HCPCS Index 2017

Mitomycin,   J7315, J9280
Mitoxantrone HCl,   J9293
Magnesium sulphate,   J3475
Maintenance contract, ESRD,   A4890
Mannitol,   J2150, J7665
aerosol,   K018
oxygen,   A4620
bra,   L8000
form,   L8020
prosthesis,   L8030, L8600
sleeve,   L8010
air pressure,   E0186
alternating pressure,   E0277
dry pressure,   E0184
gel pressure,   E0196
hospital bed,   E0271, E0272
non-powered, pressure reducing,   E0373
overlay,   E0371 - E0372
Nonpowered advanced pressure reducing overlay for mattress, standard mattress length and width   E0371
Powered air overlay for mattress, standard mattress length and width   E0372
powered, pressure reducing,   E0277
water pressure,   E0187
Mecasermin,   J2170
Mechlorethamine HCl,   J9230
Medical and surgical supplies,   A4206 - A8999
Tubing, used with suction pump, each   A7002
Tracheostomylaryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each   A7520
Stoma cap   A5055
Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card   A6000
Syringe with needle, sterile, 1 cc or less, each   A4206
Helmet, protective, soft, prefabricated, includes all components and accessories   A8000
Skin barrier, wipes or swabs, each   A5120
Implantable access catheter, (e,g , venous, arterial, epidural subarachnoid, or peritoneal, etc ) external access   A4300
Tape, non-waterproof, per 18 square inches   A4450
Tissue marker, implantable, any type, each   A4648
Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient   A4630
For 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   A5500
Bedside drainage bottle with or without tubing, rigid or expandable, each   A5102
Canister, disposable, used with suction pump, each   A7000
Ostomy pouch, closed with barrier attached (1 piece), each   A5051
External urethral clamp or compression device (not to be used for catheter clamp), each   A4356
Ostomy faceplate, each   A4361
Battery, heavy duty replacement for patient owned ventilator   A4611
Radiopharmaceutical, diagnostic, not otherwise classified   A4641
Peritoneal dialysis catheter anchoring device, belt, each   A4653
Insertion tray without drainage bag and without catheter (accessories only)   A4310
Gradient compression stocking, below knee, 18-30 mmhg, each   A6530
Syringe, with or without needle, each   A4657
Syringe with needle, sterile 2cc, each   A4207
Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries   A4642
Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc )   A4311
Implantable access total catheter, portreservoir (eg venous, arterial, epidural, subarachnoid, peritoneal, etc )   A4301
Surgical supply miscellaneous   A4649
Urinary suspensory with leg bag, with or without tube, each   A5105
Helmet, protective, hard, prefabricated, includes all components and accessories   A8001
Skin barrier solid, 6 x 6 or equivalent, each   A5121
Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each   A4357
Battery cables replacement for patient-owned ventilator   A4612
Gradient compression stocking, below knee, 30-40 mmhg, each   A6531
Collagen based wound filler, dry form, sterile, per gram of collagen   A6010
Skin barrier solid, 4 x 4 or equivalent each   A4362
Tracheostomylaryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each   A7521
Tape, waterproof, per 18 square inches   A4452
Canister, non-disposable, used with suction pump, each   A7001
Replacement bulblamp for ultraviolet light therapy system, each   A4633
For 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   A5501
Ostomy pouch, closed without barrier attached (1 piece), each   A5052
Ostomy clamp, any type, replacement only, each   A4363
Implantable radiation dosimeter, each   A4650
Helmet, protective, soft, custom fabricated, includes all components and accessories   A8002
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each   A4358
Battery charger replacement for patient-owned ventilator   A4613
Tracheostomylaryngectomy tube, stainless steel or equal (sterilizable and reusable), each   A7522
Ostomy pouch, closed for use on faceplate, each   A5053
Collagen based wound filler, gelpaste, per gram of collagen   A6011
Syringe with needle, sterile 3cc, each   A4208
Disposable drug delivery system, flow rate of 50 ml or greater per hour   A4305
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe   A5503
Skin barrier solid, 8 x 8 or equivalent, each   A5122
Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone   A4312
Replacement bulb for therapeutic light box, tabletop model   A4634
Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each   A5112
Gradient compression stocking, below knee, 40-50 mmhg, each   A6532
Sphygmomanometerblood pressure apparatus with cuff and stethoscope   A4660
Adhesive remover or solvent (for tape, cement or other adhesive), per ounce   A4455
Adhesive remover, wipes, any type, each   A4456
Underarm pad, crutch, replacement, each   A4635
Adhesive, liquid or equal, any type, per oz   A4364
Disposable drug delivery system, flow rate of less than 50 ml per hour   A4306
Syringe with needle, sterile 5cc or greater, each   A4209
Collagen dressing, sterile, size 16 sq in Or less, each   A6021
Blood pressure cuff only   A4663
Adhesive or non-adhesive disk or foam pad   A5126
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable   A7003
Tracheostomy shower protector, each   A7523
Gradient compression stocking, thigh length, 18-30 mmhg, each   A6533
Calibrated microcapillary tube, each   A4651
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe   A5504
Helmet, protective, hard, custom fabricated, includes all components and accessories   A8003
Peak expiratory flow rate meter, hand held   A4614
Disposable external urethral clamp or compression device, with pad andor pouch, each   A4360
Ostomy pouch, closed for use on barrier with flange (2 piece), each   A5054
Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation   A4313
Leg strap latex, replacement only, per set   A5113
Appliance cleaner, incontinence and ostomy appliances, per 16 oz   A5131
Microcapillary tube sealant   A4652
Needle-free injection device, each   A4210
Small volume nonfiltered pneumatic nebulizer, disposable   A7004
Collagen dressing, sterile, size more than 16 sq in But less than or equal to 48 sq in, each   A6022
Gradient compression stocking, thigh length, 30-40 mmhg, each   A6534
Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc )   A4314
Cannula, nasal   A4615
Replacement, handgrip, cane, crutch, or walker, each   A4636
Enema bag with tubing, reusable   A4458
Ostomy vent, any type, each   A4366
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe   A5505
Leg strap foam or fabric, replacement only, per set   A5114
Automatic blood pressure monitor   A4670
Tracheostoma stentstudbutton, each   A7524
Soft interface for helmet, replacement only   A8004
Replacement, tip, cane, crutch, walker, each   A4637
Supplies for self-administered injections   A4211
Surgical dressing holder, non-reusable, each   A4461
Percutaneous cathetertube anchoring device, adhesive skin attachment   A5200
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe   A5506
Tubing (oxygen), per foot   A4616
Tracheostomy mask, each   A7525
Ostomy belt, each   A4367
Collagen dressing, sterile, size more than 48 sq in, each   A6023
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable   A7005
Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each   A5056
Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone   A4315
Disposable cycler set used with cycler dialysis machine, each   A4671
Gradient compression stocking, thigh length, 40-50 mmhg, each   A6535
Administration set, with small volume filtered pneumatic nebulizer   A7006
Surgical dressing holder, reusable, each   A4463
Mouth piece   A4617
Replacement battery for patient-owned ear pulse generator, each   A4638
Gradient compression stocking, full lengthchap style, 18-30 mmhg, each   A6536
Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each   A5057
Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation   A4316
Non-coring needle or stylet with or without catheter   A4212
Collagen dressing wound filler, sterile, per 6 inches   A6024
Ostomy filter, any type, each   A4368
Drainage extension line, sterile, for dialysis, each   A4672
For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe   A5507
Tracheostomy tube collarholder, each   A7526
Extension line with easy lock connectors, used with dialysis   A4673
Replacement pad for infrared heating pad system, each   A4639
Ostomy pouch, drainable with barrier attached, (1 piece), each   A5061
Irrigation tray with bulb or piston syringe, any purpose   A4320
Ostomy skin barrier, liquid (spray, brush, etc), per oz   A4369
Gradient compression stocking, full lengthchap style, 30-40 mmhg, each   A6537
Tracheostomylaryngectomy tube plugstop, each   A7527
Large volume nebulizer, disposable, unfilled, used with aerosol compressor   A7007
For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe   A5508
Gel sheet for dermal or epidermal application, (eg silicone, hydrogel, other), each   A6025
Non-elastic binder for extremity   A4465
Breathing circuits   A4618
Syringe, sterile, 20 cc or greater, each   A4213
Wound pouch, each   A6154
Ostomy skin barrier, powder, per oz   A4371
Needle, sterile, any size, each   A4215
Gradient compression stocking, full lengthchap style, 40-50 mmhg, each   A6538
Replacement pad for use with medically necessary alternating pressure pad owned by patient   A4640
For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe   A5510
Face tent   A4619
Therapeutic agent for urinary catheter irrigation   A4321
Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each   A4466
Chemicalsantiseptics solution used to cleansterilize dialysis equipment, per 8 oz   A4674
Ostomy pouch, drainable without barrier attached (1 piece), each   A5062
Large volume nebulizer, disposable, prefilled, used with aerosol compressor   A7008
Ostomy skin barrier, solid 4x4 or equivalent, standard wear, with built-in convexity, each   A4372
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq in or less, each dressing   A6196
Activated carbon filter for hemodialysis, each   A4680
Gradient compression stocking, waist length, 18-30 mmhg, each   A6539
Gravlee jet washer   A4470
Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer   A7009
Irrigation syringe, bulb or piston, each   A4322
For 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 14 inch material of shore a 35 durometer or 316 inch material of shore a 40 durometer (or higher), prefabricated, each   A5512
Sterile water, saline andor dextrose, diluentflush, 10 ml   A4216
Ostomy pouch, drainable for use on barrier with flange (2 piece system), each   A5063
Variable concentration mask   A4620
Sterile watersaline, 500 ml   A4217
Ostomy pouch, urinary with barrier attached (1 piece), each   A5071
Male external catheter with integral collection chamber, any type, each   A4326
Ostomy skin barrier, with flange (solid, flexible or accordian), with built-in convexity, any size, each   A4373
Vabra aspirator   A4480
Corrugated tubing, disposable, used with large volume nebulizer, 100 feet   A7010
Gradient compression stocking, waist length, 30-40 mmhg, each   A6540
Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each   A4690
Tracheostomy, inner cannula   A4623
For 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 316 inch material of shore a 35 durometer or higher), includes arch filler and other shaping material, custom fabricated, each   A5513
Alginate 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   A6197
Tracheal suction catheter, any type other than closed system, each   A4624
Bicarbonate concentrate, solution, for hemodialysis, per gallon   A4706
Ostomy pouch, urinary without barrier attached (1 piece), each   A5072
Ostomy pouch, drainable, with faceplate attached, plastic, each   A4375
Female external urinary collection device meatal cup, each   A4327
Gradient compression stocking, waist length, 40-50 mmhg, each   A6541
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq in, each dressing   A6198
Tracheostoma filter, any type, any size, each   A4481
Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet   A7011
Sterile saline or water, metered dose dispenser, 10 ml   A4218
Ostomy pouch, drainable, with faceplate attached, rubber, each   A4376
Gradient compression stocking, garter belt   A6544
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   A6199
Moisture exchanger, disposable, for use with invasive mechanical ventilation   A4483
Bicarbonate concentrate, powder, for hemodialysis, per packet   A4707
Tracheostomy care kit for new tracheostomy   A4625
Water collection device, used with large volume nebulizer   A7012
Refill kit for implantable infusion pump   A4220
Female external urinary collection device pouch, each   A4328
Ostomy pouch, urinary for use on barrier with flange (2 piece), each   A5073
Filter, disposable, used with aerosol compressor or ultrasonic generator   A7013
Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each   A6545
Perianal fecal collection pouch with adhesive, each   A4330
Supplies for maintenance of drug infusion catheter, per week (list drug separately)   A4221
Acetate concentrate solution, for hemodialysis, per gallon   A4708
Continent device plug for continent stoma   A5081
Ostomy pouch, drainable, for use on faceplate, plastic, each   A4377
Composite dressing, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6203
Surgical stockings above knee length, each   A4490
Tracheostomy cleaning brush, each   A4626
Gradient compression stockingsleeve, not otherwise specified   A6549
Extension drainage tubing, any type, any length, with connectoradaptor, for use with urinary leg bag or urostomy pouch, each   A4331
Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler   A4627
Surgical stockings thigh length, each   A4495
Continent device catheter for continent stoma   A5082
Acid concentrate, solution, for hemodialysis, per gallon   A4709
Filter, nondisposable, used with aerosol compressor or ultrasonic generator   A7014
Ostomy pouch, drainable, for use on faceplate, rubber, each   A4378
Composite 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   A6204
Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)   A4222
Lubricant, individual sterile packet, each   A4332
Ostomy pouch, urinary, with faceplate attached, plastic, each   A4379
Continent device, stoma absorptive cover for continent stoma   A5083
Surgical stockings below knee length, each   A4500
Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon   A4714
Oropharyngeal suction catheter, each   A4628
Aerosol mask, used with dme nebulizer   A7015
Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately)   A4223
Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6205
y set tubing for peritoneal dialysis   A4719
Surgical stockings full length, each   A4510
Ostomy pouch, urinary, with faceplate attached, rubber, each   A4380
Ostomy accessory convex insert   A5093
Urinary catheter anchoring device, adhesive skin attachment, each   A4333
Dome and mouthpiece, used with small volume ultrasonic nebulizer   A7016
Contact layer, sterile, 16 sq in Or less, each dressing   A6206
Infusion set for external insulin pump, non needle cannula type   A4230
Tracheostomy care kit for established tracheostomy   A4629
Incontinence garment, any type, (eg brief, diaper), each   A4520
Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen   A7017
Urinary catheter anchoring device, leg strap, each   A4334
Ostomy pouch, urinary, for use on faceplate, plastic, each   A4381
Dialysate solution, any concentration of dextrose, fluid volume greater than 249cc, but less than or equal to 999cc, for peritoneal dialysis   A4720
Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6207
Infusion set for external insulin pump, needle type   A4231
Contact layer, sterile, more than 48 sq in, each dressing   A6208
Surgical trays   A4550
Incontinence supply miscellaneous   A4335
Water, distilled, used with large volume nebulizer, 1000 ml   A7018
Syringe with needle for external insulin pump, sterile, 3cc   A4232
Ostomy pouch, urinary, for use on faceplate, heavy plastic, each   A4382
Dialysate solution, any concentration of dextrose, fluid volume greater than 999cc but less than or equal to 1999cc, for peritoneal dialysis   A4721
Foam dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6209
Incontinence supply, urethral insert, any type, each   A4336
Disposable underpads, all sizes   A4554
Ostomy pouch, urinary, for use on faceplate, rubber, each   A4383
Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each   A4233
Interface for cough stimulating device, includes all components, replacement only   A7020
Dialysate solution, any concentration of dextrose, fluid volume greater than 1999cc but less than or equal to 2999cc, for peritoneal dialysis   A4722
Foam 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   A6210
Ostomy faceplate equivalent, silicone ring, each   A4384
Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each   A4234
Indwelling catheter foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc ), each   A4338
Dialysate solution, any concentration of dextrose, fluid volume greater than 2999cc but less than or equal to 3999cc, for peritoneal dialysis   A4723
Electrodetransducer for use with electrical stimulation device used for cancer treatment, replacement only   A4555
High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each   A7025
Electrodes, (eg apnea monitor), per pair   A4556
Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each   A4235
Ostomy skin barrier, solid 4x4 or equivalent, extended wear, without built-in convexity, each   A4385
Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6211
High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each   A7026
Chlorhexidine containing antiseptic, 1 ml   A4248
Dialysate solution, any concentration of dextrose, fluid volume greater than 3999cc but less than or equal to 4999cc, for peritoneal dialysis   A4724
Indwelling catheter specialty type, eg coude, mushroom, wing, etc ), each   A4340
Combination oralnasal mask, used with continuous positive airway pressure device, each   A7027
Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each   A4236
Foam dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6212
Lead wires, (eg apnea monitor), per pair   A4557
Indwelling catheter, foley type, two-way, all silicone, each   A4344
Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each   A4387
Dialysate solution, any concentration of dextrose, fluid volume greater than 4999cc but less than or equal to 5999cc, for peritoneal dialysis   A4725
Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each   A4388
Conductive gel or paste, for use with electrical device (eg tens, nmes), per oz   A4558
Alcohol or peroxide, per pint   A4244
Oral cushion for combination oralnasal mask, replacement only, each   A7028
Indwelling catheter foley type, three way for continuous irrigation, each   A4346
Foam 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   A6213
Dialysate solution, any concentration of dextrose, fluid volume greater than 5999cc, for peritoneal dialysis   A4726
Coupling gel or paste, for use with ultrasound device, per oz   A4559
Male external catheter, with or without adhesive, disposable, each   A4349
Dialysate solution, non-dextrose containing, 500 ml   A4728
Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each   A4389
Nasal pillows for combination oralnasal mask, replacement only, pair   A7029
Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6214
Alcohol wipes, per box   A4245
Foam dressing, wound filler, sterile, per gram   A6215
Intermittent urinary catheter straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc ), each   A4351
Betadine or phisohex solution, per pint   A4246
Fistula cannulation set for hemodialysis, each   A4730
Full face mask used with positive airway pressure device, each   A7030
Pessary, rubber, any type   A4561
Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each   A4390
Betadine or iodine swabswipes, per box   A4247
Topical anesthetic, for dialysis, per gram   A4736
Face mask interface, replacement for full face mask, each   A7031
Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each   A4391
Gauze, non-impregnated, non-sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6216
Pessary, non rubber, any type   A4562
Intermittent urinary catheter coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc ), each   A4352
Slings   A4565
Cushion for use on nasal mask interface, replacement only, each   A7032
Injectable anesthetic, for dialysis, per 10 ml   A4737
Gauze, 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   A6217
Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each   A4392
Intermittent urinary catheter, with insertion supplies   A4353
Pillow for use on nasal cannula type interface, replacement only, pair   A7033
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each   A4393
Gauze, non-impregnated, non-sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6218
Insertion tray with drainage bag but without catheter   A4354
Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment   A4566
Shunt accessory, for hemodialysis, any type, each   A4740
Urine test or reagent strips or tablets (100 tablets or strips)   A4250
Blood ketone test or reagent strip, each   A4252
Gauze, non-impregnated, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6219
Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce   A4394
Splint   A4570
Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each   A4355
Blood tubing, arterial or venous, for hemodialysis, each   A4750
Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap   A7034
Headgear used with positive airway pressure device   A7035
Gauze, 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   A6220
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips   A4253
Blood tubing, arterial and venous combined, for hemodialysis, each   A4755
Topical hyperbaric oxygen chamber, disposable   A4575
Ostomy deodorant for use in ostomy pouch, solid, per tablet   A4395
Platforms for home blood glucose monitor, 50 per box   A4255
Chinstrap used with positive airway pressure device   A7036
Ostomy belt with peristomal hernia support   A4396
Gauze, non-impregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6221
Cast supplies (eg plaster)   A4580
Dialysate solution test kit, for peritoneal dialysis, any type, each   A4760
Dialysate concentrate, powder, additive for peritoneal dialysis, per packet   A4765
Normal, low and high calibrator solution chips   A4256
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6222
Irrigation supply sleeve, each   A4397
Tubing used with positive airway pressure device   A7037
Special casting material (eg fiberglass)   A4590
Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml   A4766
Electrical stimulator supplies, 2 lead, per month, (eg tens, nmes)   A4595
Ostomy irrigation supply bag, each   A4398
Gauze, 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   A6223
Replacement lens shield cartridge for use with laser skin piercing device, each   A4257
Filter, disposable, used with positive airway pressure device   A7038
Ostomy irrigation supply conecatheter, with or without brush   A4399
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6224
Blood collection tube, vacuum, for dialysis, per 50   A4770
Spring-powered device for lancet, each   A4258
Sleeve for intermittent limb compression device, replacement only, each   A4600
Filter, non disposable, used with positive airway pressure device   A7039
One way chest drain valve   A7040
Lithium ion battery for non-prosthetic use, replacement   A4601
Lancets, per box of 100   A4259
Serum clotting time tube, for dialysis, per 50   A4771
Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6228
Ostomy irrigation set   A4400
Lubricant, per ounce   A4402
Blood glucose test strips, for dialysis, per 50   A4772
Gauze, 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   A6229
Cervical cap for contraceptive use   A4261
Tubing with integrated heating element for use with positive airway pressure device   A4604
Water seal drainage container and tubing for use with implanted chest tube   A7041
Ostomy ring, each   A4404
Implanted pleural catheter, each   A7042
Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6230
Temporary, absorbable lacrimal duct implant, each   A4262
Tracheal suction catheter, closed system, each   A4605
Occult blood test strips, for dialysis, per 50   A4773
Ostomy skin barrier, non-pectin based, paste, per ounce   A4405
Oxygen probe for use with oximeter device, replacement   A4606
Vacuum drainage bottle and tubing for use with implanted catheter   A7043
Ammonia test strips, for dialysis, per 50   A4774
Permanent, long term, non-dissolvable lacrimal duct implant, each   A4263
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq in Or less, each dressing   A6231
Ostomy skin barrier, pectin-based, paste, per ounce   A4406
Transtracheal oxygen catheter, each   A4608
Oral interface used with positive airway pressure device, each   A7044
Gauze, 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   A6232
Protamine sulfate, for hemodialysis, per 50 mg   A4802
Permanent implantable contraceptive intratubal occlusion device(s) and delivery system   A4264
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq in, each dressing   A6233
Disposable catheter tips for peritoneal dialysis, per 10   A4860
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each   A4407
Paraffin, per pound   A4265
Exhalation port with or without swivel used with accessories for positive airway devices, replacement only   A7045
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6234
Ostomy skin barrier, wtih flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each   A4408
Diaphragm for contraceptive use   A4266
Water chamber for humidifier, used with positive airway pressure device, replacement, each   A7046
Plumbing andor electrical work for home hemodialysis equipment   A4870
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each   A4409
Contracts, repair and maintenance, for hemodialysis equipment   A4890
Oral interface used with respiratory suction pump, each   A7047
Contraceptive supply, condom, male, each   A4267
Hydrocolloid 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   A6235
Contraceptive supply, condom, female, each   A4268
Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each   A4410
Drain bagbottle, for dialysis, each   A4911
Tracheostoma valve, including diaphragm, each   A7501
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6236
Replacement diaphragmfaceplate for tracheostoma valve, each   A7502
Miscellaneous dialysis supplies, not otherwise specified   A4913
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6237
Ostomy skin barrier, solid 4x4 or equivalent, extended wear, with built-in convexity, each   A4411
Contraceptive supply, spermicide (eg foam, gel), each   A4269
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each   A4412
Hydrocolloid 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   A6238
Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each   A7503
Disposable endoscope sheath, each   A4270
Venous pressure clamp, for hemodialysis, each   A4918
Adhesive skin support attachment for use with external breast prosthesis, each   A4280
Gloves, non-sterile, per 100   A4927
Filter for use in a tracheostoma heat and moisture exchange system, each   A7504
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6239
Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each   A4413
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each   A4414
Tubing for breast pump, replacement   A4281
Hydrocolloid dressing, wound filler, paste, sterile, per ounce   A6240
Housing, reusable without adhesive, for use in a heat and moisture exchange system andor with a tracheostoma valve, each   A7505
Surgical mask, per 20   A4928
Adhesive disc for use in a heat and moisture exchange system andor with tracheostoma valve, any type each   A7506
Tourniquet for dialysis, each   A4929
Adapter for breast pump, replacement   A4282
Hydrocolloid dressing, wound filler, dry form, sterile, per gram   A6241
Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4x4 inches, each   A4415
Gloves, sterile, per pair   A4930
Cap for breast pump bottle, replacement   A4283
Transparent film, sterile, 16 sq in Or less, each dressing   A6257
Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each   A7507
Ostomy pouch, closed, with barrier attached, with filter (1 piece), each   A4416
Hydrogel dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6242
Oral thermometer, reusable, any type, each   A4931
Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each   A4417
Breast shield and splash protector for use with breast pump, replacement   A4284
Hydrogel 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   A6243
Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system andor with a tracheostoma valve, each   A7508
Ostomy pouch, closed without barrier attached, with filter (1 piece), each   A4418
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6244
Rectal thermometer, reusable, any type, each   A4932
Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each   A7509
Polycarbonate bottle for use with breast pump, replacement   A4285
Ostomy pouch, closed for use on barrier with non-locking flange, with filter (2 piece), each   A4419
Hydrogel dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6245
Locking ring for breast pump, replacement   A4286
Sacral nerve stimulation test lead, each   A4290
Hydrogel 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   A6246
Ostomy pouch, closed for use on barrier with locking flange (2 piece), each   A4420
Ostomy supply miscellaneous   A4421
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6247
Hydrogel dressing, wound filler, gel, per fluid ounce   A6248
Ostomy absorbent material (sheetpadcrystal packet) for use in ostomy pouch to thicken liquid stomal output, each   A4422
Ostomy pouch, closed for use on barrier with locking flange, with filter (2 piece), each   A4423
Skin sealants, protectants, moisturizers, ointments, any type, any size   A6250
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6251
Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each   A4424
Ostomy pouch, drainable for use on barrier with non-locking flange, with filter (2 piece system), each   A4425
Specialty 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   A6252
Ostomy pouch, drainable for use on barrier with locking flange (2 piece system), each   A4426
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6253
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6254
Ostomy pouch, drainable for use on barrier with locking flange, with filter (2 piece system), each   A4427
Specialty 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   A6255
Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each   A4428
Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each   A4429
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6256
Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each   A4430
Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6258
Ostomy pouch, urinary with barrier attached, with faucet-type tap with valve (1 piece), each   A4431
Transparent film, sterile, more than 48 sq in, each dressing   A6259
Ostomy pouch, urinary for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each   A4432
Wound cleansers, any type, any size   A6260
Ostomy pouch, urinary for use on barrier with locking flange (2 piece), each   A4433
Wound filler, gelpaste, per fluid ounce, not otherwise specified   A6261
Ostomy pouch, urinary for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each   A4434
Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each   A4435
Wound filler, dry form, per gram, not otherwise specified   A6262
Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard   A6266
Gauze, non-impregnated, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6402
Gauze, non-impregnated, sterile, pad size more than 16 sq in less than or equal to 48 sq in, without adhesive border, each dressing   A6403
Gauze, non-impregnated, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6404
Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard   A6407
Eye pad, sterile, each   A6410
Eye pad, non-sterile, each   A6411
Eye patch, occlusive, each   A6412
Adhesive bandage, first-aid type, any size, each   A6413
Padding bandage, non-elastic, non-wovennon-knitted, width greater than or equal to three inches and less than five inches, per yard   A6441
Conforming bandage, non-elastic, knittedwoven, non-sterile, width less than three inches, per yard   A6442
Conforming bandage, non-elastic, knittedwoven, non-sterile, width greater than or equal to three inches and less than five inches, per yard   A6443
Conforming bandage, non-elastic, knittedwoven, non-sterile, width greater than or equal to 5 inches, per yard   A6444
Conforming bandage, non-elastic, knittedwoven, sterile, width less than three inches, per yard   A6445
Conforming bandage, non-elastic, knittedwoven, sterile, width greater than or equal to three inches and less than five inches, per yard   A6446
Conforming bandage, non-elastic, knittedwoven, sterile, width greater than or equal to five inches, per yard   A6447
Light compression bandage, elastic, knittedwoven, width less than three inches, per yard   A6448
Light compression bandage, elastic, knittedwoven, width greater than or equal to three inches and less than five inches, per yard   A6449
Light compression bandage, elastic, knittedwoven, width greater than or equal to five inches, per yard   A6450
Moderate compression bandage, elastic, knittedwoven, load resistance of 125 to 134 foot pounds at 50 maximum stretch, width greater than or equal to three inches and less than five inches, per yard   A6451
High compression bandage, elastic, knittedwoven, load resistance greater than or equal to 135 foot pounds at 50 maximum stretch, width greater than or equal to three inches and less than five inches, per yard   A6452
Self-adherent bandage, elastic, non-knittednon-woven, width less than three inches, per yard   A6453
Self-adherent bandage, elastic, non-knittednon-woven, width greater than or equal to three inches and less than five inches, per yard   A6454
Self-adherent bandage, elastic, non-knittednon-woven, width greater than or equal to five inches, per yard   A6455
Zinc paste impregnated bandage, non-elastic, knittedwoven, width greater than or equal to three inches and less than five inches, per yard   A6456
Tubular dressing with or without elastic, any width, per linear yard   A6457
Compression burn garment, bodysuit (head to foot), custom fabricated   A6501
Compression burn garment, chin strap, custom fabricated   A6502
Compression burn garment, facial hood, custom fabricated   A6503
Compression burn garment, glove to wrist, custom fabricated   A6504
Compression burn garment, glove to elbow, custom fabricated   A6505
Compression burn garment, glove to axilla, custom fabricated   A6506
Compression burn garment, foot to knee length, custom fabricated   A6507
Compression burn garment, foot to thigh length, custom fabricated   A6508
Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated   A6509
Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated   A6510
Compression burn garment, lower trunk including leg openings (panty), custom fabricated   A6511
Compression burn garment, not otherwise classified   A6512
Compression burn mask, face andor neck, plastic or equal, custom fabricated   A6513
Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories   A6550
Medroxyprogesterone acetate,   J105
Melphalan HCl,   J9245
Melphalan, oral,   J8600
Methylnaltrexone,   J2212
Meperidine,   J2175
Meperidine and promethazine,   J2180
Mepivacaine HCl,   J0670
Meropenem,   J2185
Mesna,   J9209
Metacarpophalangeal joint, prosthetic implant,   L8630, L8631
Metaproterenol sulfate, inhalation solution, concentrated,   J7667, J7668
Metaproterenol sulfate, inhalation solution, unit dose,   J7669, J7670
Metaraminol bitartrate,   J0380
Metatarsal joint, prosthetic implant,   L8641
Meter, bath conductivity, dialysis,   E1550
Methacholine chloride,   J7674
Methadone HCl,   J1230
Methocarbamol,   J2800
Methotrexate, oral,   J8610
Methotrexate sodium,   J9250, J9260
Methyldopate HCl,   J0210
Methylene blue,   Q9968
acetate,   J1020 - J1040
Injection, methylprednisolone acetate, 20 mg   J1020
Injection, methylprednisolone acetate, 40 mg   J1030
Injection, methylprednisolone acetate, 80 mg   J1040
oral,   J7509
sodium succinate,   J2920, J2930
Metoclopramide HCl,   J2765
Micafungin sodium,   J2248
Microbiology test,   P7001
Midazolam HCl,   J2250
Mileage, ambulance,   A0380, A0390
Milrinone lactate,   J2260
Mini-bus, nonemergency transportation,   A0120
Minocycline hydrochloride,   J2265
Modalities, with office visit,   M0005 - M0008
Moisture exchanger for use with invasive mechanical ventilation,   A4483
Moisturizer, skin,   A6250
blood glucose,   E0607
blood pressure,   A4670
pacemaker,   E0610, E0615
Monitoring featuredevice,   A9279
Monoclonal antibodies,   J7505
Morphine sulfate,   J2270
epidural or intrathecal use   J2274
Mouthpiece (for respiratory equipment),   A4617
Moxifloxacin,   J2280
Mucoprotein, blood,   P2038
Multiaxial ankle,   L5986
Multidisciplinary services,   H2000 - H2001 , T1023 - T1028
Comprehensive multidisciplinary evaluation   H2000
Rehabilitation program, per 12 day   H2001
Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter   T1023
Evaluation and treatment by an integrated, specialty team contracted to provide coordinated care to multiple or severely handicapped children, per encounter   T1024
Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, mental and psychosocial impairments, per diem   T1025
Intensive, extended multidisciplinary services provided in a clinic setting to children with complex medical, physical, medical and psychosocial impairments, per hour   T1026
Family training and counseling for child development, per 15 minutes   T1027
Assessment of home, physical and family environment, to determine suitability to meet patient's medical needs   T1028
Multiple post collar, cervical,   L0180 - L0200
Cervical, multiple post collar, occipitalmandibular supports, adjustable   L0180
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types)   L0190
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension   L0200
Multi-Podus type AFO,   L4396
Muromonab-CD3,   J7505
Mycophenolate mofetil,   J7517
Mycophenolic acid,   J7518