HCPCS Index 2017

Sacral nerve stimulation test lead,   A4290
Safety equipment,   E0700
   E0980
hypertonic,   J713
solution,   J7030 - J7050 , A4216 - A4218
Infusion, normal saline solution , 1000 cc   J7030
Infusion, normal saline solution, sterile (500 ml1 unit)   J7040
5 dextrosenormal saline (500 ml 1 unit)   J7042
Infusion, normal saline solution , 250 cc   J7050
Sterile water, saline andor dextrose, diluentflush, 10 ml   A4216
Sterile watersaline, 500 ml   A4217
Sterile saline or water, metered dose dispenser, 10 ml   A4218
Samarium SM 153 Lexidronamm,   A960
Sargramostim (GM-CSF),   J2820
Scoliosis,   L1000 - L1499
Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model   L1000
Other scoliosis procedure, body jacket molded to patient model   L1300
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only   L1200
Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment   L1001
Addition to tlso, (low profile), lateral thoracic extension   L1210
Other scoliosis procedure, post-operative body jacket   L1310
Spinal orthosis, not otherwise specified   L1499
Addition to tlso, (low profile), anterior thoracic extension   L1220
Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment   L1005
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling   L1010
Addition to tlso, (low profile), milwaukee type superstructure   L1230
Addition to tlso, (low profile), lumbar derotation pad   L1240
Addition to ctlso or scoliosis orthosis, kyphosis pad   L1020
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating   L1025
Addition to tlso, (low profile), anterior asis pad   L1250
Addition to tlso, (low profile), anterior thoracic derotation pad   L1260
Addition to ctlso or scoliosis orthosis, lumbar bolster pad   L1030
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad   L1040
Addition to tlso, (low profile), abdominal pad   L1270
Addition to tlso, (low profile), rib gusset (elastic), each   L1280
Addition to ctlso or scoliosis orthosis, sternal pad   L1050
Addition to tlso, (low profile), lateral trochanteric pad   L1290
Addition to ctlso or scoliosis orthosis, thoracic pad   L1060
Addition to ctlso or scoliosis orthosis, trapezius sling   L1070
Addition to ctlso or scoliosis orthosis, outrigger   L1080
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions   L1085
Addition to ctlso or scoliosis orthosis, lumbar sling   L1090
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather   L1100
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model   L1110
Addition to ctlso, scoliosis orthosis, cover for upright, each   L1120
additions,   L1010 - L1120 , L1210 - L1290
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling   L1010
Addition to ctlso or scoliosis orthosis, kyphosis pad   L1020
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating   L1025
Addition to ctlso or scoliosis orthosis, lumbar bolster pad   L1030
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad   L1040
Addition to ctlso or scoliosis orthosis, sternal pad   L1050
Addition to ctlso or scoliosis orthosis, thoracic pad   L1060
Addition to ctlso or scoliosis orthosis, trapezius sling   L1070
Addition to ctlso or scoliosis orthosis, outrigger   L1080
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions   L1085
Addition to ctlso or scoliosis orthosis, lumbar sling   L1090
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather   L1100
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model   L1110
Addition to ctlso, scoliosis orthosis, cover for upright, each   L1120
Addition to tlso, (low profile), lateral thoracic extension   L1210
Addition to tlso, (low profile), anterior thoracic extension   L1220
Addition to tlso, (low profile), milwaukee type superstructure   L1230
Addition to tlso, (low profile), lumbar derotation pad   L1240
Addition to tlso, (low profile), anterior asis pad   L1250
Addition to tlso, (low profile), anterior thoracic derotation pad   L1260
Addition to tlso, (low profile), abdominal pad   L1270
Addition to tlso, (low profile), rib gusset (elastic), each   L1280
Addition to tlso, (low profile), lateral trochanteric pad   L1290
Sculptra,   Q2028
skin,   A6250
attachment, walker,   E0156
insert, wheelchair,   E0992
lift (patient),   E0621, E0627 - E0629
Seat lift mechanism incorporated into a combination lift-chair mechanism   E0627
Separate seat lift mechanism for use with patient owned furniture-electric   E0628
Separate seat lift mechanism for use with patient owned furniture-non-electric   E0629
upholstery, wheelchair,   E097
Secretin,   J2850
Semen analysis,   G0027
Sensitivity study,   P7001
Sermorelin acetate,   Q0515
Serum clotting time tube,   A4771
SEWHO,   L3960 - L3974
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment   L3960
Shoulder elbow wrist hand orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3971
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3961
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3973
Shoulder elbow wrist hand orthosis, abduction positioning, erbs palsey design, prefabricated, includes fitting and adjustment   L3962
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3967
Sheepskin pad,   E0188, E0189
arch support,   L3040 - L3100
Foot, arch support, non-removable attached to shoe, longitudinal, each   L3070
Foot, arch support, removable, premolded, longitudinal, each   L3040
Foot, arch support, non-removable attached to shoe, metatarsal, each   L3080
Foot, arch support, removable, premolded, metatarsal, each   L3050
Foot, arch support, removable, premolded, longitudinal metatarsal, each   L3060
Foot, arch support, non-removable attached to shoe, longitudinalmetatarsal, each   L3090
Hallus-valgus night dynamic splint   L3100
for diabetics,   A5500 - A5508
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
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
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
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe   A5504
For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe   A5505
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
For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe   A5507
For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe   A5508
insert,   L3000 - L3030
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each   L3000
Foot, insert, removable, molded to patient model, spenco, each   L3001
Foot, insert, removable, molded to patient model, plastazote or equal, each   L3002
Foot, insert, removable, molded to patient model, silicone gel, each   L3003
Foot, insert, removable, molded to patient model, longitudinal arch support, each   L3010
Foot, insert, removable, molded to patient model, longitudinal metatarsal support, each   L3020
Foot, insert, removable, formed to patient foot, each   L3030
lift,   L3300 - L3334
Lift, elevation, heel, tapered to metatarsals, per inch   L3300
Lift, elevation, heel and sole, neoprene, per inch   L3310
Lift, elevation, heel and sole, cork, per inch   L3320
Lift, elevation, metal extension (skate)   L3330
Lift, elevation, inside shoe, tapered, up to one-half inch   L3332
Lift, elevation, heel, per inch   L3334
miscellaneous additions,   L3500 - L3595
Orthopedic shoe addition, insole, leather   L3500
Orthopedic shoe addition, insole, rubber   L3510
Orthopedic shoe addition, insole, felt covered with leather   L3520
Orthopedic shoe addition, sole, half   L3530
Orthopedic shoe addition, sole, full   L3540
Orthopedic shoe addition, toe tap standard   L3550
Orthopedic shoe addition, toe tap, horseshoe   L3560
Orthopedic shoe addition, special extension to instep (leather with eyelets)   L3570
Orthopedic shoe addition, convert instep to velcro closure   L3580
Orthopedic shoe addition, convert firm shoe counter to soft counter   L3590
Orthopedic shoe addition, march bar   L3595
orthopedic,   L3201 - L3265
Orthopedic shoe, oxford with supinator or pronator, infant   L3201
Orthopedic shoe, oxford with supinator or pronator, child   L3202
Orthopedic shoe, oxford with supinator or pronator, junior   L3203
Orthopedic shoe, hightop with supinator or pronator, infant   L3204
Orthopedic shoe, hightop with supinator or pronator, child   L3206
Orthopedic shoe, hightop with supinator or pronator, junior   L3207
Surgical boot, each, infant   L3208
Surgical boot, each, child   L3209
Surgical boot, each, junior   L3211
Benesch boot, pair, infant   L3212
Benesch boot, pair, child   L3213
Benesch boot, pair, junior   L3214
Orthopedic footwear, ladies shoe, oxford, each   L3215
Orthopedic footwear, ladies shoe, depth inlay, each   L3216
Orthopedic footwear, ladies shoe, hightop, depth inlay, each   L3217
Orthopedic footwear, mens shoe, oxford, each   L3219
Orthopedic footwear, mens shoe, depth inlay, each   L3221
Orthopedic footwear, mens shoe, hightop, depth inlay, each   L3222
Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)   L3224
Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)   L3225
Orthopedic footwear, custom shoe, depth inlay, each   L3230
Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each   L3250
Foot, shoe molded to patient model, silicone shoe, each   L3251
Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each   L3252
Foot, molded shoe plastazote (or similar) custom fitted, each   L3253
Non-standard size or width   L3254
Non-standard size or length   L3255
Orthopedic footwear, additional charge for split size   L3257
Surgical bootshoe, each   L3260
Plastazote sandal, each   L3265
positioning device,   L3140 - L3170
Foot, abduction rotation bar, including shoes   L3140
Foot, abduction rotatation bar, without shoes   L3150
Foot, adjustable shoe-styled positioning device   L3160
Foot, plastic, silicone or equal, heel stabilizer, each   L3170
transfer,   L3600 - L3649
Transfer of an orthosis from one shoe to another, caliper plate, existing   L3600
Transfer of an orthosis from one shoe to another, caliper plate, new   L3610
Transfer of an orthosis from one shoe to another, solid stirrup, existing   L3620
Transfer of an orthosis from one shoe to another, solid stirrup, new   L3630
Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes   L3640
Orthopedic shoe, modification, addition or transfer, not otherwise specified   L3649
wedge,   L3340 - L3485
Heel, counter, plastic reinforced   L3430
Heel wedge, sach   L3340
Heel, counter, leather reinforced   L3440
Heel wedge   L3350
Sole wedge, outside sole   L3360
Heel, sach cushion type   L3450
Sole wedge, between sole   L3370
Heel, new leather, standard   L3455
Heel, new rubber, standard   L3460
Clubfoot wedge   L3380
Heel, thomas with wedge   L3465
Outflare wedge   L3390
Metatarsal bar wedge, rocker   L3400
Heel, thomas extended to ball   L3470
Heel, pad and depression for spur   L3480
Metatarsal bar wedge, between sole   L3410
Heel, pad, removable for spur   L3485
Full sole and heel wedge, between sole   L3420
disarticulation, prosthetic,   L6300 - L6320 , L6550
Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm   L6300
Shoulder disarticulation, passive restoration (complete prosthesis)   L6310
Shoulder disarticulation, passive restoration (shoulder cap only)   L6320
orthosis (SO),   L3650 - L3674
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, includes fitting and adjustment   L3650
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, includes fitting and adjustment   L3660
Shoulder orthosis, acromioclavicular (canvas and webbing type), prefabricated, includes fitting and adjustment   L3670
Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3671
Shoulder orthosis, abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion jointturnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3674
spinal, cervical,   L0100 - L0200
Cervical, multiple post collar, occipitalmandibular supports, adjustable   L0180
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated   L0112
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types)   L0190
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment   L0113
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension   L0200
Cervical, flexible, non-adjustable (foam collar)   L0120
Cervical, flexible, thermoplastic collar, molded to patient   L0130
Cervical, semi-rigid, adjustable (plastic collar)   L0140
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibularoccipital piece)   L0150
Cervical, semi-rigid, wire frame occipitalmandibular support   L0160
Cervical, collar, molded to patient model   L0170
Cervical, collar, semi-rigid thermoplastic foam, two piece   L0172
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension   L0174
Shoulder-elbow-wrist-hand orthosis (SEWHO),   L3960 - L3969
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment   L3960
Shoulder elbow wrist hand orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3961
Shoulder elbow wrist hand orthosis, abduction positioning, erbs palsey design, prefabricated, includes fitting and adjustment   L3962
Shoulder elbow wrist hand orthosis, abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment   L3967
Shoulder sling,   A4566
Shunt accessory for dialysis,   A4740
aqueous,   L8612
Sigmoidoscopy, cancer screening,   G0104, G0106
Sincalide,   J2805
Sipuleucel-T,   Q2043
Sirolimus,   J7520
Sitz bath,   E0160 - E0162
Sitz type bath or equipment, portable, used with or without commode   E0160
Sitz type bath or equipment, portable, used with or without commode, with faucet attachments   E0161
Sitz bath chair   E0162
barrier, ostomy,   A4362, A4363, A4369 - A4373 , A4385, A5120
Ostomy skin barrier, liquid (spray, brush, etc), per oz   A4369
Ostomy skin barrier, powder, per oz   A4371
Ostomy skin barrier, solid 4x4 or equivalent, standard wear, with built-in convexity, each   A4372
Ostomy skin barrier, with flange (solid, flexible or accordian), with built-in convexity, any size, each   A4373
bond or cement, ostomy,   A4364
sealant, protectant, moisturizer,   A6250
substitute,   Q4100 - Q4160
Oasis burn matrix, per square centimeter   Q4103
Skin substitute, not otherwise specified   Q4100
Apligraf, per square centimeter   Q4101
Oasis wound matrix, per square centimeter   Q4102
Integra bilayer matrix wound dressing (bmwd), per square centimeter   Q4104
Integra dermal regeneration template (drt), per square centimeter   Q4105
Dermagraft, per square centimeter   Q4106
Graftjacket, per square centimeter   Q4107
Integra matrix, per square centimeter   Q4108
Primatrix, per square centimeter   Q4110
Gammagraft, per square centimeter   Q4111
Cymetra, injectable, 1cc   Q4112
Graftjacket xpress, injectable, 1cc   Q4113
Integra flowable wound matrix, injectable, 1cc   Q4114
Alloskin, per square centimeter   Q4115
Alloderm, per square centimeter   Q4116
Hyalomatrix, per square centimeter   Q4117
Matristem micromatrix, 1 mg   Q4118
Matristem wound matrix, psmx, rs, or psm, per square centimeter   Q4119
Matristem burn matrix, per square centimeter   Q4120
Theraskin, per square centimeter   Q4121
Dermacell, per square centimeter   Q4122
Alloskin rt, per square centimeter   Q4123
Oasis ultra tri-layer wound matrix, per square centimeter   Q4124
Arthroflex, per square centimeter   Q4125
Memoderm, dermaspan, tranzgraft or integuply, per square centimeter   Q4126
Talymed, per square centimeter   Q4127
Flex hd, allopatch hd, or matrix hd, per square centimeter   Q4128
Unite biomatrix, per square centimeter   Q4129
Strattice tm, per square centimeter   Q4130
Epifix, per square centimeter   Q4131
Grafix core, per square centimeter   Q4132
Grafix prime, per square centimeter   Q4133
Hmatrix, per square centimeter   Q4134
Mediskin, per square centimeter   Q4135
Ez-derm, per square centimeter   Q4136
Amnioexcel or biodexcel, per square centimeter   Q4137
Biodfence dryflex, per square centimeter   Q4138
Amniomatrix or biodmatrix, injectable, 1 cc   Q4139
Biodfence, per square centimeter   Q4140
Alloskin ac, per square centimeter   Q4141
Xcm biologic tissue matrix, per square centimeter   Q4142
Repriza, per square centimeter   Q4143
Epifix, injectable, 1 mg   Q4145
Tensix, per square centimeter   Q4146
Architect extracellular matrix, per square centimeter   Q4147
Neox 1k, per square centimeter   Q4148
Excellagen, 01 cc   Q4149
   A4565
patient lift,   E0621, E0630, E0635
Social worker, nonemergency transport,   A0160
body sock,   L0984
prosthetic sock,   L8420 - L8435 , L8470, L8480, L8485
Prosthetic sock, multiple ply, below knee, each   L8420
Prosthetic sock, multiple ply, above knee, each   L8430
Prosthetic sock, multiple ply, upper limb, each   L8435
stump sock,   L8470 - L8485
Prosthetic sock, single ply, fitting, below knee, each   L8470
Prosthetic sock, single ply, fitting, above knee, each   L8480
Prosthetic sock, single ply, fitting, upper limb, each   L8485
chloride injection,   J291
ferric gluconate complex in sucrose,   J2916
fluoride F-18,   A9580
Euflexxa,   J7323
Hyalgan,   J7321
Orthovisc,   J7324
Supartz,   J7321
Synvisc and Synvisc-One,   J7325
phosphate P32,   A9563
succinate,   J1720
calibrator,   A4256
dialysate,   A4760
elliotts b,   J9175
enteral 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
parenteral nutrition,   B4164 - B5200
Parenteral nutrition solution carbohydrates (dextrose), 50 or less (500 ml 1 unit) - homemix   B4164
Parenteral nutrition solution amino acid, 35, (500 ml 1 unit) - homemix   B4168
Parenteral nutrition solution amino acid, 55 through 7, (500 ml 1 unit) NAME   B4172
Parenteral nutrition solution amino acid, 7 through 85, (500 ml 1 unit) NAME   B4176
Parenteral nutrition solution amino acid, greater than 85 (500 ml 1 unit) NAME   B4178
Parenteral nutrition solution carbohydrates (dextrose), greater than 50 (500 ml1 unit) - homemix   B4180
Parenteral nutrition solution, per 10 grams lipids   B4185
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix   B4189
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix   B4193
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix   B4197
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix   B4199
Parenteral nutrition additives (vitamins, trace elements, heparin, electrolytes) homemix per day   B4216
Parenteral nutrition supply kit premix, per day   B4220
Parenteral nutrition supply kit home mix, per day   B4222
Parenteral nutrition administration kit, per day   B4224
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal - amirosyn rf, nephramine, renamine - premix   B5000
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, hepatic - freamine hbc, hepatamine - premix   B5100
Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress - branch chain amino acids - premix   B5200
Somatrem,   J2940
Somatropin,   J2941
Sorbent cartridge, ESRD,   E1636
Specialty absorptive dressing,   A6251 - A6256
Specialty absorptive dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6251
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
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
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
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6256
Spectinomycin HCl,   J3320
Speech assessment,   V5362 - V5364
Speech screening   V5362
Language screening   V5363
Dysphagia screening   V5364
Speech generating device,   E2500 - E2599
Speech generating device, digitized speech, using pre-recorded messages, less than or equal to 8 minutes recording time   E2500
Speech generating device, digitized speech, using pre-recorded messages, greater than 8 minutes but less than or equal to 20 minutes recording time   E2502
Speech generating device, digitized speech, using pre-recorded messages, greater than 20 minutes but less than or equal to 40 minutes recording time   E2504
Speech generating device, digitized speech, using pre-recorded messages, greater than 40 minutes recording time   E2506
Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device   E2508
Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access   E2510
Speech generating software program, for personal computer or personal digital assistant   E2511
Accessory for speech generating device, mounting system   E2512
Accessory for speech generating device, not otherwise classified   E2599
cervical,   L0100 - L0200
Cervical, multiple post collar, occipitalmandibular supports, adjustable   L0180
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated   L0112
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types)   L0190
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment   L0113
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension   L0200
Cervical, flexible, non-adjustable (foam collar)   L0120
Cervical, flexible, thermoplastic collar, molded to patient   L0130
Cervical, semi-rigid, adjustable (plastic collar)   L0140
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibularoccipital piece)   L0150
Cervical, semi-rigid, wire frame occipitalmandibular support   L0160
Cervical, collar, molded to patient model   L0170
Cervical, collar, semi-rigid thermoplastic foam, two piece   L0172
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension   L0174
cervical-thoracic-lumbar-sacral (CTLSO),   L0700, L0710
DME,   K0112 - K0116
halo,   L0810 - L0830
Halo procedure, cervical halo incorporated into jacket vest   L0810
Halo procedure, cervical halo incorporated into plaster body jacket   L0820
Halo procedure, cervical halo incorporated into milwaukee type orthosis   L0830
multiple post collar,   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
scoliosis,   L1000 - L1499
Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model   L1000
Other scoliosis procedure, body jacket molded to patient model   L1300
Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only   L1200
Cervical thoracic lumbar sacral orthosis, immobilizer, infant size, prefabricated, includes fitting and adjustment   L1001
Addition to tlso, (low profile), lateral thoracic extension   L1210
Other scoliosis procedure, post-operative body jacket   L1310
Spinal orthosis, not otherwise specified   L1499
Addition to tlso, (low profile), anterior thoracic extension   L1220
Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment   L1005
Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling   L1010
Addition to tlso, (low profile), milwaukee type superstructure   L1230
Addition to tlso, (low profile), lumbar derotation pad   L1240
Addition to ctlso or scoliosis orthosis, kyphosis pad   L1020
Addition to ctlso or scoliosis orthosis, kyphosis pad, floating   L1025
Addition to tlso, (low profile), anterior asis pad   L1250
Addition to tlso, (low profile), anterior thoracic derotation pad   L1260
Addition to ctlso or scoliosis orthosis, lumbar bolster pad   L1030
Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad   L1040
Addition to tlso, (low profile), abdominal pad   L1270
Addition to tlso, (low profile), rib gusset (elastic), each   L1280
Addition to ctlso or scoliosis orthosis, sternal pad   L1050
Addition to tlso, (low profile), lateral trochanteric pad   L1290
Addition to ctlso or scoliosis orthosis, thoracic pad   L1060
Addition to ctlso or scoliosis orthosis, trapezius sling   L1070
Addition to ctlso or scoliosis orthosis, outrigger   L1080
Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions   L1085
Addition to ctlso or scoliosis orthosis, lumbar sling   L1090
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather   L1100
Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model   L1110
Addition to ctlso, scoliosis orthosis, cover for upright, each   L1120
torso supports,   L096
Splint,   A4570, L3100, L4350 - L4380
Ankle control orthosis, stirrup style, rigid, includes any type interface (e G , pneumatic, gel), prefabricated, includes fitting and adjustment   L4350
Walking boot, pneumatic andor vacuum, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment   L4360
Pneumatic full leg splint, prefabricated, includes fitting and adjustment   L4370
Walking boot, pneumatic andor vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf   L4361
ankle,   L4390 - L4398
Replacement, soft interface material, static afo   L4392
Replace soft interface material, foot drop splint   L4394
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, includes fitting and adjustment   L4396
Foot drop splint, recumbent positioning device, prefabricated, includes fitting and adjustment   L4398
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf   L4397
dynamic,   E1800, E1805, E1810, E1815, E1825, E1830, E1840
footdrop,   L4398
Static progressive stretch,   E1801, E1806, E1811, E1816, E1818, E1821
Sterile cefuroxime sodium,   J0697
Sterile water,   A4216 - A4217
Sterile water, saline andor dextrose, diluentflush, 10 ml   A4216
Sterile watersaline, 500 ml   A4217
neuromuscular,   E0744, E0745
osteogenesis, electrical,   E0747 - E0749
Osteogenesis stimulator, electrical, non-invasive, other than spinal applications   E0747
Osteogenesis stimulator, electrical, non-invasive, spinal applications   E0748
Osteogenesis stimulator, electrical, surgically implanted   E0749
ultrasound,   E0760
salivary reflex,   E0755
stoma absorptive cover,   A5083
Stomach tube,   B4083
Streptokinase,   J2995
Streptomycin,   J3000
Streptozocin,   J9320
Strip, blood glucose test,   A4253, A4772
urine reagent,   A4250
Strontium-89 chloride, supply of,   A9600
Stump sock,   L8470 - L8485
Prosthetic sock, single ply, fitting, below knee, each   L8470
Prosthetic sock, single ply, fitting, above knee, each   L8480
Prosthetic sock, single ply, fitting, upper limb, each   L8485
Stylet,   A4212
Succinylcholine chloride,   J0330
gastric, home model,   E2000
portable,   E0600
respiratory, home model,   E0600
Sumatriptan succinate,   J3030
Supartz,   J7321
Supplyaccessoryservice,   A9900
arch,   L3040 - L3090
Foot, arch support, removable, premolded, longitudinal, each   L3040
Foot, arch support, non-removable attached to shoe, longitudinal, each   L3070
Foot, arch support, removable, premolded, metatarsal, each   L3050
Foot, arch support, non-removable attached to shoe, metatarsal, each   L3080
Foot, arch support, removable, premolded, longitudinal metatarsal, each   L3060
Foot, arch support, non-removable attached to shoe, longitudinalmetatarsal, each   L3090
cervical,   L0100 - L0200
Cervical, multiple post collar, occipitalmandibular supports, adjustable   L0180
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated   L0112
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars (somi, guilford, taylor types)   L0190
Cranial cervical orthosis, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment   L0113
Cervical, multiple post collar, occipitalmandibular supports, adjustable cervical bars, and thoracic extension   L0200
Cervical, flexible, non-adjustable (foam collar)   L0120
Cervical, flexible, thermoplastic collar, molded to patient   L0130
Cervical, semi-rigid, adjustable (plastic collar)   L0140
Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibularoccipital piece)   L0150
Cervical, semi-rigid, wire frame occipitalmandibular support   L0160
Cervical, collar, molded to patient model   L0170
Cervical, collar, semi-rigid thermoplastic foam, two piece   L0172
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension   L0174
spinal,   L096
stockings,   L8100 - L8239
boot,   L3208 - L3211
Surgical boot, each, infant   L3208
Surgical boot, each, child   L3209
Surgical boot, each, junior   L3211
brush, dialysis,   A491
dressing,   A6196 - A6406
Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq in or less, each dressing   A6196
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
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq in, each dressing   A6198
Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches   A6199
Composite dressing, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6203
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
Composite dressing, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6205
Contact layer, sterile, 16 sq in Or less, each dressing   A6206
Contact layer, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6207
Contact layer, sterile, more than 48 sq in, each dressing   A6208
Foam dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6209
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
Foam dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6211
Foam dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6212
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
Foam dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6214
Foam dressing, wound filler, sterile, per gram   A6215
Gauze, non-impregnated, non-sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6216
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
Gauze, non-impregnated, non-sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6218
Gauze, non-impregnated, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6219
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
Gauze, non-impregnated, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6221
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6222
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
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6224
Gauze, impregnated, water or normal saline, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6228
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
Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6230
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq in Or less, each dressing   A6231
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
Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq in, each dressing   A6233
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6234
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
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6236
Hydrocolloid dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6237
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
Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6239
Hydrocolloid dressing, wound filler, paste, sterile, per ounce   A6240
Hydrocolloid dressing, wound filler, dry form, sterile, per gram   A6241
Hydrogel dressing, wound cover, sterile, pad size 16 sq in Or less, without adhesive border, each dressing   A6242
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
Hydrogel dressing, wound cover, sterile, pad size more than 48 sq in, without adhesive border, each dressing   A6244
Hydrogel dressing, wound cover, sterile, pad size 16 sq in Or less, with any size adhesive border, each dressing   A6245
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
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
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
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
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
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
Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq in, with any size adhesive border, each dressing   A6256
Transparent film, sterile, 16 sq in Or less, each dressing   A6257
Transparent film, sterile, more than 16 sq in but less than or equal to 48 sq in, each dressing   A6258
Transparent film, sterile, more than 48 sq in, each dressing   A6259
Wound cleansers, any type, any size   A6260
Wound filler, gelpaste, per fluid ounce, not otherwise specified   A6261
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
stocking,   A4490 - A4510
Surgical stockings above knee length, each   A4490
Surgical stockings thigh length, each   A4495
Surgical stockings below knee length, each   A4500
Surgical stockings full length, each   A4510
supplies,   A4649
tray,   A4550
Swabs, betadine or iodine,   A4247
Syringe,   A4213
with needle,   A4206 - A4209
Syringe with needle, sterile, 1 cc or less, each   A4206
Syringe with needle, sterile 2cc, each   A4207
Syringe with needle, sterile 3cc, each   A4208
Syringe with needle, sterile 5cc or greater, each   A4209
Synvisc and Synvisc-One,   J7325