HCPCS Index 2017

Ear mold,   V5264
Ecallantide,   J1290
Echocardiography injectable contrast material,   A9700
Eculizumab,   J1300
Edetate calcium disodium,   J0600
   J3520
Eggcrate dry pressure padmattress,   E0184, E0199
Elastic garments,   A4466
disarticulation, endoskeletal,   L6450
orthosis (EO),   E1800, L3700 - L3740 , L3760
Elbow orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3702
Elbow orthosis, elastic with metal joints, prefabricated, includes fitting and adjustment   L3710
Elbow orthosis, double upright with forearmarm cuffs, free motion, custom-fabricated   L3720
Elbow orthosis, double upright with forearmarm cuffs, extension flexion assist, custom-fabricated   L3730
Elbow orthosis, double upright with forearmarm cuffs, adjustable position lock with active control, custom-fabricated   L3740
protector,   E0191
Electrical work, dialysis equipment,   A4870
Electrical stimulation device used for cancer treatment ,   E0766
Electrodes, per pair,   A4555, A4556
Elevating leg rest,   K0195
Elliotts b solution,   J9175
EMG,   E0746
Eminase,   J0350
Endarterectomy, chemical,   M0300
Endoscope sheath,   A4270
Endoskeletal system, addition,   L5848, L5856 - L5857 , L5925, L5969
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type   L5856
Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, includes electronic sensor(s), any type   L5857
Enfuvirtide,   J1324
Enoxaparin sodium,   J1650
feeding supply kit (syringe) (pump) (gravity),   B4034 - B4036
Enteral feeding supply kit syringe fed, per day, includes but not limited to feedingflushing syringe, administration set tubing, dressings, tape   B4034
Enteral feeding supply kit pump fed, per day, includes but not limited to feedingflushing syringe, administration set tubing, dressings, tape   B4035
Enteral feeding supply kit gravity fed, per day, includes but not limited to feedingflushing syringe, administration set tubing, dressings, tape   B4036
formulae,   B4149 - B4156
Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit   B4149
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit   B4150
Enteral formula, nutritionally complete, calorically dense (equal to or greater than 15 kcalml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit   B4152
Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit   B4153
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins andor minerals, may include fiber, administered through an enteral feeding tube, 100 calories 1 unit   B4154
Enteral formula, nutritionally incompletemodular nutrients, includes specific nutrients, carbohydrates (eg glucose polymers), proteinsamino acids (eg glutamine, arginine), fat (eg medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories 1 unit   B4155
nutrition infusion pump (with alarm) (without),   B9000, B9002
Epinephrine,   J0171
Epirubicin HCl,   J9178
Epoetin alpha,   J0885 - J0886 , Q4081
Injection, epoetin alfa, (for non-esrd use), 1000 units   J0885
Injection, epoetin alfa, 1000 units (for esrd on dialysis)   J0886
Epoetin beta,   J0887 - J0888
Epoprostenol,   J1325
Ergonovine maleate,   J1330
Eribulin mesylate,   J9179
Ertapenem sodium,   J1335
Erythromycin lactobionate,   J1364
machines and accessories,   E1500 - E1699
Unipuncture control system for hemodialysis   E1580
Centrifuge, for dialysis   E1500
Kidney, dialysate delivery syst Kidney machine, pump recirculat- ing, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i V Poles, pressure gauge, concentrate container   E1510
Heparin infusion pump for hemodialysis   E1520
Air bubble detector for hemodialysis, each, replacement   E1530
Pressure alarm for hemodialysis, each, replacement   E1540
Bath conductivity meter for hemodialysis, each   E1550
Blood leak detector for hemodialysis, each, replacement   E1560
Adjustable chair, for esrd patients   E1570
Transducer protectorsfluid barriers, for hemodialysis, any size, per 10   E1575
Hemodialysis machine   E1590
Automatic intermittent peritioneal dialysis system   E1592
Cycler dialysis machine for peritoneal dialysis   E1594
Delivery andor installation charges for hemodialysis equipment   E1600
Reverse osmosis water purification system, for hemodialysis   E1610
Deionizer water purification system, for hemodialysis   E1615
Blood pump for hemodialysis, replacement   E1620
Water softening system, for hemodialysis   E1625
Reciprocating peritoneal dialysis system   E1630
Wearable artificial kidney, each   E1632
Peritoneal dialysis clamps, each   E1634
Compact (portable) travel hemodialyzer system   E1635
Sorbent cartridges, for hemodialysis, per 10   E1636
Hemostats, each   E1637
Scale, each   E1639
Dialysis equipment, not otherwise specified   E1699
plumbing,   A4870
supplies,   A4651 - A4929
Peritoneal dialysis catheter anchoring device, belt, each   A4653
Syringe, with or without needle, each   A4657
Sphygmomanometerblood pressure apparatus with cuff and stethoscope   A4660
Calibrated microcapillary tube, each   A4651
Blood pressure cuff only   A4663
Microcapillary tube sealant   A4652
Automatic blood pressure monitor   A4670
Disposable cycler set used with cycler dialysis machine, each   A4671
Drainage extension line, sterile, for dialysis, each   A4672
Extension line with easy lock connectors, used with dialysis   A4673
Chemicalsantiseptics solution used to cleansterilize dialysis equipment, per 8 oz   A4674
Activated carbon filter for hemodialysis, each   A4680
Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each   A4690
Bicarbonate concentrate, solution, for hemodialysis, per gallon   A4706
Bicarbonate concentrate, powder, for hemodialysis, per packet   A4707
Acetate concentrate solution, for hemodialysis, per gallon   A4708
Acid concentrate, solution, for hemodialysis, per gallon   A4709
Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon   A4714
y set tubing for peritoneal dialysis   A4719
Dialysate solution, any concentration of dextrose, fluid volume greater than 249cc, but less than or equal to 999cc, for peritoneal dialysis   A4720
Dialysate solution, any concentration of dextrose, fluid volume greater than 999cc but less than or equal to 1999cc, for peritoneal dialysis   A4721
Dialysate solution, any concentration of dextrose, fluid volume greater than 1999cc but less than or equal to 2999cc, for peritoneal dialysis   A4722
Dialysate solution, any concentration of dextrose, fluid volume greater than 2999cc but less than or equal to 3999cc, for peritoneal dialysis   A4723
Dialysate solution, any concentration of dextrose, fluid volume greater than 3999cc but less than or equal to 4999cc, for peritoneal dialysis   A4724
Dialysate solution, any concentration of dextrose, fluid volume greater than 4999cc but less than or equal to 5999cc, for peritoneal dialysis   A4725
Dialysate solution, any concentration of dextrose, fluid volume greater than 5999cc, for peritoneal dialysis   A4726
Dialysate solution, non-dextrose containing, 500 ml   A4728
Fistula cannulation set for hemodialysis, each   A4730
Topical anesthetic, for dialysis, per gram   A4736
Injectable anesthetic, for dialysis, per 10 ml   A4737
Shunt accessory, for hemodialysis, any type, each   A4740
Blood tubing, arterial or venous, for hemodialysis, each   A4750
Blood tubing, arterial and venous combined, for hemodialysis, each   A4755
Dialysate solution test kit, for peritoneal dialysis, any type, each   A4760
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet   A4765
Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml   A4766
Blood collection tube, vacuum, for dialysis, per 50   A4770
Serum clotting time tube, for dialysis, per 50   A4771
Blood glucose test strips, for dialysis, per 50   A4772
Occult blood test strips, for dialysis, per 50   A4773
Ammonia test strips, for dialysis, per 50   A4774
Protamine sulfate, for hemodialysis, per 50 mg   A4802
Disposable catheter tips for peritoneal dialysis, per 10   A4860
Plumbing andor electrical work for home hemodialysis equipment   A4870
Contracts, repair and maintenance, for hemodialysis equipment   A4890
Drain bagbottle, for dialysis, each   A4911
Miscellaneous dialysis supplies, not otherwise specified   A4913
Venous pressure clamp, for hemodialysis, each   A4918
Gloves, non-sterile, per 100   A4927
Surgical mask, per 20   A4928
Tourniquet for dialysis, each   A4929
Estrogen conjugated,   J1410
Estrone (5, Aqueous),   J1435
Ethanolamine oleate,   J1430
Etidronate disodium,   J1436
Etonogestrel implant system,   J7307
Etoposide,   J9181
Etoposide, oral,   J8560
Euflexxa,   J7323
Everolimus,   J7527
Exercise equipment,   A9300
ambulatory infusion pump,   E0781, E0784
ambulatory insulin delivery system,   A9274
power, battery components,   L7360 - L7368
Six volt battery, each   L7360
Battery charger, six volt, each   L7362
Twelve volt battery, each   L7364
Battery charger, twelve volt, each   L7366
Lithium ion battery, replacement   L7367
Lithium ion battery charger, replacement only   L7368
power, elbow,   L7160 - L7191
Electronic elbow, hosmer or equal, switch controlled   L7170
Electronic elbow, microprocessor sequential control of elbow and terminal device   L7180
Electronic elbow, microprocessor simultaneous control of elbow and terminal device   L7181
Electronic elbow, adolescent, variety village or equal, switch controlled   L7185
Electronic elbow, child, variety village or equal, switch controlled   L7186
Electronic elbow, adolescent, variety village or equal, myoelectronically controlled   L7190
Electronic elbow, child, variety village or equal, myoelectronically controlled   L7191
urinary supplies,   A4356 - A4359
External urethral clamp or compression device (not to be used for catheter clamp), each   A4356
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each   A4357
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each   A4358
Extremity beltharness,   E0945
case,   V2756
lens (contact) (spectacle),   V2100 - V2615
Hand held low vision aids and other nonspectacle mounted aids   V2600
Sphere, single vision, plano to plus or minus 400, per lens   V2100
Variable asphericity lens, single vision, full field, glass or plastic, per lens   V2410
Sphere, trifocal, plano to plus or minus 400d, per lens   V2300
Sphere, bifocal, plano to plus or minus 400d, per lens   V2200
Contact lens, pmma, spherical, per lens   V2500
Variable asphericity lens, bifocal, full field, glass or plastic, per lens   V2430
Sphere, single vision, plus or minus 412 to plus or minus 700d, per lens   V2101
Sphere, bifocal, plus or minus 412 to plus or minus 700d, per lens   V2201
Single lens spectacle mounted low vision aids   V2610
Contact lens, pmma, toric or prism ballast, per lens   V2501
Sphere, trifocal, plus or minus 412 to plus or minus 700d, per lens   V2301
Variable sphericity lens, other type   V2499
Sphere, trifocal, plus or minus 712 to plus or minus 2000, per lens   V2302
Contact lens pmma, bifocal, per lens   V2502
Sphere, single vision, plus or minus 712 to plus or minus 2000d, per lens   V2102
Sphere, bifocal, plus or minus 712 to plus or minus 2000d, per lens   V2202
Telescopic and other compound lens system, including distance vision telescopic, near vision telescopes and compound microscopic lens system   V2615
Contact lens, pmma, color vision deficiency, per lens   V2503
Spherocylinder, trifocal, plano to plus or minus 400d sphere, 12-200d cylinder, per lens   V2303
Spherocylinder, bifocal, plano to plus or minus 400d sphere, 12 to 200d cylinder, per lens   V2203
Spherocylinder, single vision, plano to plus or minus 400d sphere, 12 to 2 00d cylinder, per lens   V2103
Spherocylinder, single vision, plano to plus or minus 400d sphere, 212 to 400d cylinder, per lens   V2104
Spherocylinder, trifocal, plano to plus or minus 400d sphere, 225-400d cylinder, per lens   V2304
Spherocylinder, bifocal, plano to plus or minus 400d sphere, 212 to 400d cylinder, per lens   V2204
Contact lens, gas permeable, spherical, per lens   V2510
Spherocylinder, trifocal, plano to plus or minus 400d sphere, 425 to 600 cylinder, per lens   V2305
Contact lens, gas permeable, toric, prism ballast, per lens   V2511
Spherocylinder, single vision, plano to plus or minus 400d sphere, 425 to 600d cylinder, per lens   V2105
Spherocylinder, bifocal, plano to plus or minus 400d sphere, 425 to 600d cylinder, per lens   V2205
Spherocylinder, bifocal, plano to plus or minus 400d sphere, over 600d cylinder, per lens   V2206
Aniseikonic lens, single vision   V2118
Spherocylinder, single vision, plano to plus or minus 400d sphere, over 6 00d cylinder, per lens   V2106
Spherocylinder, trifocal, plano to plus or minus 400d sphere, over 600d cylinder, per lens   V2306
Contact lens, gas permeable, bifocal, per lens   V2512
Spherocylinder, bifocal, plus or minus 425 to plus or minus 700d sphere, 12 to 200d cylinder, per lens   V2207
Spherocylinder, single vision, plus or minus 425 to plus or minus 700 sphere, 12 to 200d cylinder, per lens   V2107
Contact lens, gas permeable, extended wear, per lens   V2513
Spherocylinder, trifocal, plus or minus 425 to plus or minus 700d sphere, 12 to 200d cylinder, per lens   V2307
Spherocylinder, bifocal, plus or minus 425 to plus or minus 700d sphere, 2 12 to 400d cylinder, per lens   V2208
Contact lens, hydrophilic, spherical, per lens   V2520
Spherocylinder, single vision, plus or minus 425d to plus or minus 700d sphere, 212 to 400d cylinder, per lens   V2108
Spherocylinder, trifocal, plus or minus 425 to plus or minus 700d sphere, 212 to 400d cylinder, per lens   V2308
Contact lens, hydrophilic, toric, or prism ballast, per lens   V2521
Spherocylinder, trifocal, plus or minus 425 to plus or minus 700d sphere, 425 to 600d cylinder, per lens   V2309
Spherocylinder, single vision, plus or minus 425 to plus or minus 700d sphere, 425 to 600d cylinder, per lens   V2109
Spherocylinder, bifocal, plus or minus 425 to plus or minus 700d sphere, 4 25 to 600d cylinder, per lens   V2209
Spherocylinder, single vision, plus or minus 425 to 700d sphere, over 6 00d cylinder, per lens   V2110
Spherocylinder, bifocal, plus or minus 425 to plus or minus 700d sphere, over 600d cylinder,per lens   V2210
Spherocylinder, trifocal, plus or minus 425 to plus or minus 700d sphere, over 600d cylinder, per lens   V2310
Contact lens, hydrophillic, bifocal, per lens   V2522
Spherocylinder, bifocal, plus or minus 725 to plus or minus 1200d sphere, 25 to 225d cylinder, per lens   V2211
Spherocylinder, single vision, plus or minus 725 to plus or minus 1200d sphere, 25 to 225d cylinder, per lens   V2111
Contact lens, hydrophilic, extended wear, per lens   V2523
Spherocylinder, trifocal, plus or minus 725 to plus or minus 1200d sphere, 25 to 225d cylinder, per lens   V2311
Spherocylinder, bifocal, plus or minus 725 to plus or minus 1200d sphere, 225 to 400d cylinder, per lens   V2212
Spherocylinder, trifocal, plus or minus 725 to plus or minus 1200d sphere, 225 to 400d cylinder, per lens   V2312
Contact lens, scleral, gas impermeable, per lens (for contact lens modification, see 92325)   V2530
Spherocylinder, single vision, plus or minus 725 to plus or minus 1200d sphere, 225d to 400d cylinder, per lens   V2112
Contact lens, scleral, gas permeable, per lens (for contact lens modification, see 92325)   V2531
Spherocylinder, trifocal, plus or minus 725 to plus or minus 1200d sphere, 425 to 600d cylinder, per lens   V2313
Spherocylinder, bifocal, plus or minus 725 to plus or minus 1200d sphere, 425 to 600d cylinder, per lens   V2213
Spherocylinder, single vision, plus or minus 725 to plus or minus 1200d sphere, 425 to 600d cylinder, per lens   V2113
Contact lens, other type   V2599
Spherocylinder, single vision, sphere over plus or minus 1200d, per lens   V2114
Spherocylinder, trifocal, sphere over plus or minus 1200d, per lens   V2314
Spherocylinder, bifocal, sphere over plus or minus 1200d, per lens   V2214
Lenticular, (myodisc), per lens, single vision   V2115
Lenticular (myodisc), per lens, bifocal   V2215
Lenticular, (myodisc), per lens, trifocal   V2315
Aniseikonic lens, trifocal   V2318
Aniseikonic, per lens, bifocal   V2218
Trifocal seg width over 28 mm   V2319
Bifocal seg width over 28mm   V2219
Lenticular lens, per lens, single   V2121
Trifocal add over 325d   V2320
Bifocal add over 325d   V2220
Not otherwise classified, single vision lens   V2199
Lenticular lens, per lens, trifocal   V2321
Lenticular lens, per lens, bifocal   V2221
Specialty bifocal (by report)   V2299
Specialty trifocal (by report)   V2399
prosthetic,   V2623, V2629
service (miscellaneous),   V2700 - V2799
Balance lens, per lens   V2700
Deluxe lens feature   V2702
Slab off prism, glass or plastic, per lens   V2710
Prism, per lens   V2715
Press-on lens, fresnell prism, per lens   V2718
Special base curve, glass or plastic, per lens   V2730
Tint, photochromatic, per lens   V2744
Addition to lens tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens   V2745
Anti-reflective coating, per lens   V2750
U-v lens, per lens   V2755
Eye glass case   V2756
Scratch resistant coating, per lens   V2760
Mirror coating, any type, solid, gradient or equal, any lens material, per lens   V2761
Polarization, any lens material, per lens   V2762
Occluder lens, per lens   V2770
Oversize lens, per lens   V2780
Progressive lens, per lens   V2781
Lens, index 154 to 165 plastic or 160 to 179 glass, excludes polycarbonate, per lens   V2782
Lens, index greater than or equal to 166 plastic or greater than or equal to 180 glass, excludes polycarbonate, per lens   V2783
Lens, polycarbonate or equal, any index, per lens   V2784
Processing, preserving and transporting corneal tissue   V2785
Specialty occupational multifocal lens, per lens   V2786
Astigmatism correcting function of intraocular lens   V2787
Presbyopia correcting function of intraocular lens   V2788
Amniotic membrane for surgical reconstruction, per procedure   V2790
Vision supply, accessory andor service component of another hcpcs vision code   V2797
Vision service, miscellaneous   V2799