HCPCS Level II · 861 active codes
A codes: Transportation, medical and surgical supplies
- A0021Ambulance service, outside state per mile, transport (medicaid only)
- A0080Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest
- A0090Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest
- A0100Non-emergency transportation; taxi
- A0110Non-emergency transportation and bus, intra or inter state carrier
- A0120Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems
- A0130Non-emergency transportation: wheelchair van
- A0140Non-emergency transportation and air travel (private or commercial) intra or inter state
- A0160Non-emergency transportation: per mile - case worker or social worker
- A0170Transportation ancillary: parking fees, tolls, other
- A0180Non-emergency transportation: ancillary: lodging-recipient
- A0190Non-emergency transportation: ancillary: meals-recipient
- A0200Non-emergency transportation: ancillary: lodging escort
- A0210Non-emergency transportation: ancillary: meals-escort
- A0225Ambulance service, neonatal transport, base rate, emergency transport, one way
- A0380Bls mileage (per mile)
- A0382Bls routine disposable supplies
- A0384Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)
- A0390Als mileage (per mile)
- A0392Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)
- A0394Als specialized service disposable supplies; iv drug therapy
- A0396Als specialized service disposable supplies; esophageal intubation
- A0398Als routine disposable supplies
- A0420Ambulance waiting time (als or bls), one half (1/2) hour increments
- A0422Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation
- A0424Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review)
- A0425Ground mileage, per statute mile
- A0426Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)
- A0427Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)
- A0428Ambulance service, basic life support, non-emergency transport, (bls)
- A0429Ambulance service, basic life support, emergency transport (bls-emergency)
- A0430Ambulance service, conventional air services, transport, one way (fixed wing)
- A0431Ambulance service, conventional air services, transport, one way (rotary wing)
- A0432Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers
- A0433Advanced life support, level 2 (als 2)
- A0434Specialty care transport (sct)
- A0435Fixed wing air mileage, per statute mile
- A0436Rotary wing air mileage, per statute mile
- A0888Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)
- A0998Ambulance response and treatment, no transport
- A0999Unlisted ambulance service
- A2001Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure)
- A2002Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2004Xcellistem, 1 mg
- A2005Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2006Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2007Restrata, per square centimeter (add-on, list separately in addition to primary procedure)
- A2008Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure)
- A2009Symphony, per square centimeter (add-on, list separately in addition to primary procedure)
- A2010Apis, per square centimeter (add-on, list separately in addition to primary procedure)
- A2011Supra sdrm, per square centimeter (add-on, list separately in addition to primary procedure)
- A2012Suprathel, per square centimeter (add-on, list separately in addition to primary procedure)
- A2013Innovamatrix fs, per square centimeter (add-on, list separately in addition to primary procedure)
- A2014Omeza collagen matrix or omeza complete matrix, per 100 mg
- A2015Phoenix wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2016Permeaderm b, per square centimeter (add-on, list separately in addition to primary procedure)
- A2017Permeaderm glove, each
- A2018Permeaderm c, per square centimeter (add-on, list separately in addition to primary procedure)
- A2019Kerecis omega3 marigen shield, per square centimeter (add-on, list separately in addition to primary procedure)
- A2020Ac5 advanced wound system (ac5)
- A2021Neomatrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2022Innovaburn or innovamatrix xl, per square centimeter (add-on, list separately in addition to primary procedure)
- A2023Innovamatrix pd, 1 mg
- A2024Resolve matrix or xenopatch, per square centimeter (add-on, list separately in addition to primary procedure)
- A2025Miro3d, per cubic centimeter (add-on, list separately in addition to primary procedure)
- A2026Restrata minimatrix, 5 mg
- A2027Matriderm, per square centimeter (add-on, list separately in addition to primary procedure)
- A2028Micromatrix flex, per mg
- A2029Mirotract wound matrix sheet, per cubic centimeter (add-on, list separately in addition to primary procedure)
- A2030Miro3d fibers, per milligram
- A2031Mirodry wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2032Myriad matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2033Myriad morcells, 4 milligrams
- A2034Foundation drs solo, per square centimeter (add-on, list separately in addition to primary procedure)
- A2035Corplex p or theracor p or allacor p, per milligram
- A2036Cohealyx collagen dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2037G4derm plus/suprello, per milliliter
- A2038Marigen pacto, per square centimeter (add-on, list separately in addition to primary procedure)
- A2039Innovamatrix fd, per square centimeter (add-on, list separately in addition to primary procedure)
- A2040Microlyte painguard (add-on, list separately in addition to primary procedure), per square centimeter
- A2041Foundation drs+ duo (add-on, list separately in addition to primary procedure), per square centimeter
- A2042Foundation drs+ solo (add-on, list separately in addition to primary procedure), per square centimeter
- A2043Biobrane (add-on, list separately in addition to primary procedure), per square centimeter
- A2044Biobrane glove, each
- A2045Novashield or novogen wound matrix (add-on, list separately in addition to primary procedure), per square centimeter
- A2046Dermisphere hdrt, per square centimeter (add-on, list separately in addition to primary procedure)
- A2047Lacertamatrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2048Puraply mz, per milligram
- A2049Theracor, per square centimeter (add-on, list separately in addition to primary procedure)
- A2050Fibrillar collagen wound dressing, per milligram
- A4100Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure)
- A4206Syringe with needle, sterile, 1 cc or less, each
- A4207Syringe with needle, sterile 2 cc, each
- A4208Syringe with needle, sterile 3 cc, each
- A4209Syringe with needle, sterile 5 cc or greater, each
- A4210Needle-free injection device, each
- A4211Supplies for self-administered injections
- A4212Non-coring needle or stylet with or without catheter
- A4213Syringe, sterile, 20 cc or greater, each
- A4215Needle, sterile, any size, each
- A4216Sterile water, saline and/or dextrose, diluent/flush, 10 ml
- A4217Sterile water/saline, 500 ml
- A4218Sterile saline or water, metered dose dispenser, 10 ml
- A4220Refill kit for implantable infusion pump
- A4221Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)
- A4222Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)
- A4223Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)
- A4224Supplies for maintenance of insulin infusion catheter, per week
- A4225Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
- A4226Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week
- A4228Supplies for maintenance of non-insulin, device-drug combination infusion catheter, per week
- A4230Infusion set for external insulin pump, non needle cannula type
- A4231Infusion set for external insulin pump, needle type
- A4232Syringe with needle for external insulin pump, sterile, 3 cc
- A4233Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each
- A4234Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each
- A4235Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each
- A4236Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each
- A4238Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
- A4239Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service
- A4244Alcohol or peroxide, per pint
- A4245Alcohol wipes, per box
- A4246Betadine or phisohex solution, per pint
- A4247Betadine or iodine swabs/wipes, per box
- A4248Chlorhexidine containing antiseptic, 1 ml
- A4250Urine test or reagent strips or tablets (100 tablets or strips)
- A4252Blood ketone test or reagent strip, each
- A4253Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
- A4255Platforms for home blood glucose monitor, 50 per box
- A4256Normal, low and high calibrator solution / chips
- A4257Replacement lens shield cartridge for use with laser skin piercing device, each
- A4258Spring-powered device for lancet, each
- A4259Lancets, per box of 100
- A4261Cervical cap for contraceptive use
- A4262Temporary, absorbable lacrimal duct implant, each
- A4263Permanent, long term, non-dissolvable lacrimal duct implant, each
- A4264Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
- A4265Paraffin, per pound
- A4266Diaphragm for contraceptive use
- A4267Contraceptive supply, condom, male, each
- A4268Contraceptive supply, condom, female, each
- A4269Contraceptive supply, spermicide (e.g., foam, gel), each
- A4270Disposable endoscope sheath, each
- A4271Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests
- A4280Adhesive skin support attachment for use with external breast prosthesis, each
- A4281Tubing for breast pump, replacement
- A4282Adapter for breast pump, replacement
- A4283Cap for breast pump bottle, replacement
- A4284Breast shield and splash protector for use with breast pump, replacement
- A4285Polycarbonate bottle for use with breast pump, replacement
- A4286Locking ring for breast pump, replacement
- A4287Disposable collection and storage bag for breast milk, any size, any type, each
- A4288Valve for breast pump, replacement
- A4290Sacral nerve stimulation test lead, each
- A4295Intermittent urinary catheter; straight tip, hydrophilic coating, each
- A4296Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each
- A4297Intermittent urinary catheter; hydrophilic coating, with insertion supplies
- A4300Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
- A4301Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
- A4305Disposable drug delivery system, flow rate of 50 ml or greater per hour
- A4306Disposable drug delivery system, flow rate of less than 50 ml per hour
- A4310Insertion tray without drainage bag and without catheter (accessories only)
- A4311Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)
- A4312Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone
- A4313Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation
- A4314Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)
- A4315Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone
- A4316Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation
- A4318Female external urinary collection cup, with or without ring attachment, per day
- A4320Irrigation tray with bulb or piston syringe, any purpose
- A4321Therapeutic agent for urinary catheter irrigation
- A4322Irrigation syringe, bulb or piston, each
- A4326Male external catheter with integral collection chamber, any type, each
- A4327Female external urinary collection device; meatal cup, each
- A4328Female external urinary collection device; pouch, each
- A4330Perianal fecal collection pouch with adhesive, each
- A4331Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each
- A4332Lubricant, individual sterile packet, each
- A4333Urinary catheter anchoring device, adhesive skin attachment, each
- A4334Urinary catheter anchoring device, leg strap, each
- A4335Incontinence supply; miscellaneous
- A4336Incontinence supply, urethral insert, any type, each
- A4337Incontinence supply, rectal insert, any type, each
- A4338Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each
- A4340Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each
- A4341Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each
- A4342Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each
- A4344Indwelling catheter, foley type, two-way, all silicone or polyurethane, each
- A4346Indwelling catheter; foley type, three way for continuous irrigation, each
- A4349Male external catheter, with or without adhesive, disposable, each
- A4351Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each
- A4352Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each
- A4353Intermittent urinary catheter, with insertion supplies
- A4354Insertion tray with drainage bag but without catheter
- A4355Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each
- A4356External urethral clamp or compression device (not to be used for catheter clamp), each
- A4357Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each
- A4358Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each
- A4360Disposable external urethral clamp or compression device, with pad and/or pouch, each
- A4361Ostomy faceplate, each
- A4362Skin barrier; solid, 4 x 4 or equivalent; each
- A4363Ostomy clamp, any type, replacement only, each
- A4364Adhesive, liquid or equal, any type, per oz
- A4366Ostomy vent, any type, each
- A4367Ostomy belt, each
- A4368Ostomy filter, any type, each
- A4369Ostomy skin barrier, liquid (spray, brush, etc.), per oz
- A4371Ostomy skin barrier, powder, per oz
- A4372Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each
- A4373Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each
- A4375Ostomy pouch, drainable, with faceplate attached, plastic, each
- A4376Ostomy pouch, drainable, with faceplate attached, rubber, each
- A4377Ostomy pouch, drainable, for use on faceplate, plastic, each
- A4378Ostomy pouch, drainable, for use on faceplate, rubber, each
- A4379Ostomy pouch, urinary, with faceplate attached, plastic, each
- A4380Ostomy pouch, urinary, with faceplate attached, rubber, each
- A4381Ostomy pouch, urinary, for use on faceplate, plastic, each
- A4382Ostomy pouch, urinary, for use on faceplate, heavy plastic, each
- A4383Ostomy pouch, urinary, for use on faceplate, rubber, each
- A4384Ostomy faceplate equivalent, silicone ring, each
- A4385Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each
- A4387Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each
- A4388Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each
- A4389Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each
- A4390Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each
- A4391Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each
- A4392Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each
- A4393Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each
- A4394Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce
- A4395Ostomy deodorant for use in ostomy pouch, solid, per tablet
- A4396Ostomy belt with peristomal hernia support
- A4397Irrigation supply; sleeve, each
- A4398Ostomy irrigation supply; bag, each
- A4399Ostomy irrigation supply; cone/catheter, with or without brush
- A4400Ostomy irrigation set
- A4402Lubricant, per ounce
- A4404Ostomy ring, each
- A4405Ostomy skin barrier, non-pectin based, paste, per ounce
- A4406Ostomy skin barrier, pectin-based, paste, per ounce
- A4407Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each
- A4408Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each
- A4409Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each
- A4410Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each
- A4411Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each
- A4412Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each
- A4413Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each
- A4414Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each
- A4415Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each
- A4416Ostomy pouch, closed, with barrier attached, with filter (1 piece), each
- A4417Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each
- A4418Ostomy pouch, closed; without barrier attached, with filter (1 piece), each
- A4419Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each
- A4420Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each
- A4421Ostomy supply; miscellaneous
- A4422Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each
- A4423Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each
- A4424Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each
- A4425Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each
- A4426Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each
- A4427Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each
- A4428Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each
- A4429Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
- A4430Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each
- A4431Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each
- A4432Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each
- A4433Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each
- A4434Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each
- A4435Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each
- A4436Irrigation supply; sleeve, reusable, per month
- A4437Irrigation supply; sleeve, disposable, per month
- A4438Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, each
- A4450Tape, non-waterproof, per 18 square inches
- A4452Tape, waterproof, per 18 square inches
- A4453Rectal catheter with or without balloon, for use with any type transanal irrigation system, each
- A4455Adhesive remover or solvent (for tape, cement or other adhesive), per ounce
- A4456Adhesive remover, wipes, any type, each
- A4457Enema tube, with or without adapter, any type, replacement only, each
- A4458Enema bag with tubing, reusable
- A4459Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any type
- A4461Surgical dressing holder, non-reusable, each
- A4463Surgical dressing holder, reusable, each
- A4465Non-elastic binder for extremity
- A4466Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each
- A4467Belt, strap, sleeve, garment, or covering, any type
- A4468Exsufflation belt, includes all supplies and accessories
- A4470Gravlee jet washer
- A4479Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any type
- A4480Vabra aspirator
- A4481Tracheostoma filter, any type, any size, each
- A4483Moisture exchanger, disposable, for use with invasive mechanical ventilation
- A4490Surgical stockings above knee length, each
- A4495Surgical stockings thigh length, each
- A4500Surgical stockings below knee length, each
- A4510Surgical stockings full length, each
- A4520Incontinence garment, any type, (e.g., brief, diaper), each
- A4540Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm
- A4541Monthly supplies for use of device coded at e0733
- A4542Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wrist
- A4543Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month
- A4544Electrode for external lower extremity nerve stimulator for restless legs syndrome
- A4545Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one month
- A4550Surgical trays
- A4553Non-disposable underpads, all sizes
- A4554Disposable underpads, all sizes
- A4555Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only
- A4556Electrodes, (e.g., apnea monitor), per pair
- A4557Lead wires, (e.g., apnea monitor), per pair
- A4558Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz
- A4559Coupling gel or paste, for use with ultrasound device, per oz
- A4560Neuromuscular electrical stimulator (nmes), disposable, replacement only
- A4561Pessary, reusable, rubber, any type
- A4562Pessary, reusable, non rubber, any type
- A4563Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each
- A4564Pessary, disposable, any type
- A4565Slings
- A4566Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment
- A4570Splint
- A4575Topical hyperbaric oxygen chamber, disposable
- A4580Cast supplies (e.g., plaster)
- A4590Special casting material (e.g., fiberglass)
- A4593Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controller
- A4594Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each
- A4595Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)
- A4596Cranial electrotherapy stimulation (ces) system supplies and accessories, per month
- A4600Sleeve for intermittent limb compression device, replacement only, each
- A4601Lithium ion battery, rechargeable, for non-prosthetic use, replacement
- A4602Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each
- A4604Tubing with integrated heating element for use with positive airway pressure device
- A4605Tracheal suction catheter, closed system, each
- A4606Oxygen probe for use with oximeter device, replacement
- A4608Transtracheal oxygen catheter, each
- A4611Battery, heavy duty; replacement for patient owned ventilator
- A4612Battery cables; replacement for patient-owned ventilator
- A4613Battery charger; replacement for patient-owned ventilator
- A4614Peak expiratory flow rate meter, hand held
- A4615Cannula, nasal
- A4616Tubing (oxygen), per foot
- A4617Mouth piece
- A4618Breathing circuits
- A4619Face tent
- A4620Variable concentration mask
- A4623Tracheostomy, inner cannula
- A4624Tracheal suction catheter, any type other than closed system, each
- A4625Tracheostomy care kit for new tracheostomy
- A4626Tracheostomy cleaning brush, each
- A4627Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler
- A4628Oral and/or oropharyngeal suction catheter, each
- A4629Tracheostomy care kit for established tracheostomy
- A4630Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient
- A4633Replacement bulb/lamp for ultraviolet light therapy system, each
- A4634Replacement bulb for therapeutic light box, tabletop model
- A4635Underarm pad, crutch, replacement, each
- A4636Replacement, handgrip, cane, crutch, or walker, each
- A4637Replacement, tip, cane, crutch, walker, each.
- A4638Replacement battery for patient-owned ear pulse generator, each
- A4639Replacement pad for infrared heating pad system, each
- A4640Replacement pad for use with medically necessary alternating pressure pad owned by patient
- A4641Radiopharmaceutical, diagnostic, not otherwise classified
- A4642Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
- A4648Tissue marker, implantable, any type, each
- A4649Surgical supply; miscellaneous
- A4650Implantable radiation dosimeter, each
- A4651Calibrated microcapillary tube, each
- A4652Microcapillary tube sealant
- A4653Peritoneal dialysis catheter anchoring device, belt, each
- A4657Syringe, with or without needle, each
- A4660Sphygmomanometer/blood pressure apparatus with cuff and stethoscope
- A4663Blood pressure cuff only
- A4670Automatic blood pressure monitor
- A4671Disposable cycler set used with cycler dialysis machine, each
- A4672Drainage extension line, sterile, for dialysis, each
- A4673Extension line with easy lock connectors, used with dialysis
- A4674Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz
- A4680Activated carbon filter for hemodialysis, each
- A4690Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each
- A4706Bicarbonate concentrate, solution, for hemodialysis, per gallon
- A4707Bicarbonate concentrate, powder, for hemodialysis, per packet
- A4708Acetate concentrate solution, for hemodialysis, per gallon
- A4709Acid concentrate, solution, for hemodialysis, per gallon
- A4714Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon
- A4719"y set" tubing for peritoneal dialysis
- A4720Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis
- A4721Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis
- A4722Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis
- A4723Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis
- A4724Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis
- A4725Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis
- A4726Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis
- A4728Dialysate solution, non-dextrose containing, 500 ml
- A4730Fistula cannulation set for hemodialysis, each
- A4736Topical anesthetic, for dialysis, per gram
- A4737Injectable anesthetic, for dialysis, per 10 ml
- A4740Shunt accessory, for hemodialysis, any type, each
- A4750Blood tubing, arterial or venous, for hemodialysis, each
- A4755Blood tubing, arterial and venous combined, for hemodialysis, each
- A4760Dialysate solution test kit, for peritoneal dialysis, any type, each
- A4765Dialysate concentrate, powder, additive for peritoneal dialysis, per packet
- A4766Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml
- A4770Blood collection tube, vacuum, for dialysis, per 50
- A4771Serum clotting time tube, for dialysis, per 50
- A4772Blood glucose test strips, for dialysis, per 50
- A4773Occult blood test strips, for dialysis, per 50
- A4774Ammonia test strips, for dialysis, per 50
- A4802Protamine sulfate, for hemodialysis, per 50 mg
- A4860Disposable catheter tips for peritoneal dialysis, per 10
- A4870Plumbing and/or electrical work for home hemodialysis equipment
- A4890Contracts, repair and maintenance, for hemodialysis equipment
- A4911Drain bag/bottle, for dialysis, each
- A4913Miscellaneous dialysis supplies, not otherwise specified
- A4918Venous pressure clamp, for hemodialysis, each
- A4927Gloves, non-sterile, per 100
- A4928Surgical mask, per 20
- A4929Tourniquet for dialysis, each
- A4930Gloves, sterile, per pair
- A4931Oral thermometer, reusable, any type, each
- A4932Rectal thermometer, reusable, any type, each
- A5051Ostomy pouch, closed; with barrier attached (1 piece), each
- A5052Ostomy pouch, closed; without barrier attached (1 piece), each
- A5053Ostomy pouch, closed; for use on faceplate, each
- A5054Ostomy pouch, closed; for use on barrier with flange (2 piece), each
- A5055Stoma cap
- A5056Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each
- A5057Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each
- A5061Ostomy pouch, drainable; with barrier attached, (1 piece), each
- A5062Ostomy pouch, drainable; without barrier attached (1 piece), each
- A5063Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each
- A5071Ostomy pouch, urinary; with barrier attached (1 piece), each
- A5072Ostomy pouch, urinary; without barrier attached (1 piece), each
- A5073Ostomy pouch, urinary; for use on barrier with flange (2 piece), each
- A5081Stoma plug or seal, any type
- A5082Continent device; catheter for continent stoma
- A5083Continent device, stoma absorptive cover for continent stoma
- A5093Ostomy accessory; convex insert
- A5102Bedside drainage bottle with or without tubing, rigid or expandable, each
- A5105Urinary suspensory with leg bag, with or without tube, each
- A5112Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each
- A5113Leg strap; latex, replacement only, per set
- A5114Leg strap; foam or fabric, replacement only, per set
- A5120Skin barrier, wipes or swabs, each
- A5121Skin barrier; solid, 6 x 6 or equivalent, each
- A5122Skin barrier; solid, 8 x 8 or equivalent, each
- A5126Adhesive or non-adhesive; disk or foam pad
- A5131Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
- A5200Percutaneous catheter/tube anchoring device, adhesive skin attachment
- A5500For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
- A5501For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
- A5503For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe
- A5504For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
- A5505For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
- A5506For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
- A5507For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
- A5508For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
- A5510For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe
- A5512For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each
- A5513For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
- A5514For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
- A6000Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card
- A6010Collagen based wound filler, dry form, sterile, per gram of collagen
- A6011Collagen based wound filler, gel/paste, per gram of collagen
- A6021Collagen dressing, sterile, size 16 sq. in. or less, each
- A6022Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each
- A6023Collagen dressing, sterile, size more than 48 sq. in., each
- A6024Collagen dressing wound filler, sterile, per 6 inches
- A6025Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each
- A6154Wound pouch, each
- A6196Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing
- A6197Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
- A6198Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing
- A6199Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches
- A6203Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
- A6204Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
- A6205Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6206Contact layer, sterile, 16 sq. in. or less, each dressing
- A6207Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
- A6208Contact layer, sterile, more than 48 sq. in., each dressing
- A6209Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6210Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6211Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6212Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
- A6213Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
- A6214Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6215Foam dressing, wound filler, sterile, per gram
- A6216Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6217Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6218Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6219Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
- A6220Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
- A6221Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6222Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6223Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6224Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6228Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6229Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6230Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6231Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing
- A6232Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing
- A6233Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing
- A6234Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6235Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6236Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6237Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
- A6238Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
- A6239Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6240Hydrocolloid dressing, wound filler, paste, sterile, per ounce
- A6241Hydrocolloid dressing, wound filler, dry form, sterile, per gram
- A6242Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6243Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6244Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6245Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
- A6246Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
- A6247Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6248Hydrogel dressing, wound filler, gel, per fluid ounce
- A6250Skin sealants, protectants, moisturizers, ointments, any type, any size
- A6251Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6252Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6253Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6254Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
- A6255Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
- A6256Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
- A6257Transparent film, sterile, 16 sq. in. or less, each dressing
- A6258Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
- A6259Transparent film, sterile, more than 48 sq. in., each dressing
- A6260Wound cleansers, any type, any size
- A6261Wound filler, gel/paste, per fluid ounce, not otherwise specified
- A6262Wound filler, dry form, per gram, not otherwise specified
- A6266Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard
- A6402Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6403Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing
- A6404Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
- A6407Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard
- A6410Eye pad, sterile, each
- A6411Eye pad, non-sterile, each
- A6412Eye patch, occlusive, each
- A6413Adhesive bandage, first-aid type, any size, each
- A6441Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard
- A6442Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard
- A6443Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard
- A6444Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard
- A6445Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard
- A6446Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard
- A6447Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard
- A6448Light compression bandage, elastic, knitted/woven, width less than three inches, per yard
- A6449Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
- A6450Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard
- A6451Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard
- A6452High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard
- A6453Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard
- A6454Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard
- A6455Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard
- A6456Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
- A6457Tubular dressing with or without elastic, any width, per linear yard
- A6460Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
- A6461Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
- A6501Compression burn garment, bodysuit (head to foot), custom fabricated
- A6502Compression burn garment, chin strap, custom fabricated
- A6503Compression burn garment, facial hood, custom fabricated
- A6504Compression burn garment, glove to wrist, custom fabricated
- A6505Compression burn garment, glove to elbow, custom fabricated
- A6506Compression burn garment, glove to axilla, custom fabricated
- A6507Compression burn garment, foot to knee length, custom fabricated
- A6508Compression burn garment, foot to thigh length, custom fabricated
- A6509Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated
- A6510Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated
- A6511Compression burn garment, lower trunk including leg openings (panty), custom fabricated
- A6512Compression burn garment, not otherwise classified
- A6513Compression burn mask, face and/or neck, plastic or equal, custom fabricated
- A6515Gradient compression wrap with adjustable straps, full leg, each, custom
- A6516Gradient compression wrap with adjustable straps, foot, each, custom
- A6517Gradient compression wrap with adjustable straps, below knee, each, custom
- A6518Gradient compression wrap with adjustable straps, arm, each, custom
- A6519Gradient compression garment, not otherwise specified, for nighttime use, each
- A6520Gradient compression garment, glove, padded, for nighttime use, each
- A6521Gradient compression garment, glove, padded, for nighttime use, custom, each
- A6522Gradient compression garment, arm, padded, for nighttime use, each
- A6523Gradient compression garment, arm, padded, for nighttime use, custom, each
- A6524Gradient compression garment, lower leg and foot, padded, for nighttime use, each
- A6525Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, each
- A6526Gradient compression garment, full leg and foot, padded, for nighttime use, each
- A6527Gradient compression garment, full leg and foot, padded, for nighttime use, custom, each
- A6528Gradient compression garment, bra, for nighttime use, each
- A6529Gradient compression garment, bra, for nighttime use, custom, each
- A6530Gradient compression stocking, below knee, 18-30 mmhg, each
- A6531Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each
- A6532Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each
- A6533Gradient compression stocking, thigh length, 18-30 mmhg, each
- A6534Gradient compression stocking, thigh length, 30-40 mmhg, each
- A6535Gradient compression stocking, thigh length, 40 mmhg or greater, each
- A6536Gradient compression stocking, full length/chap style, 18-30 mmhg, each
- A6537Gradient compression stocking, full length/chap style, 30-40 mmhg, each
- A6538Gradient compression stocking, full length/chap style, 40 mmhg or greater, each
- A6539Gradient compression stocking, waist length, 18-30 mmhg, each
- A6540Gradient compression stocking, waist length, 30-40 mmhg, each
- A6541Gradient compression stocking, waist length, 40 mmhg or greater, each
- A6544Gradient compression stocking, garter belt
- A6545Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each
- A6548Accessory to custom gradient compression garment, silicone band, any size
- A6549Gradient compression garment, not otherwise specified, for daytime use, each
- A6550Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories
- A6552Gradient compression stocking, below knee, 30-40 mmhg, each
- A6553Gradient compression stocking, below knee, 30-40 mmhg, custom, each
- A6554Gradient compression stocking, below knee, 40 mmhg or greater, each
- A6555Gradient compression stocking, below knee, 40 mmhg or greater, custom, each
- A6556Gradient compression stocking, thigh length, 18-30 mmhg, custom, each
- A6557Gradient compression stocking, thigh length, 30-40 mmhg, custom, each
- A6558Gradient compression stocking, thigh length, 40 mmhg or greater, custom, each
- A6559Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, each
- A6560Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, each
- A6561Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, each
- A6562Gradient compression stocking, waist length, 18-30 mmhg, custom, each
- A6563Gradient compression stocking, waist length, 30-40 mmhg, custom, each
- A6564Gradient compression stocking, waist length, 40 mmhg or greater, custom, each
- A6565Gradient compression gauntlet, custom, each
- A6566Gradient compression garment, neck/head, each
- A6567Gradient compression garment, neck/head, custom, each
- A6568Gradient compression garment, torso and shoulder, each
- A6569Gradient compression garment, torso/shoulder, custom, each
- A6570Gradient compression garment, genital region, each
- A6571Gradient compression garment, genital region, custom, each
- A6572Gradient compression garment, toe caps, each
- A6573Gradient compression garment, toe caps, custom, each
- A6574Gradient compression arm sleeve and glove combination, custom, each
- A6575Gradient compression arm sleeve and glove combination, each
- A6576Gradient compression arm sleeve, custom, medium weight, each
- A6577Gradient compression arm sleeve, custom, heavy weight, each
- A6578Gradient compression arm sleeve, each
- A6579Gradient compression glove, custom, medium weight, each
- A6580Gradient compression glove, custom, heavy weight, each
- A6581Gradient compression glove, each
- A6582Gradient compression gauntlet, each
- A6583Gradient compression wrap with adjustable straps, below knee, each
- A6584Gradient compression wrap with adjustable straps, not otherwise specified
- A6585Gradient compression wrap with adjustable straps, above knee, each
- A6586Gradient compression wrap with adjustable straps, full leg, each
- A6587Gradient compression wrap with adjustable straps, foot, each
- A6588Gradient compression wrap with adjustable straps, arm, each
- A6589Gradient pressure wrap with adjustable straps, bra, each
- A6590External urinary catheters; disposable, with wicking material, for use with suction pump, per month
- A6591External urinary catheter; non-disposable, for use with suction pump, per month
- A6593Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specified
- A6594Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each
- A6595Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, each
- A6596Gradient compression bandaging supply, conforming gauze, per linear yard, any width, each
- A6597Gradient compression bandage roll, elastic long stretch, linear yard, any width, each
- A6598Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each
- A6599Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each
- A6600Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, each
- A6601Gradient compression bandaging supply, high density foam pad, any size or shape, each
- A6602Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, each
- A6603Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, each
- A6604Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, each
- A6605Gradient compression bandaging supply, padded foam, per linear yard, any width, each
- A6606Gradient compression bandaging supply, padded textile, per linear yard, any width, each
- A6607Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, each
- A6608Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, each
- A6609Gradient compression bandaging supply, not otherwise specified
- A6610Gradient compression stocking, below knee, 18-30 mmhg, custom, each
- A6611Gradient compression wrap with adjustable straps, above knee, each, custom
- A6614Supplies and accessories for use with an external ocular negative pressure pump, any type, per month
- A7000Canister, disposable, used with suction pump, each
- A7001Canister, non-disposable, used with suction pump, each
- A7002Tubing, used with suction pump, each
- A7003Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
- A7004Small volume nonfiltered pneumatic nebulizer, disposable
- A7005Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable
- A7006Administration set, with small volume filtered pneumatic nebulizer
- A7007Large volume nebulizer, disposable, unfilled, used with aerosol compressor
- A7008Large volume nebulizer, disposable, prefilled, used with aerosol compressor
- A7009Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer
- A7010Corrugated tubing, disposable, used with large volume nebulizer, 100 feet
- A7011Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet
- A7012Water collection device, used with large volume nebulizer
- A7013Filter, disposable, used with aerosol compressor or ultrasonic generator
- A7014Filter, nondisposable, used with aerosol compressor or ultrasonic generator
- A7015Aerosol mask, used with dme nebulizer
- A7016Dome and mouthpiece, used with small volume ultrasonic nebulizer
- A7017Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen
- A7018Water, distilled, used with large volume nebulizer, 1000 ml
- A7020Interface for cough stimulating device, includes all components, replacement only
- A7021Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (e.g., handset, nebulizer kit, biofilter)
- A7023Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical
- A7025High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each
- A7026High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each
- A7027Combination oral/nasal mask, used with continuous positive airway pressure device, each
- A7028Oral cushion for combination oral/nasal mask, replacement only, each
- A7029Nasal pillows for combination oral/nasal mask, replacement only, pair
- A7030Full face mask used with positive airway pressure device, each
- A7031Face mask interface, replacement for full face mask, each
- A7032Cushion for use on nasal mask interface, replacement only, each
- A7033Pillow for use on nasal cannula type interface, replacement only, pair
- A7034Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap
- A7035Headgear used with positive airway pressure device
- A7036Chinstrap used with positive airway pressure device
- A7037Tubing used with positive airway pressure device
- A7038Filter, disposable, used with positive airway pressure device
- A7039Filter, non disposable, used with positive airway pressure device
- A7040One way chest drain valve
- A7041Water seal drainage container and tubing for use with implanted chest tube
- A7042Implanted pleural catheter, each
- A7043Vacuum drainage bottle and tubing for use with implanted catheter
- A7044Oral interface used with positive airway pressure device, each
- A7045Exhalation port with or without swivel used with accessories for positive airway devices, replacement only
- A7046Water chamber for humidifier, used with positive airway pressure device, replacement, each
- A7047Oral interface used with respiratory suction pump, each
- A7048Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each
- A7049Expiratory positive airway pressure intranasal resistance valve
- A7501Tracheostoma valve, including diaphragm, each
- A7502Replacement diaphragm/faceplate for tracheostoma valve, each
- A7503Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each
- A7504Filter for use in a tracheostoma heat and moisture exchange system, each
- A7505Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each
- A7506Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each
- A7507Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each
- A7508Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each
- A7509Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each
- A7520Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each
- A7521Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each
- A7522Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each
- A7523Tracheostomy shower protector, each
- A7524Tracheostoma stent/stud/button, each
- A7525Tracheostomy mask, each
- A7526Tracheostomy tube collar/holder, each
- A7527Tracheostomy/laryngectomy tube plug/stop, each
- A8000Helmet, protective, soft, prefabricated, includes all components and accessories
- A8001Helmet, protective, hard, prefabricated, includes all components and accessories
- A8002Helmet, protective, soft, custom fabricated, includes all components and accessories
- A8003Helmet, protective, hard, custom fabricated, includes all components and accessories
- A8004Soft interface for helmet, replacement only
- A8005Powered, cable driven grip assist glove, hand, finger, includes microprocessor, pressure sensors, all components and accessories, custom fitted
- A8006Powered, cable driven grip assist glove, hand, finger, includes pressure sensors, glove replacement only
- A9150Non-prescription drugs
- A9152Single vitamin/mineral/trace element, oral, per dose, not otherwise specified
- A9153Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified
- A9154Artificial saliva, 1 ml
- A9155Artificial saliva, 30 ml
- A9156Oral mucoadhesive, any type (liquid, gel, paste, etc.), per 1 ml
- A9180Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker
- A9268Programmer for transient, orally ingested capsule
- A9269Programable, transient, orally ingested capsule, for use with external programmer, per month
- A9270Non-covered item or service
- A9272Wound suction, disposable, includes dressing, all accessories and components, any type, each
- A9273Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type
- A9274External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories
- A9275Home glucose disposable monitor, includes test strips
- A9276Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply
- A9277Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
- A9278Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system
- A9279Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified
- A9280Alert or alarm device, not otherwise classified
- A9281Reaching/grabbing device, any type, any length, each
- A9282Wig, any type, each
- A9283Foot pressure off loading/supportive device, any type, each
- A9284Spirometer, non-electronic, includes all accessories
- A9285Inversion/eversion correction device
- A9286Hygienic item or device, disposable or non-disposable, any type, each
- A9291Prescription digital cognitive and/or behavioral therapy, fda cleared, per course of treatment
- A9292Prescription digital visual therapy, software-only, fda cleared, per course of treatment
- A9293Fertility cycle (contraception & conception) tracking software application, fda cleared, per month, includes accessories (e.g., thermometer)
- A9294Prescription digital cognitive and/or behavioral therapy, biofeedback, fda cleared, per course of treatment
- A9300Exercise equipment
- A9500Technetium tc-99m sestamibi, diagnostic, per study dose
- A9501Technetium tc-99m teboroxime, diagnostic, per study dose
- A9502Technetium tc-99m tetrofosmin, diagnostic, per study dose
- A9503Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
- A9504Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries
- A9505Thallium tl-201 thallous chloride, diagnostic, per millicurie
- A9506Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucible
- A9507Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
- A9508Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
- A9509Iodine i-123 sodium iodide, diagnostic, per millicurie
- A9510Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
- A9512Technetium tc-99m pertechnetate, diagnostic, per millicurie
- A9513Lutetium lu 177, dotatate, therapeutic, 1 millicurie
- A9515Choline c-11, diagnostic, per study dose up to 20 millicuries
- A9516Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
- A9517Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie
- A9520Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries
- A9521Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
- A9524Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries
- A9526Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries
- A9527Iodine i-125, sodium iodide solution, therapeutic, per millicurie
- A9528Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie
- A9529Iodine i-131 sodium iodide solution, diagnostic, per millicurie
- A9530Iodine i-131 sodium iodide solution, therapeutic, per millicurie
- A9531Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)
- A9532Iodine i-125 serum albumin, diagnostic, per 5 microcuries
- A9536Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries
- A9537Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
- A9538Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
- A9539Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries
- A9540Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries
- A9541Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
- A9542Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries
- A9543Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries
- A9544Iodine i-131 tositumomab, diagnostic, per study dose
- A9545Iodine i-131 tositumomab, therapeutic, per treatment dose
- A9546Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie
- A9547Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie
- A9548Indium in-111 pentetate, diagnostic, per 0.5 millicurie
- A9550Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie
- A9551Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries
- A9552Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries
- A9553Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries
- A9554Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries
- A9555Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries
- A9556Gallium ga-67 citrate, diagnostic, per millicurie
- A9557Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries
- A9558Xenon xe-133 gas, diagnostic, per 10 millicuries
- A9559Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie
- A9560Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries
- A9561Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries
- A9562Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries
- A9563Sodium phosphate p-32, therapeutic, per millicurie
- A9564Chromic phosphate p-32 suspension, therapeutic, per millicurie
- A9566Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries
- A9567Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries
- A9568Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
- A9569Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
- A9570Indium in-111 labeled autologous white blood cells, diagnostic, per study dose
- A9571Indium in-111 labeled autologous platelets, diagnostic, per study dose
- A9572Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
- A9573Injection, gadopiclenol, 1 ml
- A9574Injection, ferumoxytol, 1 mg
- A9575Injection, gadoterate meglumine, 0.1 ml
- A9576Injection, gadoteridol, (prohance multipack), per ml
- A9577Injection, gadobenate dimeglumine (multihance), per ml
- A9578Injection, gadobenate dimeglumine (multihance multipack), per ml
- A9579Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml
- A9580Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries
- A9581Injection, gadoxetate disodium, 1 ml
- A9582Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
- A9583Injection, gadofosveset trisodium, 1 ml
- A9584Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
- A9585Injection, gadobutrol, 0.1 ml
- A9586Florbetapir f18, diagnostic, per study dose, up to 10 millicuries
- A9587Gallium ga-68, dotatate, diagnostic, 0.1 millicurie
- A9588Fluciclovine f-18, diagnostic, 1 millicurie
- A9589Instillation, hexaminolevulinate hydrochloride, 100 mg
- A9590Iodine i-131, iobenguane, 1 millicurie
- A9591Fluoroestradiol f 18, diagnostic, 1 millicurie
- A9592Copper cu-64, dotatate, diagnostic, 1 millicurie
- A9593Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie
- A9594Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie
- A9595Piflufolastat f 18 (pylarify), diagnostic, 1 millicurie
- A9596Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie
- A9597Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
- A9598Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
- A9599Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified
- A9600Strontium sr-89 chloride, therapeutic, per millicurie
- A9601Flortaucipir f 18 injection, diagnostic, 1 millicurie
- A9602Fluorodopa f-18, diagnostic, per millicurie
- A9603Injection, pafolacianine, 0.1 mg
- A9604Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
- A9606Radium ra-223 dichloride, therapeutic, per microcurie
- A9607Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie
- A9608Flotufolastat f 18, diagnostic, 1 millicurie
- A9609Fludeoxyglucose f18 up to 15 millicuries
- A9610Xenon xe-129 hyperpolarized gas, diagnostic, per study dose
- A9611Flurpiridaz f 18, diagnostic, 1 millicurie
- A9612Injection, fluorescein, 1 mg
- A9613Piflufolastat f 18 (pylarify truvu), diagnostic, 1 millicurie
- A9615Injection, pegulicianine, 1 mg
- A9616Gallium ga-68 gozetotide (gozellix), diagnostic, 1 millicurie
- A9697Injection, carboxydextran-coated superparamagnetic iron oxide, per study dose
- A9698Non-radioactive contrast imaging material, not otherwise classified, per study
- A9699Radiopharmaceutical, therapeutic, not otherwise classified
- A9700Supply of injectable contrast material for use in echocardiography, per study
- A9800Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie
- A9900Miscellaneous dme supply, accessory, and/or service component of another hcpcs code
- A9901Dme delivery, set up, and/or dispensing service component of another hcpcs code
- A9999Miscellaneous dme supply or accessory, not otherwise specified