspc svc any time in meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1192 Pt w/ dx sq cell ca of esoph M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1193 Rpts w/ imp/con mmr/msi M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1194 Med rsn no imp/con mmr/msi M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1195 Rpt wo imp/con mmr/msi M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1196 Ixv nrs vrs iqa >=4 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1197 Isa reduced >=3 fr ixv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1198 Isa not red 3pts /no assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1199 Pt rec'g rrt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1200 Ace-i/arb rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1201 Med rsn no ace-i/arb rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1202 Pt rsn no ace-i/arb rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1203 No rsn ace-i/arb rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1204 Ixv nrs vrs iqa >=4 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1205 Isa reduced >=3 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1206 Isa not red 3pts/no assess M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1207 Pt scrn sdoh M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1208 Pt no scrn sdoh M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1209 >=2 same hi-rsk med w/o diag M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1210 >=2 same meds tbl4 not ord M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1211 Gsa level>9.0% M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1212 Missing gsa not perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1213 No hx spiro prs spiro>=70% M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1214 Spiro results wth obs doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1215 Med rsn for no doc spiro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1216 No spiro doc no res doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1217 Sys rsn no doc spiro M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1218 Pt copd symptoms M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1220 Dre wth interp rtnopthy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1221 Dre w/o rtnopthy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1222 Glaucoma pln of care not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1223 Glaucoma plan of care doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1224 Iop dec <20% from base M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1225 Iop dec>=20% from base M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1226 Iop not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1227 Eb therapy prescribed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1228 Pt + hcv aby +vir w/ rx 3 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1229 Pt w/ +hcv +vir ref win 1 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1230 Pt hcv rctv aby no f/u tst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1231 Pt hcv tst no reactive res M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1232 Pt hcv tst reactive result M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1233 Pt no hcv aby or result M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1234 Pt hcv rctv aby f/u neg M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1235 Doc pt hcv aby rna tst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1236 Baseline mrs > 2 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1237 Pt rsn no scrn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1238 Doc 2nd recom hzv 2-6 mo int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1239 Pt no resp heard M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1240 Pt no resp best int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1241 Pt no resp seen as person M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1242 Pt no resp imprt to me M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1243 Pt othr thn true heard M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1244 Pt othr thn true best int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1245 Pt othr thn true person M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1246 Pt othr thn true imprt to me M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1247 Pt resp true best int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1248 Pt resp true seen as person M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1249 Pt resp true imprt to me M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1250 Pt resp true heard M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1251 Pts proxy cmplt hu surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1252 Pts no cmplt hu survey M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1253 Pts hu surv no amb plltv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1254 Pts deceased prior hu surv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1255 Pts w/ othr rsn vst,+prg tst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1256 Prior history of known cvd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1257 Cvd risk assess not perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1258 Cvd risk assess perf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1259 Pt stat doc <= 1 yr dialysis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1260 Pt not doc <= 1 yr dialysis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1261 Pts on wtlist bef dialysis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1262 Pts transplt bef dialysis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1263 Pts hosp dialysis dt M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1265 Cms 2728 completed M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1266 Pts admit snf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1267 Pt no act kid transplt wtlst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1268 Pt ac stat kid trnsplt wtlst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1269 Rec'd esrd mcp lst day of mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1270 Pts no kid transplt wtlst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1271 Pts dem any time/dur mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1272 Pts kid transplt wtlst M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1273 Pts snf 1 yr dialysis M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1274 Pts snf exl mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1275 Pts hosp exl M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1276 Calc bmi out nrm param nof/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1277 Colorectal ca screen doc rev M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1278 Pre-htn or htn doc, f/u indc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1279 Pre-htn/htn, no f/u, not gvn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1280 Bilat mast/hx bi /unilat mas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1281 Bp scrn no perf at interval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1282 Pt scrn tbco id as non user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1283 Pt scrn tbco and id as user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1284 Pt 66+ snp or ltc pos > 90d M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1285 Scrn mam perf rslts not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1286 Bmi doc onl fup not cmpltd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1287 Calc bmi blw low param f/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1288 Doc rsn no hbp scrn or f/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1289 No pt tbco cess interv rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1290 Pt not eli d/t act dig htn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1291 Pt 66+ frailty and med dem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1292 Pt 66+ frail inpt adv ill M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1293 Calc bmi abv up param f/u M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1294 Bp scrn perf rec interval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1295 Pt hx tot col or colon ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1296 Calc bmi norm parameters M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1297 Bmi not doc medrsn ptref M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1298 Doc pt preg dur msrmt pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1299 Flu immunize order/admin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1300 Flu imm no admin doc rea M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1301 Pt recv tbco cess interv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1302 Scrn mam perf rslts doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1303 Hospc serv dur meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1304 No pneum vax admin 19+ M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1305 Pneum vax admin 19+ M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1306 Pt anphx due to pneum M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1307 Doc pt pal or hospice M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1308 Flu immunize no admin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1309 Pall serv during meas M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1310 Pt scr tob & cess int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1311 Aphlx to vax bef enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1312 No pt tbco scrn rng M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1313 No tob scr/cess int M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1314 Bmi not calculated M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1315 Crc no doc no rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1316 Tobacco non-user M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1317 Pts counsl cpt opt out M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1318 Pts no csp doc contact M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1319 Pts csp doc contact M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1320 Pts scrn + hrsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1321 Pts no 7wk inj,no iop,iop>25 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1322 Pts 7wk inj, scrn iop =<25 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1323 Pts 7wk inj, scrn iop >25 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1324 Pts intravitreal/pci M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1325 Doc med rsn not seen M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1326 Pts dx hypotony M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1327 Pts no eval ini xm no 8 wks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1328 Pts dx acute vitreous hem M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1329 Pts act pvd 2 wks 8 wks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1330 Doc pts rsn no f/u xm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1331 Pts eval ini xm 8 wks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1332 Pts no eval ini xm no 2 wks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1333 Acute vitreous hemorrhage M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1334 Pts act pvd 2 wks 2 wks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1335 Doc pts rsn no f/u xm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1336 Pts eval ini xm 2 wks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1337 Acute pvd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1338 Pt f/u 30-180 dys no + imprv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1339 Pts f/u 30-180 dys + improv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1340 Indx whodas 2.0 or sds M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1341 Pt no f/u 30-180 dys M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1342 Pts died perf per M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1343 Pt pam lvl 4 base or srt lin M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1344 No bsln/2nd pam score 4-12mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1345 Pt bsln pam, 2nd scr 4-12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1346 No pam inc 6 pts 4-12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1347 Pt pam incr 3 pt 4-12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1348 Pam incr 6 pt 4-12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1349 No pam inc 3 pts 4-12 mo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1350 Pt w/ suic saf pln init rev M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1351 Pt cmplt suicd saf pln 120dy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1352 Suicd c-ssrs assessment, equ M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1353 Pts no cmplt suicd saf pln M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1354 Pt no suicd saf pln 120dy M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1355 Suicd based cln eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1356 Pt died dur meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1357 Pt w/red suic idea 120 days M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1358 Pts no <suicd idea 120 dys M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1359 Indx suicd idea, no 0 scr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1360 Suicd c-ssrs assessment M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1361 Suicd based cln eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1362 Pt died dur meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1363 Pts no f/u 120 dys M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1364 Ascvd risk >=20pct M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1365 Hosp+pall care spec code 17 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1366 Focus on women's health mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1367 Qual care ent disorder mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1368 Prev trt inf d/o hiv/hep mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1369 Qualcare mental hlth/sud mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1370 Rehab support msk care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1371 Mst rec gsa<7 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1372 Mst rec gsa >=7 and<8 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1373 Mst rec gsa >=8 and <=9 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1374 Ra dx enc 90 days dur per pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1375 Ra dx enc 90 days dur per pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1376 Ra dx enc 90 days dur per pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1377 Fu colscop 10 yr doc w/ disc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1378 Med rsn no 10 yr fu colscope M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1379 10 yr fu no rec rsn not giv M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1380 2 rx in perf pd any com meds M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1381 Pt sec strk wthin 5 days M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1382 Enc dur perf pd pos 11 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1383 Acute pvd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1384 Pt died dur perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1385 Pt rsn not seen 2nd pam M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1386 Exc sx melmn or mlnm is M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1387 Pt died dur perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1388 Pt doc exm rec melmn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1390 Pt no doc exm for rec M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1391 All pt dx w/ rec mlnm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1392 Pt rsn no exm or lst to fu M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1393 Pr no dx rec mlnm M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1394 Stg i-iii br ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1395 Init chemo w/def dur ec grp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1396 Pt ther clin trial M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1397 Pt w/ recur/prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1398 Bslne and fu promis doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1399 Pt lve prac M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1400 Pt died dur perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1401 Stg i-iii br ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1402 Init chemo w/def dur ec grp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1403 Bslne and fu promis doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1404 Pt ther clin trial M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1405 Pt w/ recur/prog M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1406 Pt lve prac M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1407 Pt died dur perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1408 Gmln brca bef dx ca M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1409 Recd gmln brca1/brca2 couns M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1410 No gmln brca1/brca2 couns M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1411 1st ln ici no chemo M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1412 Met nsclc w/ egfr alk oth ab M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1413 Pos pdl1 bef init ici tx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1414 Med rsn no pdl1 bef 1st ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1415 No pos pdl1 bef ici ther M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1416 Pt rec hosp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1417 Pt up to date cov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1418 Med rsn not up to date cov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1419 Pt not up to date cov M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1420 Complete ophthalmologic mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1421 Dermatological care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1422 Gastroenterology care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1423 Opt care urologic cnd mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1424 Pulmonology care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1425 Surgical care mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1426 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1427 Doc med rsn bone scn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1428 Bilateral absence of eyes M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1429 Retinopathy in od, os, ou M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1430 Ret exm ou no retinopthy doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1431 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1432 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1433 Oral chemo wthn 30 days enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1434 Orl chemo wthn 30 d post enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1435 Oral chemo in perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1436 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1437 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1438 Lst knwn well <=210 min M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1439 Sig ocu cond imp surg out M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1440 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1441 Init dx slp apn = 1st enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1442 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1443 Telehealth enc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1444 Del < 39 weeks gest M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1445 Pp care visit by 12 weeks M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1446 Pt died bef end meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1447 Pt dx bd bef end meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1448 Pt dx pd bef end meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1449 Pt dx scz/pys bef end msr pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1450 Pt hos/pal care dur id/pf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1451 Pt dx ppd dur id/pf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1452 Pt dx dementia ever M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1453 Preop vis acu > 20/40 M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1454 New cied M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1455 Rep/rev cied M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1456 Pt had htx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1457 Dx asth dur crnt/prv perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1458 Pt died bef end meas pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1459 Pt hosp/pal care dur perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1460 Dx copd, cf, or arf M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1461 Pt dx chron hepc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1462 Pt clin ind hd image M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1463 2 f/u wthn 180 day rx atmp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1464 No record of f/u by 180 days M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1465 F/u > 180 days after rx M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1466 Pt disc/lam proc same day M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1467 Pt dx lynch syn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1468 Hep b vaccine received M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1469 Hx of hep b, or pos bld test M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1470 Hep b vac not rec'd med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1471 Ffs hep b not covered M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1472 Hep b vaccine not received M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1473 Pt func cap not allow impr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1474 Pt dx dementia M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1475 Pt dx huntington M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1476 Pt dx cog imp or ad M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1477 Dx delirium M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1478 Psychoactive sub abuse M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1479 Pt func cap not allow impr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1480 Pt func cap not allow impr M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1481 Pt in hosp/pal care who died M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1482 Pos quan hep c or qual rna M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1483 Neg quan hep c or qual rna M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1484 No rpt hcv rna perf med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1485 Neg viro resp hep c/qual rna M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1486 Pt admitted to snf dur eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1487 Pt adm to hospice dur eval M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1488 Dx dementia in msr timeframe M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1489 Pt status doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1490 Pt status not doc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1491 Rec'd esrd mcp dur perf pd M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1492 No reported fall M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1493 No fall doc med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1494 Fall rep since last visit M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1495 Fall w/ poc, no fall M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1496 No doc of fall or poc M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1497 No doc fall med rsn M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1498 Diagnostic radiology mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1499 Interventional radiology mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1500 Neuropsychology mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1501 Pathology mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1502 Podiatry mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- M1503 Vascular surgery mvp M 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00P0000’s
|HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- P2028 Cephalin floculation test X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P2029 Congo red blood test X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P2031 Hair analysis N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P2033 Blood thymol turbidity X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P2038 Blood mucoprotein X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P3000 Screen pap by tech w md supv X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P3001 Screening pap smear by phys A 0.25 0.46 0.46 0.01 0.72 0.720XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- P7001 Culture bacterial urine I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9010 Whole blood for transfusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9011 Blood split unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9012 Cryoprecipitate each unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9016 Rbc leukocytes reduced E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9017 Plasma 1 donor frz w/in 8 hr E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9019 Platelets, each unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9020 Plaelet rich plasma unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9021 Red blood cells unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9022 Washed red blood cells unit E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9023 Frozen plasma, pooled, sd X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9025 Plasma cryo redu path each X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9026 Cryo fib comp path redu each E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9027 Rbc o2 co2 reduced X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9031 Platelets leukocytes reduced X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9032 Platelets, irradiated X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9033 Platelets leukoreduced irrad X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9034 Platelets, pheresis X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9035 Platelet pheres leukoreduced X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9036 Platelet pheresis irradiated X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9037 Plate pheres leukoredu irrad X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9038 Rbc irradiated X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9039 Rbc deglycerolized X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9040 Rbc leukoreduced irradiated X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9041 Albumin (human),5%, 50ml X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9043 Plasma protein fract,5%,50ml X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9044 Cryoprecipitatereducedplasma X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9045 Albumin (human), 5%, 250 ml X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9046 Albumin (human), 25%, 20 ml X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9047 Albumin (human), 25%, 50ml X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9048 Plasmaprotein fract,5%,250ml X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9050 Granulocytes, pheresis unit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9051 Blood, l/r, cmv-neg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9052 Platelets, hla-m, l/r, unit X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9053 Plt, pher, l/r cmv-neg, irr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9054 Blood, l/r, froz/degly/wash X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9055 Plt, aph/pher, l/r, cmv-neg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9056 Blood, l/r, irradiated X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9057 Rbc, frz/deg/wsh, l/r, irrad X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9058 Rbc, l/r, cmv-neg, irrad X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9059 Plasma, frz between 8-24hour X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9060 Fr frz plasma donor retested X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9070 Pathogen reduced plasma pool X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9071 Pathogen reduced plasma sing X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9073 Platelets pheresis path redu X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9099 Blood component/product noc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9100 Pathogen test for platelets X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9603 One-way allow prorated miles X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9604 One-way allow prorated trip X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9612 Catheterize for urine spec X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- P9615 Urine specimen collect mult X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00Q0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- Q0035 Cardiokymography A 0.17 0.38 0.38NA 0.02 0.57 0.571XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q0035 26 Cardiokymography A 0.17 0.06 0.06 0.01 0.24 0.241XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q0035 TC Cardiokymography A 0.00 0.32 0.32NA 0.01 0.33 0.331XXX.00.00.00000009 33.4009 010 99 0.00 0.00 0.00
- Q0081 Infusion ther other than che E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0083 Chemo by other than infusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0084 Chemotherapy by infusion E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0085 Chemo by both infusion and o E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0091 Obtaining screen pap smear A 0.36 0.99 0.08 0.03 1.38 0.470XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q0092 Set up port xray equipment A 0.00 0.76 0.76 0.01 0.77 0.773XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q0111 Wet mounts/ w preparations X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0112 Potassium hydroxide preps X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0113 Pinworm examinations X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0114 Fern test X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0115 Post-coital mucous exam X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0138 Ferumoxytol, non-esrd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0139 Ferumoxytol, esrd use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0144 Azithromycin dihydrate, oral N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0155 Dronabinol (syndros) 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0161 Chlorpromazine hcl 5mg oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0162 Ondansetron oral E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0163 Diphenhydramine hcl 50mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0164 Prochlorperazine maleate 5mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0166 Granisetron hcl 1 mg oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0167 Dronabinol 2.5mg oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0169 Promethazine hcl 12.5mg oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0173 Trimethobenzamide hcl 250mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0175 Perphenazine 4mg oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0177 Hydroxyzine pamoate 25mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0180 Dolasetron mesylate oral X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0181 Unspecified oral anti-emetic X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0224 Inj, pemivibart, 4500 mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0235 Inj, monoclon antibody, 1 mg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0237 Inj, tocilizumab-anoh, hospi X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0238 Inj, tocilizumab-aazg, hospi X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0249 Tocilizumab for covid-19 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0477 Pwr module pt cable lvad rpl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0478 Power adapter, combo vad E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0479 Power module combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0480 Driver pneumatic vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0481 Microprcsr cu elec vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0482 Microprcsr cu combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0483 Monitor elec vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0484 Monitor elec or comb vad rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0485 Monitor cable elec vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0486 Mon cable elec/pneum vad rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0487 Leads any type vad, rep only E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0488 Pwr pack base elec vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0489 Pwr pck base combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0490 Emr pwr source elec vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0491 Emr pwr source combo vad rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0492 Emr pwr cbl elec vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0493 Emr pwr cbl combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0494 Emr hd pmp elec/combo, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0495 Charger elec/combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0496 Battery elec/combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0497 Bat clps elec/comb vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0498 Holster elec/combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0499 Belt/vest elec/combo vad rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0500 Filters elec/combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0501 Shwr cov elec/combo vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0502 Mobility cart pneum vad, rep E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0503 Battery pneum vad replacemnt E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0504 Pwr adpt pneum vad, rep veh E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0506 Lith-ion batt elec/pneum vad E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0507 Misc sup/acc ext vad E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0508 Mis sup/acc imp vad E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0509 Mis sup/ac imp vad nopay med E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0510 Dispens fee immunosupressive E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0511 Sup fee antiem,antica,immuno E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0512 Px sup fee anti-can sub pres E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0513 Disp fee inhal drugs/30 days E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0514 Disp fee inhal drugs/90 days E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0515 Sermorelin acetate injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q0521 Supply fee hiv prep fda appr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q1004 Ntiol category 4 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q1005 Ntiol category 5 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2004 Bladder calculi irrig sol E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2009 Fosphenytoin inj pe E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2026 Radiesse injection E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2028 Inj, sculptra, 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2034 Agriflu vaccine X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2035 Afluria vacc, 3 yrs & >, im X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2036 Flulaval vacc, 3 yrs & >, im X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2037 Fluvirin vacc, 3 yrs & >, im X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2038 Fluzone vacc, 3 yrs & >, im X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2039 Influenza virus vaccine, nos X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2041 Axicabtagene ciloleucel car+ E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2042 Tisagenlecleucel car-pos t E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2043 Sipuleucel-t auto cd54+ E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2049 Imported lipodox inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2050 Doxorubicin inj 10mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2052 Home ivig, services/supplies E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2053 Brexucabtagene car pos t E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2054 Lisocabtagene mara car pos t E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2055 Idecabtagene vicleucel car E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2056 Ciltacabtagene car-pos t E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2057 Afamitresgene autoleucel E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q2058 Obecbtge autol up to 400 mil E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q3001 Brachytherapy radioelements C 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q3014 Telehealth facility fee X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q3027 Inj beta interferon im 1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q3028 Inj beta interferon sq 1 mcg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q3031 Collagen skin test B 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4001 Cast sup body cast plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4002 Cast sup body cast fiberglas X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4003 Cast sup shoulder cast plstr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4004 Cast sup shoulder cast fbrgl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4005 Cast sup long arm adult plst X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4006 Cast sup long arm adult fbrg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4007 Cast sup long arm ped plster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4008 Cast sup long arm ped fbrgls X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4009 Cast sup sht arm adult plstr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4010 Cast sup sht arm adult fbrgl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4011 Cast sup sht arm ped plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4012 Cast sup sht arm ped fbrglas X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4013 Cast sup gauntlet plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4014 Cast sup gauntlet fiberglass X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4015 Cast sup gauntlet ped plster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4016 Cast sup gauntlet ped fbrgls X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4017 Cast sup lng arm splint plst X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4018 Cast sup lng arm splint fbrg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4019 Cast sup lng arm splnt ped p X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4020 Cast sup lng arm splnt ped f X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4021 Cast sup sht arm splint plst X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4022 Cast sup sht arm splint fbrg X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4023 Cast sup sht arm splnt ped p X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4024 Cast sup sht arm splnt ped f X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4025 Cast sup hip spica plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4026 Cast sup hip spica fiberglas X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4027 Cast sup hip spica ped plstr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4028 Cast sup hip spica ped fbrgl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4029 Cast sup long leg plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4030 Cast sup long leg fiberglass X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4031 Cast sup lng leg ped plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4032 Cast sup lng leg ped fbrgls X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4033 Cast sup lng leg cylinder pl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4034 Cast sup lng leg cylinder fb X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4035 Cast sup lngleg cylndr ped p X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4036 Cast sup lngleg cylndr ped f X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4037 Cast sup shrt leg plaster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4038 Cast sup shrt leg fiberglass X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4039 Cast sup shrt leg ped plster X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4040 Cast sup shrt leg ped fbrgls X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4041 Cast sup lng leg splnt plstr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4042 Cast sup lng leg splnt fbrgl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4043 Cast sup lng leg splnt ped p X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4044 Cast sup lng leg splnt ped f X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4045 Cast sup sht leg splnt plstr X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4046 Cast sup sht leg splnt fbrgl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4047 Cast sup sht leg splnt ped p X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4048 Cast sup sht leg splnt ped f X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4049 Finger splint, static X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4050 Cast supplies unlisted X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4051 Splint supplies misc X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4074 Iloprost non-comp unit dose E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4081 Epoetin alfa, 100 units esrd E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4082 Drug/bio noc part b drug cap E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4101 Apligraf A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4102 Oasis wound matrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4103 Oasis burn matrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4104 Integra bmwd A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4105 Integra drt or omnigraft A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4107 Graftjacket A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4108 Integra matrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4110 Primatrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4111 Gammagraft A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4112 Cymetra injectable E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4113 Graftjacket xpress E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4114 Integra flowable wound matri E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4115 Alloskin A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4116 Alloderm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4117 Hyalomatrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4118 Matristem micromatrix E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4121 Theraskin A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4122 Dermacell, awm, porous sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4123 Alloskin A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4124 Oasis tri-layer wound matrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4125 Arthroflex A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4126 Memoderm/derma/tranz/integup A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4127 Talymed A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4128 Flexhd/allopatchhd/sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4130 Strattice tm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4132 Grafix core, grafixpl core A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4133 Grafix stravix prime pl sqcm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4134 Hmatrix A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4135 Mediskin A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4136 Ezderm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4137 Amnioexcel biodexcel 1sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4138 Biodfence dryflex, 1cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4139 Amnio or biodmatrix, inj 1cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4140 Biodfence 1cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4141 Alloskin ac, 1 cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4142 Xcm biologic tiss matrix 1cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4143 Repriza, 1cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4145 Epifix, inj, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4146 Tensix, 1cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4147 Architect ecm px fx 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4148 Neox neox rt or clarix cord A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4149 Excellagen, 0.1 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4150 Allowrap ds or dry 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4151 Amnioband, guardian 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4152 Dermapure 1 square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4153 Dermavest, plurivest sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4154 Biovance 1 square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4155 Neoxflo or clarixflo 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4156 Neox 100 or clarix 100 A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4157 Revitalon 1 square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4158 Kerecis omega3, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4159 Affinity1 square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4160 Nushield 1 square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4161 Bio-connekt per square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4162 Wndex flw, bioskn flw, 0.5cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4163 Woundex, bioskin, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4164 Helicoll, per square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4165 Keramatrix, kerasorb sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4166 Cytal, per square centimeter A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4167 Truskin, per sq centimeter A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4168 Amnioband, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4169 Artacent wound, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4170 Cygnus, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4171 Interfyl, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4173 Palingen or palingen xplus A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4174 Palingen or promatrx E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4175 Miroderm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4176 Neopatch or therion, 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4177 Floweramnioflo, 0.1 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4178 Floweramniopatch, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4179 Flowerderm, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4180 Revita, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4181 Amnio wound, per square cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4182 Transcyte, per sq centimeter A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4183 Surgigraft, 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4184 Cellesta or duo per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4185 Cellesta flowab amnion 0.5cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4186 Epifix 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4187 Epicord 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4188 Amnioarmor 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4189 Artacent ac, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4190 Artacent ac 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4191 Restorigin 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4192 Restorigin, 1 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4193 Coll-e-derm 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4194 Novachor 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4195 Puraply 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4196 Puraply am 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4197 Puraply xt 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4198 Genesis amnio membrane 1sqcm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4199 Cygnus matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4200 Skin te 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4201 Matrion 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4202 Keroxx (2.5g/cc), 1cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4203 Derma-gide, 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4204 Xwrap 1 sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4205 Membrane graft or wrap sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4206 Fluid flow or fluid gf 1 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4208 Novafix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4209 Surgraft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4211 Amnion bio or axobio sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4212 Allogen, per cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4213 Ascent, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4214 Cellesta cord per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4215 Axolotl ambient, cryo 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4216 Artacent cord per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4217 Woundfix biowound plus xplus A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4218 Surgicord per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4219 Surgigraft dual per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4220 Bellacell hd, surederm sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4221 Amniowrap2 per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4222 Progenamatrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4224 Hhf10-p per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4225 Amnio or derma tl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4226 Myown harv prep proc sq cm E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4227 Amniocore per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4229 Cogenex amnio memb per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4230 Cogenex flow amnion 0.5 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4232 Corplex, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4233 Surfactor /nudyn per 0.5 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4234 Xcellerate, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4235 Amniorepair or altiply sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4236 Carepatch per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4237 Cryo-cord, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4238 Derm-maxx, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4239 Amnio-maxx or lite per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4240 Corecyte topical only 0.5 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4241 Polycyte, topical only 0.5cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4242 Amniocyte plus, per 0.5 cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4245 Amniotext, per cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4246 Coretext or protext, per cc E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4247 Amniotext patch, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4248 Dermacyte amn mem allo sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4249 Amniply, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4250 Amnioamp-mp per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4251 Vim, per square centimeter A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4252 Vendaje, per square centimet A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4253 Zenith amniotic membrane psc A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4254 Novafix dl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4255 Reguard, topical use per sq A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4256 Mlg complet, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4257 Relese, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4258 Enverse, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4259 Celera per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4260 Signature apatch, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4261 Tag, per square centimeter A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4262 Dual layer impax, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4263 Surgraft tl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4264 Cocoon membrane, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4265 Neostim tl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4266 Neostim per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4267 Neostim dl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4268 Surgraft ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4269 Surgraft xt per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4270 Complete sl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4271 Complete ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4272 Esano a, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4273 Esano aaa, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4274 Esano ac, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4275 Esano aca, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4276 Orion, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4278 Epieffect, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4279 Vendaje ac, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4280 Xcell amnio matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4281 Barrera slor dl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4282 Cygnus dual per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4283 Biovance tri or 3l, sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4284 Dermabind sl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4285 Nudyn dl or dl mesh pr sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4286 Nudyn sl or slw, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4287 Dermabind dl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4288 Dermabind ch, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4289 Revoshield+ amnio, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4290 Membrane wrap hydr per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4291 Lamellas xt, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4292 Lamellas, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4293 Acesso dl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4294 Amnio quad-core, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4295 Amnio tri-core, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4296 Rebound matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4297 Emerge matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4298 Amniocore pro, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4299 Amniocore pro+, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4300 Acesso tl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4301 Activate matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4302 Complete aca, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4303 Complete aa, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4304 Grafix plus, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4305 Amer am ac tri-lay per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4306 Americ amnion ac per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4307 American amnion, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4308 Sanopellis, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4309 Via matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4310 Procenta, per 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4311 Acesso, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4312 Acesso ac, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4313 Dermabind fm, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4314 Reeva, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4315 Regenelink amniotic mem allo A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4316 Amchoplast, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4317 Vitograft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4318 E-graft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4319 Sanograft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4320 Pellograft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4321 Renograft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4322 Caregraft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4323 Alloply, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4324 Amniotx, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4325 Acapatch, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4326 Woundplus, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4327 Duoamnion, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4328 Most, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4329 Singlay, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4330 Total, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4331 Axolotl graft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4332 Axolotl dualgraft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4333 Ardeograft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4334 Amnioplast 1, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4335 Amnioplast 2, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4336 Artecent c, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4337 Artecent trident, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4338 Artacent velos, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4339 Artacent vericlen, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4340 Simpligraft, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4341 Simplimax, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4342 Theramend, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4343 Dermacyte ac matrx per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4344 Tri membrane wrap, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4345 Matrix hd allogrft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4346 Shelter dm matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4347 Rampart dl matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4348 Sentry sl matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4349 Mantle dl matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4350 Palisade dm matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4351 Enclose tl matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4352 Overlay sl matrix, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4353 Xceed tl matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4354 Palingen dl-palingen dl-x A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4355 Abio xpl abio xpl hy p sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4356 Abio mem abio hyd per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4357 Xwrap plus, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4358 Xwrap dual, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4359 Choriply, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4360 Amchoplast fd per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4361 Epixpress, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4362 Cygnus disk, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4363 Am bur mem hydro per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4364 Am bur xp mem xpl hy p sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4365 Amnio bur dl mem per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4366 Dl amnio bur x-mem per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4367 Amniocore sl, per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4368 Amchothick per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4369 Amnioplast 3 per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4370 Aeroguard per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4371 Neoguard per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4372 Amchoplast excl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4373 Membrane wrp lt per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4375 Duograft ac per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4376 Duograft aa per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4377 Trigraft ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4378 Renew ft matrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4379 Amniodefend ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4380 Advograft one per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4382 Advograft dual per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4383 Axolotl graft ult per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4384 Axolotl dual ult per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4385 Apollo ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4386 Acesso trifaca per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4387 Neothelium ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4388 Neothelium 4l per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4389 Neothelium 4l+ per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4390 Ascendion per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4391 Amnioplast double per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4392 Grafix duo per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4393 Surgraft ac per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4394 Surgraft aca per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4395 Acelagraft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4396 Natalin per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4397 Summit aaa per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4398 Summit ac per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4399 Summit fx per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4400 Polygon3 per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4401 Absolv3 per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4402 Xwrap 2.0 per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4403 Xwrap dual plus per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4404 Xwrap hydro plus per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4405 Xwrap fenestra plus sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4406 Xwrap fenestra per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4407 Xwrap tribus per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4408 Xwrap hydro per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4409 Amniomatrixf3x per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4410 Amchomatrixdl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4411 Amniomatrixf4x per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4412 Choriofix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4413 Cygnus solo per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4414 Simplichor per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4415 Alexiguard st-l per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4416 Alexiguard tl-t per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4417 Alexiguard dl-t per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4418 Biolab wrap flow per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4419 Biolab wrap flw lt per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4420 Nuform per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4421 Biolab wrap solo per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4422 Ac wrap per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4423 Biolab tri wrap fl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4424 Revive ft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4425 Revive tl per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4426 Dermbnd tl+, tlx per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4427 Dermbnd dln dl+ dlx sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4428 Dermbnd sln sl+ slx sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4429 Dermbnd chn, chx per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4431 Pma skin substitute, nos C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4432 510(k) skin subs, nos C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4433 361 hct/p skin subs, nos C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q4435 Renati membrane per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4436 Renati ac membrane per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4437 Revival ac per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4438 Pretect per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4439 Instagraft per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q4440 Curamatrix per sq cm A 0.00 3.81 3.81NA 0.00 3.81 3.813ZZZ.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- Q5001 Hospice or home hlth in home E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5002 Hospice/home hlth in asst lv E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5003 Hospice in lt/non-skilled nf E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5004 Hospice in snf E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5005 Hospice, inpatient hospital E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5006 Hospice in hospice facility E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5007 Hospice in ltch E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5008 Hospice in inpatient psych E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5009 Hospice/home hlth, place nos E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5010 Hospice home care in hospice E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5098 Inj ustekinumab-srlf, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5099 Inj ustekinumab-stba, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5100 Inj ustekinumab-kfce, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5101 Injection, zarxio E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5103 Injection, inflectra E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5104 Injection, renflexis E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5105 Inj retacrit esrd on dialysi E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5106 Inj retacrit non-esrd use E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5107 Inj mvasi 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5108 Injection, fulphila E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5110 Nivestym E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5111 Injection, udenyca 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5112 Inj ontruzant 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5113 Inj herzuma 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5114 Inj ogivri 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5115 Inj truxima 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5116 Inj., trazimera, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5117 Inj., kanjinti, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5118 Inj., zirabev, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5119 Inj ruxience, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5120 Inj pegfilgrastim-bmez 0.5mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5121 Inj. avsola, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5122 Inj, nyvepria E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5123 Inj. riabni, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5124 Inj. byooviz, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5125 Inj, releuko 1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5126 Inj alymsys 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5127 Inj, stimufend, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5128 Inj, cimerli, 0.1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5129 Inj, vegzelma, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5130 Inj, fylnetra, 0.5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5133 Inj, tofidence, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5134 Inj, tyruko, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5135 Inj, tyenne, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5136 Inj. denosumab-bbdz, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5137 Inj, wezlana, sub cu, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5138 Inj, wezlana, iv, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5140 Inj adalimumab-fkjp, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5141 Inj adalimumab-aaty, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5142 Inj adalimumab-ryvk, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5143 Inj adalimumab-adbm, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5144 Inj, idacio, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5145 Inj, abrilada, 1 mg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5146 Inj, hercessi, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5147 Inj, aflibercept-ayyh, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5148 Inj, nyposi 1 mcg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5149 Inj, aflibercept-abzv, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5150 Inj, aflibercept-mrbb, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5151 Inj, eculizumab-aagh, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5152 Inj, eculizumab-aeeb, 2 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5153 Inj, aflibercept-yszy, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5154 Inj, omlyclo, 5 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5155 Inj, aflibercept-jbvf, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5156 Inj, tocilizumab-anoh, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5157 Inj, denosumab-bmwo, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5158 Inj, denosumab-bnht, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5159 Inj, denosumab-dssb, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5160 Inj, jobevne, 10 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5161 Inj, den (auk/bos), bio, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q5162 Inj, den (bil/bil), bio, 1mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9001 Chaplain assessment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9002 Chaplain counsel individu I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9003 Chaplain counsel group I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9004 Va whole health partner serv I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9950 Inj sulf hexa lipid microsph E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9951 Locm >= 400 mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9953 Inj fe-based mr contrast,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9954 Oral mr contrast, 100 ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9955 Inj perflexane lip micros,ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9956 Inj octafluoropropane mic,ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9957 Inj perflutren lip micros,ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9958 Hocm <=149 mg/ml iodine, 1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9959 Hocm 150-199mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9960 Hocm 200-249mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9961 Hocm 250-299mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9962 Hocm 300-349mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9963 Hocm 350-399mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9964 Hocm>= 400mg/ml iodine, 1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9965 Locm 100-199mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9966 Locm 200-299mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9967 Locm 300-399mg/ml iodine,1ml E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9968 Visualization adjunct E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9982 Flutemetamol f18 diagnostic E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9983 Florbetaben f18 diagnostic E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9991 Buprenorph xr 100 mg or less E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9992 Buprenorphine xr over 100 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9996 Ustekinumab- ttwe sub cu inj E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9997 Ustekinumab-ttwe iv inj 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9998 Inj ustekinumab-aekn, 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- Q9999 Inj ustekinumab-aauz 1 mg E 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00r0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- R0070 Transport portable x-ray C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- R0075 Transport port x-ray multipl C 0.00 0.00 0.00 0.00 0.00 0.003XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- R0076 Transport portable ekg B 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00S0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- S0012 Butorphanol tartrate, nasal I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0014 Tacrine hydrochloride, 10 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0021 Injection, cefoperazone sod I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0023 Injection, cimetidine hydroc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0034 Injection, ofloxacin, 400 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0040 Injection, ticarcillin disod I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0078 Injection, fosphenytoin sodi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0081 Injection, piperacillin sodi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0088 Imatinib 100 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0090 Sildenafil citrate, 25 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0091 Granisetron 1mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0092 Hydromorphone 250 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0093 Morphine 500 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0104 Zidovudine, oral, 100 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0106 Bupropion hcl sr 60 tablets I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0108 Mercaptopurine 50 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0109 Methadone oral 5mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0117 Tretinoin topical 5 g I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0119 Ondansetron 4 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0122 Inj menotropins 75 iu I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0126 Inj follitropin alfa 75 iu I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0128 Inj follitropin beta 75 iu I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0132 Inj ganirelix acetat 250 mcg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0136 Clozapine, 25 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0137 Didanosine, 25 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0138 Finasteride, 5 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0139 Minoxidil, 10 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0140 Saquinavir, 200 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0142 Colistimethate inh sol mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0145 Peg interferon alfa-2a/180 I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0148 Peg interferon alfa-2b/10 I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0155 Epoprostenol dilutant I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0156 Exemestane, 25 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0157 Becaplermin gel 1%, 0.5 gm I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0160 Dextroamphetamine I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0169 Calcitrol I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0170 Anastrozole 1 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0172 Chlorambucil 2 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0174 Dolasetron 50 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0175 Flutamide 125 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0176 Hydroxyurea 500 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0177 Levamisole 50 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0178 Lomustine 10 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0179 Megestrol 20 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0182 Procarbazine, oral I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0183 Prochlorperazine 5 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0187 Tamoxifen 10 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0190 Mifepristone, oral, 200 mg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0191 Misoprostol, oral, 200 mcg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0194 Vitamin suppl 100 caps I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0197 Prenatal vitamins 30 day I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0199 Med abortion inc all ex drug I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0201 Partial hospitalization serv I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0207 Paramedicintercep nonhospals I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0208 Paramed intrcept nonvol I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0209 Wc van mileage per mi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0215 Nonemerg transp mileage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0220 Medical conference by physic I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0221 Medical conference, 60 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0250 Comp geriatr assmt team I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0255 Hospice refer visit nonmd I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0257 End of life counseling I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0260 H&p for surgery I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0265 Genetic counsel 15 mins I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0270 Home std case rate 30 days I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0271 Home hospice case 30 days I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0272 Home episodic case 30 days I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0273 Md home visit outside cap I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0274 Nurse practr visit outs cap I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0280 Medical home, initial plan I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0281 Medical home, maintenance I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0285 Cnslt before screen colonosc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0302 Completed epsdt I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0310 Hospitalist visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0311 Comp mgmt care coord adv ill I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0315 Disease management program I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0316 Follow-up/reassessment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0317 Disease mgmt per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0320 Rn telephone calls to dmp I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0340 Lifestyle mod 1st stage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0341 Lifestyle mod 2 or 3 stage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0342 Lifestyle mod 4th stage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0353 Cancer treatmentplan initial I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0354 Cancer treatment plan change I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0390 Rout foot care per visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0395 Impression casting ft I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0400 Global eswl kidney I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0500 Dispos cont lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0504 Singl prscrp lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0506 Bifoc prscp lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0508 Trifoc prscrp lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0510 Non-prscrp lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0512 Daily cont lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0514 Color cont lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0515 Scleral lens liquid bandage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0516 Safety frames I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0518 Sunglass frames I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0580 Polycarb lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0581 Nonstnd lens I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0590 Misc integral lens serv I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0592 Comp cont lens eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0595 New lenses in pts old frame I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0596 Phakic iol refractive error I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0601 Screening proctoscopy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0610 Annual gynecological examina I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0612 Annual gynecological examina I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0613 Ann breast exam I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0618 Audiometry for hearing aid I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0620 Routine ophthalmological exa I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0621 Routine ophthalmological exa I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0622 Phys exam for college I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0630 Removal of sutures I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0800 Laser in situ keratomileusis I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0810 Photorefractive keratectomy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S0812 Phototherap keratect I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1001 Deluxe item I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1002 Custom item I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1015 Iv tubing extension set I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1016 Non-pvc intravenous administ I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1030 Gluc monitor purchase I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1031 Gluc monitor rental I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1034 Art pancreas system I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1035 Art pancreas inv disp sensor I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1036 Art pancreas ext transmitter I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1037 Art pancreas ext receiver I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1040 Cranial remolding orthosis I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S1091 Stent non-coronary propel I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2053 Transplantation of small int I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2054 Transplantation of multivisc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2055 Harvesting of donor multivis I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2060 Lobar lung transplantation I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2061 Donor lobectomy (lung) I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2065 Simult panc kidn trans I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2066 Breast gap flap reconst I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2067 Breast "stacked" diep/gap I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2068 Breast diep or siea flap I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2070 Cysto laser tx ureteral calc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2079 Lap esophagomyotomy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2080 Laup I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2083 Adjustment gastric band I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2095 Transcath emboliz microspher I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2102 Islet cell tissue transplant I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2103 Adrenal tissue transplant I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2107 Adoptive immunotherapy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2112 Knee arthroscp harv I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2115 Periacetabular osteotomy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2117 Arthroereisis, subtalar I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2118 Total hip resurfacing I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2120 Low density lipoprotein(ldl) I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2140 Cord blood harvesting I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2142 Cord blood-derived stem-cell I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2150 Bmt harv/transpl 28d pkg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2152 Solid organ transpl pkg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2202 Echosclerotherapy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2205 Minimally invasive direct co I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2206 Minimally invasive direct co I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2207 Minimally invasive direct co I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2208 Minimally invasive direct co I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2209 Minimally invasive direct co I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2225 Myringotomy laser-assist I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2230 Implant semi-imp hear I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2235 Implant auditory brain imp I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2260 Induced abortion 17-24 weeks I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2265 Induced abortion 25-28 wks I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2266 Induced abortion 29-31 wks I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2267 Induced abortion 32 or more I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2300 Arthroscopy, shoulder, surgi I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2325 Hip core decompression I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2340 Chemodenervation of abductor I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2341 Chemodenerv adduct vocal I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2342 Nasal endoscop po debrid I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2348 Decompress disc rf lumbar I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2350 Diskectomy, anterior, with d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2351 Diskectomy, anterior, with d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2400 Fetal surg congen hernia I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2401 Fetal surg urin trac obstr I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2402 Fetal surg cong cyst malf I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2403 Fetal surg pulmon sequest I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2404 Fetal surg myelomeningo I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2405 Fetal surg sacrococ teratoma I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2409 Fetal surg noc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2411 Fetoscop laser ther ttts I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S2900 Robotic surgical system I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3000 Bilat dil retinal exam I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3005 Eval self-assess depression I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3600 Stat lab I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3601 Stat lab home/nf I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3620 Newborn metabolic screening I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3630 Eosinophil blood count I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3645 Hiv-1 antibody testing of or I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3650 Saliva test, hormone level; I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3652 Saliva test, hormone level; I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3655 Antisperm antibodies test I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3708 Gastrointestinal fat absorpt I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3722 Dose optimization auc - 5fu I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3800 Genetic testing als I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3840 Dna analysis ret-oncogene I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3841 Gene test retinoblastoma I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3842 Gene test hippel-lindau I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3844 Dna analysis deafness I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3845 Gene test alpha-thalassemia I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3846 Gene test beta-thalassemia I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3849 Gene test niemann-pick I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3850 Gene test sickle cell I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3852 Dna analysis apoe alzheimer I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3853 Gene test myo musclr dyst I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3854 Gene profile panel breast I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3861 Genetic test brugada I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3865 Comp genet test hyp cardiomy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3866 Spec gene test hyp cardiomy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3870 Cgh test developmental delay I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3900 Surface emg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3902 Ballistocardiogram I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S3904 Masters two step I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4005 Interim labor facility globa I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4011 Ivf package I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4013 Compl gift case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4014 Compl zift case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4015 Complete ivf nos case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4016 Frozen ivf case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4017 Ivf canc a stim case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4018 F emb trns canc case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4020 Ivf canc b4 aspir case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4021 Ivf canc aftr aspr case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4022 Asst oocyte fert case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4023 Incompl donor egg case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4024 Air polymer foam per study I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4025 Donor serv ivf case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4026 Procure donor sperm I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4027 Store prev froz embryos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4028 Microsurg epi sperm asp I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4030 Sperm procure init visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4031 Sperm procure subs visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4035 Stimulated iui case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4037 Cryo embryo transf case rate I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4040 Monit store cryo embryo 30 d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4042 Ovulation mgmt per cycle I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4981 Insert levonorgestrel ius I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4989 Contracept iud I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4990 Nicotine patch legend I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4991 Nicotine patch nonlegend I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4993 Contraceptive pills for bc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S4995 Smoking cessation gum I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5000 Prescription drug, generic I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5001 Prescription drug,brand name I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5010 5% dextrose and 0.45% saline I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5012 5% dextrose with potassium I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5013 5%dextrose/0.45%saline1000ml I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5014 D5w/0.45ns w kcl and mgs04 I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5035 Hit routine device maint I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5036 Hit device repair I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5100 Adult daycare services 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5101 Adult day care per half day I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5102 Adult day care per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5105 Centerbased day care perdiem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5108 Homecare train pt 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5109 Homecare train pt session I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5110 Family homecare training 15m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5111 Family homecare train/sessio I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5115 Nonfamily homecare train/15m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5116 Nonfamily hc train/session I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5120 Chore services per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5121 Chore services per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5125 Attendant care service /15m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5126 Attendant care service /diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5130 Homaker service nos per 15m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5131 Homemaker service nos /diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5135 Adult companioncare per 15m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5136 Adult companioncare per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5140 Adult foster care per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5141 Adult foster care per month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5145 Child fostercare th per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5146 Ther fostercare child /month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5150 Unskilled respite care /15m I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5151 Unskilled respitecare /diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5160 Emer response sys instal&tst I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5161 Emer rspns sys serv permonth I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5162 Emer rspns system purchase I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5165 Home modifications per serv I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5170 Homedelivered prepared meal I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5175 Laundry serv,ext,prof,/order I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5180 Hh respiratory thrpy in eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5181 Hh respiratory thrpy nos/day I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5185 Med reminder serv per month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5190 Wellness assessment by nonph I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5199 Personal care item nos each I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5497 Hit cath care noc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5498 Hit simple cath care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5501 Hit complex cath care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5502 Hit interim cath care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5517 Hit declotting kit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5518 Hit cath repair kit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5520 Hit picc insert kit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5521 Hit midline cath insert kit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5522 Hit picc insert no supp I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5523 Hip midline cath insert kit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5550 Insulin rapid 5 u I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5551 Insulin most rapid 5 u I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5552 Insulin intermed 5 u I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5553 Insulin long acting 5 u I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5560 Insulin reuse pen 1.5 ml I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5561 Insulin reuse pen 3 ml I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5565 Insulin cartridge 150 u I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5566 Insulin cartridge 300 u I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5570 Insulin dispos pen 1.5 ml I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S5571 Insulin dispos pen 3 ml I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8030 Tantalum ring application I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8035 Magnetic source imaging I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8037 Mrcp I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8040 Topographic brain mapping I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8042 Mri low field I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8055 Us guidance fetal reduct I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8080 Scintimammography I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8085 Fluorine-18 fluorodeoxygluco I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8092 Electron beam computed tomog I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8096 Portable peak flow meter I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8097 Asthma kit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8100 Spacer without mask I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8101 Spacer with mask I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8110 Peak expiratory flow rate (p I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8120 O2 contents gas cubic ft I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8121 O2 contents liquid lb I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8130 Interferential stim 2 chan I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8131 Interferential stim 4 chan I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8185 Flutter device I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8186 Swivel adaptor I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8189 Trach supply noc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8210 Mucus trap I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8265 Haberman feeder I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8270 Enuresis alarm I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8301 Infect control supplies nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8415 Supplies for home delivery I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8420 Custom gradient sleev/glov I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8421 Ready gradient sleev/glov I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8422 Custom grad sleeve med I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8423 Custom grad sleeve heavy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8424 Ready gradient sleeve I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8425 Custom grad glove med I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8426 Custom grad glove heavy I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8427 Ready gradient glove I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8428 Ready gradient gauntlet I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8429 Gradient pressure wrap I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8430 Padding for comprssn bdg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8431 Compression bandage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8450 Splint digit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8451 Splint wrist or ankle I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8452 Splint elbow I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8460 Camisole post-mast I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8490 100 insulin syringes I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8930 Auricular electrostimulation I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8940 Hippotherapy per session I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8948 Low-level laser trmt 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8950 Complex lymphedema therapy, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8990 Pt or manip for maint I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S8999 Resuscitation bag I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9001 Home uterine monitor with or I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9002 Intra-vag motion sens biofk I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9007 Ultrafiltration monitor I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9024 Paranasal sinus ultrasound I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9025 Omnicardiogram/cardiointegra I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9034 Eswl for gallstones I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9055 Procuren or other growth fac I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9056 Coma stimulation per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9061 Medical supplies and equipme I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9083 Urgent care center global I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9088 Services provided in urgent I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9090 Vertebral axial decompressio I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9097 Home visit wound care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9098 Home phototherapy visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9110 Telemonitoring/home per mnth I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9117 Back school visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9122 Home health aide or certifie I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9123 Nursing care in home rn I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9124 Nursing care, in the home; b I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9125 Respite care, in the home, p I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9126 Hospice care, in the home, p I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9127 Social work visit, in the ho I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9128 Speech therapy, in the home, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9129 Occupational therapy, in the I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9131 Pt in the home per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9140 Diabetic management program, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9141 Diabetic management program, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9145 Insulin pump initiation I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9150 Evaluation by ocularist I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9152 Speech therapy, re-eval I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9208 Home mgmt preterm labor I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9209 Home mgmt pprom I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9211 Home mgmt gest hypertension I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9212 Hm postpar hyper per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9213 Hm preeclamp per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9214 Hm gest dm per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9325 Hit pain mgmt per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9326 Hit cont pain per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9327 Hit int pain per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9328 Hit pain imp pump diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9329 Hit chemo per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9330 Hit cont chem diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9331 Hit intermit chemo diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9335 Ht hemodialysis diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9336 Hit cont anticoag diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9338 Hit immunotherapy diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9339 Hit periton dialysis diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9340 Hit enteral per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9341 Hit enteral grav diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9342 Hit enteral pump diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9343 Hit enteral bolus nurs I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9345 Hit anti-hemophil diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9346 Hit alpha-1-proteinas diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9347 Hit longterm infusion diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9348 Hit sympathomim diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9349 Hit tocolysis diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9351 Hit cont antiemetic diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9353 Hit cont insulin diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9355 Hit chelation diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9357 Hit enzyme replace diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9359 Hit anti-tnf per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9361 Hit diuretic infus diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9363 Hit anti-spasmotic diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9364 Hit tpn total diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9365 Hit tpn 1 liter diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9366 Hit tpn 2 liter diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9367 Hit tpn 3 liter diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9368 Hit tpn over 3l diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9370 Ht inj antiemetic diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9372 Ht inj anticoag diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9373 Hit hydra total diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9374 Hit hydra 1 liter diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9375 Hit hydra 2 liter diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9376 Hit hydra 3 liter diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9377 Hit hydra over 3l diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9379 Hit noc per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9381 Hit high risk/escort I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9401 Anticoag clinic per session I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9430 Pharmacy comp/disp serv I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9432 Med food non inborn err meta I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9433 Medical food oral 100% nutr I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9434 Mod solid food suppl I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9435 Medical foods for inborn err I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9436 Lamaze class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9437 Childbirth refresher class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9438 Cesarean birth class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9439 Vbac class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9441 Asthma education I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9442 Birthing class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9443 Lactation class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9444 Parenting class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9445 Pt education noc individ I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9446 Pt education noc group I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9447 Infant safety class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9449 Weight mgmt class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9451 Exercise class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9452 Nutrition class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9453 Smoking cessation class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9454 Stress mgmt class I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9455 Diabetic management program, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9460 Diabetic management program, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9465 Diabetic management program, I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9470 Nutritional counseling, diet I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9472 Cardiac rehabilitation progr I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9473 Pulmonary rehabilitation pro I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9474 Enterostomal therapy by a re I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9475 Ambulatory setting substance I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9476 Vestibular rehab per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9480 Intensive outpatient psychia I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9482 Family stabilization 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9484 Crisis intervention per hour I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9485 Crisis intervention mental h I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9490 Hit corticosteroid/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9494 Hit antibiotic total diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9497 Hit antibiotic q3h diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9500 Hit antibiotic q24h diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9501 Hit antibiotic q12h diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9502 Hit antibiotic q8h diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9503 Hit antibiotic q6h diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9504 Hit antibiotic q4h diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9529 Venipuncture home/snf I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9537 Ht hem horm inj diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9538 Hit blood products diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9542 Ht inj noc per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9558 Ht inj growth horm diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9559 Hit inj interferon diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9560 Ht inj hormone diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9562 Ht inj palivizumab/ab diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9563 Ht inj immuno diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9590 Ht irrigation diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9810 Ht pharm per hour I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9900 Christian sci pract visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9901 Christian sci nurse visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9960 Air ambulanc nonemerg fixed I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9961 Air ambulan nonemerg rotary I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9970 Health club membership yr I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9975 Transplant related per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9976 Lodging per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9977 Meals per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9981 Med record copy admin I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9982 Med record copy per page I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9986 Not medically necessary svc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9988 Serv part of phase i trial I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9989 Services outside us I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9990 Services provided as part of I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9991 Services provided as part of I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9992 Transportation costs to and I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9994 Lodging costs (e.g. hotel ch I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9996 Meals for clinical trial par I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- S9999 Sales tax I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00T0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- T1000 Private duty/independent nsg I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1001 Nursing assessment/evaluatn I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1002 Rn services up to 15 minutes I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1003 Lpn/lvn services up to 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1004 Nsg aide service up to 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1005 Respite care service 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1006 Family/couple counseling I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1007 Treatment plan development I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1009 Child sitting services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1010 Meals when receive services I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1012 Alcohol/substance abuse skil I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1013 Sign lang/oral interpreter I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1014 Telehealth transmit, per min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1015 Clinic service I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1016 Case management I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1017 Targeted case management I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1018 School-based iep ser bundled I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1019 Personal care ser per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1020 Personal care ser per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1021 Hh aide or cn aide per visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1022 Contracted services per day I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1023 Program intake assessment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1024 Team evaluation & management I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1025 Ped compr care pkg, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1026 Ped compr care pkg, per hour I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1027 Family training & counseling I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1028 Home environment assessment I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1029 Dwelling lead investigation I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1030 Rn home care per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1031 Lpn home care per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1032 Sv doula brth wrk per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1033 Sv doula brth wrk per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1040 Comm bh clinic svc per diem N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1041 Comm bh clinic svc per month N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1502 Medication admin visit I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1503 Med admin, not oral/inject I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1505 Elec med comp dev, noc I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T1999 Noc retail items andsupplies I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2001 N-et; patient attend/escort I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2002 N-et; per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2003 N-et; encounter/trip I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2004 N-et; commerc carrier pass I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2005 N-et; stretcher van I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2007 Non-emer transport wait time I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2010 Pasrr level i I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2011 Pasrr level ii I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2012 Habil ed waiver, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2013 Habil ed waiver per hour I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2014 Habil prevoc waiver, per d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2015 Habil prevoc waiver per hr I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2016 Habil res waiver per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2017 Habil res waiver 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2018 Habil sup empl waiver/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2019 Habil sup empl waiver 15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2020 Day habil waiver per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2021 Day habil waiver per 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2022 Case management, per month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2023 Targeted case mgmt per month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2024 Serv asmnt/care plan waiver I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2025 Waiver service, nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2026 Special childcare waiver/d I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2027 Spec childcare waiver 15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2028 Special supply, nos waiver I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2029 Special med equip, noswaiver I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2030 Assist living waiver/month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2031 Assist living waiver/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2032 Res care, nos waiver/month I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2033 Res, nos waiver per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2034 Crisis interven waiver/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2035 Utility services waiver I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2036 Camp overnite waiver/session I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2037 Camp day waiver/session I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2038 Comm trans waiver/service I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2039 Vehicle mod waiver/service I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2040 Financial mgt waiver/15min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2041 Support broker waiver/15 min I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2042 Hospice routine home care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2043 Hospice continuous home care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2044 Hospice respite care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2045 Hospice general care I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2046 Hospice long term care, r&b I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2047 Hab prevo waiver per 15 I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2048 Bh ltc res r&b, per diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2049 N-et; stretcher van, mileage I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2050 Financial mgt waiver/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2051 Support broker waiver/diem I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T2101 Breast milk proc/store/dist I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4521 Adult size brief/diaper sm N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4522 Adult size brief/diaper med N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4523 Adult size brief/diaper lg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4524 Adult size brief/diaper xl N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4525 Adult size pull-on sm N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4526 Adult size pull-on med N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4527 Adult size pull-on lg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4528 Adult size pull-on xl N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4529 Ped size brief/diaper sm/med N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4530 Ped size brief/diaper lg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4531 Ped size pull-on sm/med N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4532 Ped size pull-on lg N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4533 Youth size brief/diaper N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4534 Youth size pull-on N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4535 Disposable liner/shield/pad N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4536 Reusable pull-on any size N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4537 Reusable underpad bed size N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4538 Diaper serv reusable diaper N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4539 Reuse diaper/brief any size N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4540 Reusable underpad chair size N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4541 Large disposable underpad I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4542 Small disposable underpad I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4543 Adult disp brief/diap abv xl N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4544 Adlt disp und/pull on abv xl N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T4545 Incon disposable penile wrap N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T5001 Position seat spec orth need I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- T5999 Supply, nos I 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00V0000’s
| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |
- V2020 Vision svcs frames purchases X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2025 Eyeglasses delux frames N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2100 Lens spher single plano 4.00 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2101 Single visn sphere 4.12-7.00 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2102 Singl visn sphere 7.12-20.00 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2103 Spherocylindr 4.00d/12-2.00d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2104 Spherocylindr 4.00d/2.12-4d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2105 Spherocylinder 4.00d/4.25-6d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2106 Spherocylinder 4.00d/>6.00d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2107 Spherocylinder 4.25d/12-2d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2108 Spherocylinder 4.25d/2.12-4d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2109 Spherocylinder 4.25d/4.25-6d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2110 Spherocylinder 4.25d/over 6d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2111 Spherocylindr 7.25d/.25-2.25 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2112 Spherocylindr 7.25d/2.25-4d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2113 Spherocylindr 7.25d/4.25-6d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2114 Spherocylinder over 12.00d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2115 Lens lenticular bifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2118 Lens aniseikonic single X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2121 Lenticular lens, single X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2199 Lens single vision not oth c X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2200 Lens spher bifoc plano 4.00d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2201 Lens sphere bifocal 4.12-7.0 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2202 Lens sphere bifocal 7.12-20. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2203 Lens sphcyl bifocal 4.00d/.1 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2204 Lens sphcy bifocal 4.00d/2.1 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2205 Lens sphcy bifocal 4.00d/4.2 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2206 Lens sphcy bifocal 4.00d/ove X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2207 Lens sphcy bifocal 4.25-7d/. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2208 Lens sphcy bifocal 4.25-7/2. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2209 Lens sphcy bifocal 4.25-7/4. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2210 Lens sphcy bifocal 4.25-7/ov X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2211 Lens sphcy bifo 7.25-12/.25- X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2212 Lens sphcyl bifo 7.25-12/2.2 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2213 Lens sphcyl bifo 7.25-12/4.2 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2214 Lens sphcyl bifocal over 12. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2215 Lens lenticular bifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2218 Lens aniseikonic bifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2219 Lens bifocal seg width over X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2220 Lens bifocal add over 3.25d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2221 Lenticular lens, bifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2299 Lens bifocal speciality X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2300 Lens sphere trifocal 4.00d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2301 Lens sphere trifocal 4.12-7. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2302 Lens sphere trifocal 7.12-20 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2303 Lens sphcy trifocal 4.0/.12- X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2304 Lens sphcy trifocal 4.0/2.25 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2305 Lens sphcy trifocal 4.0/4.25 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2306 Lens sphcyl trifocal 4.00/>6 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2307 Lens sphcy trifocal 4.25-7/. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2308 Lens sphc trifocal 4.25-7/2. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2309 Lens sphc trifocal 4.25-7/4. X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2310 Lens sphc trifocal 4.25-7/>6 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2311 Lens sphc trifo 7.25-12/.25- X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2312 Lens sphc trifo 7.25-12/2.25 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2313 Lens sphc trifo 7.25-12/4.25 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2314 Lens sphcyl trifocal over 12 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2315 Lens lenticular trifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2318 Lens aniseikonic trifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2319 Lens trifocal seg width > 28 X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2320 Lens trifocal add over 3.25d X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2321 Lenticular lens, trifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2399 Lens trifocal speciality X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2410 Lens variab asphericity sing X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2430 Lens variable asphericity bi X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2499 Variable asphericity lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2500 Contact lens pmma spherical X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2501 Cntct lens pmma-toric/prism X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2502 Contact lens pmma bifocal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2503 Cntct lens pmma color vision X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2510 Cntct gas permeable sphericl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2511 Cntct toric prism ballast X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2512 Cntct lens gas permbl bifocl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2513 Contact lens extended wear X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2520 Contact lens hydrophilic P 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2521 Cntct lens hydrophilic toric X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2522 Cntct lens hydrophil bifocl X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2523 Cntct lens hydrophil extend X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2524 Cntct lens hydrophil photoch X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2525 Cl, hydrophilic, dual focus N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2526 Cntct lens blue violet N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2530 Contact lens gas impermeable X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2531 Contact lens gas permeable X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2599 Contact lens/es other type X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2600 Hand held low vision aids X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2610 Single lens spectacle mount X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2615 Telescop/othr compound lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2623 Plastic eye prosth custom X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2624 Polishing artifical eye X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2625 Enlargemnt of eye prosthesis X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2626 Reduction of eye prosthesis X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2627 Scleral cover shell X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2628 Fabrication & fitting X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2629 Prosthetic eye other type X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2630 Anter chamber intraocul lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2631 Iris support intraoclr lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2632 Post chmbr intraocular lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2700 Balance lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2702 Deluxe lens feature N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2710 Glass/plastic slab off prism X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2715 Prism lens/es X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2718 Fresnell prism press-on lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2730 Special base curve X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2744 Tint photochromatic lens/es X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2745 Tint, any color/solid/grad X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2750 Anti-reflective coating X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2755 Uv lens/es X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2756 Eye glass case X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2760 Scratch resistant coating X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2761 Mirror coating X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2762 Polarization, any lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2770 Occluder lens/es X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2780 Oversize lens/es X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2781 Progressive lens per lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2782 Lens, 1.54-1.65 p/1.60-1.79g X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2783 Lens, >= 1.66 p/>=1.80 g X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2784 Lens polycarb or equal X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2785 Corneal tissue processing X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2786 Occupational multifocal lens X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2787 Astigmatism-correct function N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2788 Presbyopia-correct function N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2790 Amniotic membrane X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2797 Vis item/svc in other code X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V2799 Misc vision item or service X 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5008 Hearing screening N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5010 Assessment for hearing aid N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5011 Hearing aid fitting/checking N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5014 Hearing aid repair/modifying N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5020 Conformity evaluation N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5030 Body-worn hearing aid air N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5040 Body-worn hearing aid bone N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5050 Hearing aid monaural in ear N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5060 Behind ear hearing aid N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5070 Glasses air conduction N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5080 Glasses bone conduction N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5090 Hearing aid dispensing fee N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5095 Implant mid ear hearing pros N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5100 Body-worn bilat hearing aid N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5110 Hearing aid dispensing fee N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5120 Body-worn binaur hearing aid N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5130 In ear binaural hearing aid N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5140 Behind ear binaur hearing ai N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5150 Glasses binaural hearing aid N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5160 Dispensing fee binaural N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5171 Hearing aid monaural ite N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5172 Hearing aid monaural itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5181 Hearing aid monaural bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5190 Hearing aid monaural glasses N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5200 Disp fee contralateral monau N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5211 Hearing aid binaural ite/ite N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5212 Hearing aid binaural ite/itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5213 Hearing aid binaural ite/bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5214 Hearing aid binaural itc/itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5215 Hearing aid binaural itc/bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5221 Hearing aid binaural bte/bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5230 Hearing aid binaural glasses N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5240 Disp fee contralateral binau N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5241 Dispensing fee, monaural N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5242 Hearing aid, monaural, cic N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5243 Hearing aid, monaural, itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5244 Hearing aid, prog, mon, cic N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5245 Hearing aid, prog, mon, itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5246 Hearing aid, prog, mon, ite N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5247 Hearing aid, prog, mon, bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5248 Hearing aid, binaural, cic N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5249 Hearing aid, binaural, itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5250 Hearing aid, prog, bin, cic N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5251 Hearing aid, prog, bin, itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5252 Hearing aid, prog, bin, ite N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5253 Hearing aid, prog, bin, bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5254 Hearing id, digit, mon, cic N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5255 Hearing aid, digit, mon, itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5256 Hearing aid, digit, mon, ite N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5257 Hearing aid, digit, mon, bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5258 Hearing aid, digit, bin, cic N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5259 Hearing aid, digit, bin, itc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5260 Hearing aid, digit, bin, ite N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5261 Hearing aid, digit, bin, bte N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5262 Hearing aid, disp, monaural N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5263 Hearing aid, disp, binaural N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5264 Ear mold/insert N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5265 Ear mold/insert, disp N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5266 Battery for hearing device N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5267 Hearing aid sup/access/dev N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5268 Ald telephone amplifier N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5269 Alerting device, any type N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5270 Ald, tv amplifier, any type N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5271 Ald, tv caption decoder N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5272 Tdd N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5273 Ald for cochlear implant N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5274 Ald unspecified N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5275 Ear impression N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5281 Ald fm/dm system, monaural N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5282 Ald fm/dm system binaural N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5283 Ald neck, loop ind receiver N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5284 Ald fm/dm ear level receiver N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5285 Ald fm/dm aud input receiver N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5286 Ald blu tooth fm/dm receiver N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5287 Ald fm/dm receiver, nos N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5288 Ald fm/dm transmitter ald N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5289 Ald fm/dm adapt/boot couplin N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5290 Ald transmitter microphone N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5298 Hearing aid noc N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5299 Hearing service R 0.00 0.00 0.00 0.00 0.00 0.000XXX.00.00.00000009 33.4009 090 99 0.00 0.00 0.00
- V5336 Repair communication device N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 090 99 0.00 0.00 0.00
- V5362 Speech screening N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 010 99 0.00 0.00 0.00
- V5363 Language screening N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 010 99 0.00 0.00 0.00
- V5364 Dysphagia screening N 0.00 0.00 0.00 0.00 0.00 0.009XXX.00.00.00999999 33.4009 010 99 0.00 0.00 0.00| HCPCS Code | Modifier | Short Description | Proc Stat. | PCTC | Not Used for Medicare | Work RVU | NA Flag for Trans Non-FAC PE RVU | Transitioned Non-FAC PE RVU | NA Flag for Fully IMP Non-FAC PE RVU | Fully Implemented Non-FAC PE RVU | NA Flag for Trans Facility PE RVU | Transitioned Facility PE RVU | NA Flag for Fully IMP FAC PE RVU | Fully Implemented Facility PE RVU | MP RVU | Non-FAC PE Used for OPPS PMT AMT | Facility PE Used for OPPS PMT AMT | Malpractice Used for OPPS PMT AMT |