| HCPCS Code | HCPCS Long Description | HCPCS Short Description | HCPCS Pricing Indicator Code (1) | HCPCS Pricing Indicator Code (2) | HCPCS Multiple Pricing Indicator Code | Coverage Issues Manual Ref. Section Number(s) (HCPCS) | Medicare Carriers Manual Ref. Section Number(s) (HCPCS) | HCPCS Statute Number | HCPCS Lab Certification Code (1) | HCPCS Lab Certification Code (2) | HCPCS Cross Reference Code | HCPCS Coverage Code | ASC Payment Group Code (HCPCS) | ASC Payment Group Eff Date (HCPCS) | MOG Payment Group Code (HCPCS) | MOG Payment Policy Indicator (HCPCS) | MOG Payment Group Effective Date (HCPCS) | Processing Note Number (HCPCS) | BETOS Code (HCPCS) | HCPCS Type Of Service Code | HCPCS Code Added Date | HCPCS Action Effective Date | HCPCS Termination Date | HCPCS Action Code |
|---|
| S0141 | ZALCITABINE (DDC), 0.375 MG | Zalcitabine, 0.375 mg | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 04/01/2003 | 10/01/2008 | 10/01/2008 | D |
| S0088 | IMATINIB, 100 MG | Imatinib 100 mg | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | 88 | 0 = Service not separately priced by part B | 9 | 01/01/2002 | 01/01/2003 | | N |
| J1752 | INJECTION, IRON DEXTRAN 267, 50 MG | Iron dextran 267 injection | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | YY | 01/01/2008 | | | | 123 | 51 = Drugs | 1 | 01/01/2006 | 04/01/2008 | | N |
| J1751 | INJECTION, IRON DEXTRAN 165, 50 MG | Iron dextran 165 injection | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | YY | 01/01/2008 | | | | 123 | 51 = Drugs | 1 | 01/01/2006 | 04/01/2008 | | N |
| J7603 | ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION,; FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT; DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) | Albuterol inh non-comp u d | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | | | | | | 135 | 51 = Drugs | 1 | 01/01/2008 | 04/01/2008 | | A |
| J7602 | ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION,; FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME,; CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) | Albuterol inh non-comp con | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | | | | | | 135 | 51 = Drugs | 1 | 01/01/2008 | 04/01/2008 | | A |
| G0300 | INSERTION OR REPOSITIONING OF ELECTRODE LEAD(S) FOR DUAL CHAMBER PACING; CARDIOVERTER DEFIBRILLATOR AND INSERTION OF PULSE GENERATOR | Insert reposit lead dual+gen | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 10/01/2003 | 01/01/2008 | 12/31/2007 | D |
| C8926 | TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST FOR CONGENITAL CARDIAC; ANOMALIES; INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND; REPORT | Cong TEE w/contr, int/rept | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8927 | TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST FOR MONITORING PURPOSES,; INCLUDING PROBE PLACEMENT, REAL TIME 2-DIMENSIONAL IMAGE ACQUISITION AND; INTERPRETATION LEADING TO ONGOING (CONTINUOUS) ASSESSMENT OF (DYNAMICALLY; TIME BASIS; CHANGING) CARDIAC PUMPING FUNCTION AND TO THERAPEUTIC MEASURES ON AN IMMEDIATE | TEE w/contrast; monitor | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8925 | TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) WITH CONTRAST, REAL TIME WITH IMAGE; DOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE; PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT | 2D TEE w/contrast, int/rept | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8928 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, REAL-TIME WITH IMAGE; DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING, DURING REST AND; CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR; PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPORT | 2D transtho w/contr; stress | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8923 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, REAL-TIME WITH IMAGE; DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; COMPLETE | 2D com transtho echo w/contr | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8921 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST FOR CONGENITAL CARDIAC ANOMALIES;; COMPLETE | Comp transtho echo w/contr | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8922 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST FOR CONGENITAL CARDIAC ANOMALIES;; FOLLOW-UP OR LIMITED STUDY | Limit transtho echo w/contr | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8924 | TRANSTHORACIC ECHOCARDIOGRAPHY WITH CONTRAST, REAL-TIME WITH IMAGE; DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR LIMITED STUDY | 2D lim transtho echo w/contr | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2008 | 04/01/2008 | | C |
| C8920 | MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST,; PELVIS | MRA w/o fol w/cont, pelvis | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 430 BIPA | | | | 53 = Statute | YY | 01/01/2008 | | | | | 53 = Statute | 4 | 07/01/2003 | 04/01/2008 | | C |
| J7612 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,; ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG | Levalbuterol non-comp con | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 1 | 01/01/2005 | 04/01/2008 | | D |
| J7614 | LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,; ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG | Levalbuterol non-comp unit | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 1 | 01/01/2005 | 04/01/2008 | | D |
| J7613 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,; ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG | Albuterol non-comp unit | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 1 | 01/01/2005 | 04/01/2008 | | D |
| J7611 | ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,; ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1 MG | Albuterol non-comp con | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 1 | 01/01/2005 | 04/01/2008 | | D |
| G0297 | INSERTION OF SINGLE CHAMBER PACING CARDIOVERTER DEFIBRILLATOR PULSE GENERATOR | Insert single chamber/cd | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 10/01/2003 | 04/14/2008 | 12/31/2007 | D |
| G0377 | ADMINISTRATION OF VACCINE FOR PART D DRUG | Administra Part D vaccine | 11 = Price established using national rvu's (Physician Fee Schedule) | 11 = Price established using national rvu's (Physician Fee Schedule) | A | ; ; | ; ; | 1861s10B | | | | 11 = Price established using national rvu's (Physician Fee Schedule) | | | | | | | 11 = Price established using national rvu's (Physician Fee Schedule) | 1 | 01/01/2007 | 04/15/2008 | 12/31/2007 | D |
| A4455 | ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE | Adhesive remover per ounce | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1989 | 01/01/1995 | | N |
| A4461 | SURGICAL DRESSING HOLDER, NON-REUSABLE, EACH | Surgicl dress hold non-reuse | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2007 | 01/01/2007 | | N |
| A4462 | ABDOMINAL DRESSING HOLDER, EACH | Abdmnl drssng holder/binder | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/1998 | 01/01/2007 | 12/31/2006 | N |
| A4463 | SURGICAL DRESSING HOLDER, REUSABLE, EACH | Surgical dress holder reuse | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2007 | 01/01/2007 | | N |
| A4470 | GRAVLEE JET WASHER | Gravlee jet washer | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 50-4; ; | 2320; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1986 | 01/01/2001 | | N |
| A4480 | VABRA ASPIRATOR | Vabra aspirator | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 50-10; ; | 2320; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1986 | 01/01/2001 | | N |
| A4481 | TRACHEOSTOMA FILTER, ANY TYPE, ANY SIZE, EACH | Tracheostoma filter | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/2003 | | N |
| A4490 | SURGICAL STOCKINGS ABOVE KNEE LENGTH, EACH | Above knee surgical stocking | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | 2079; 2100; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1986 | 01/01/2003 | | N |
| A4495 | SURGICAL STOCKINGS THIGH LENGTH, EACH | Thigh length surg stocking | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | 2079; 2100; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1986 | 01/01/2003 | | N |
| A4500 | SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH | Below knee surgical stocking | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | 2079; 2100; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1986 | 01/01/2003 | | N |
| A4510 | SURGICAL STOCKINGS FULL LENGTH, EACH | Full length surg stocking | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | 2079; 2100; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1986 | 01/01/2003 | | N |
| A4521 | ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, SMALL SIZE, EACH | Adult size diaper sm each | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2005 | 12/31/2004 | N |
| A4522 | ADULT-SIZED INCONTINENCE PRODUCT, DIAPER, MEDIUM SIZE, EACH | Adult size diaper med each | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2005 | 12/31/2004 | N |
| A4616 | TUBING (OXYGEN), PER FOOT | Tubing (oxygen) per foot | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-4; ; | 3312; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1990 | 04/01/2007 | | P |
| A4617 | MOUTH PIECE | Mouth piece | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-4; ; | 3312; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1990 | 04/01/2007 | | P |
| A4619 | FACE TENT | Face tent | 33 = Oxygen and oxygen equipment (price subject to floors and ceilings) | 33 = Oxygen and oxygen equipment (price subject to floors and ceilings) | A | 60-4; ; | 3312; ; | | | | | 33 = Oxygen and oxygen equipment (price subject to floors and ceilings) | | | | | | | 33 = Oxygen and oxygen equipment (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1996 | | N |
| A4620 | VARIABLE CONCENTRATION MASK | Variable concentration mask | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-4; ; | 3312; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1990 | 04/01/2007 | | P |
| A4623 | TRACHEOSTOMY, INNER CANNULA | Tracheostomy inner cannula | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | 65-16; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/2004 | | N |
| A4625 | TRACHEOSTOMY CARE KIT FOR NEW TRACHEOSTOMY | Trach care kit for new trach | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/2003 | | N |
| A4626 | TRACHEOSTOMY CLEANING BRUSH, EACH | Tracheostomy cleaning brush | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/2003 | | N |
| A4627 | SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE; INHALER | Spacer bag/reservoir | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | 2100; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1991 | 01/01/1997 | | N |
| A4628 | OROPHARYNGEAL SUCTION CATHETER, EACH | Oropharyngeal suction cath | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1996 | 01/01/1996 | | N |
| A4629 | TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY | Tracheostomy care kit | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1996 | 01/01/2003 | | N |
| A4630 | REPLACEMENT BATTERIES, MEDICALLY NECESSARY, TRANSCUTANEOUS ELECTRICAL; STIMULATOR, OWNED BY PATIENT | Repl bat t.e.n.s. own by pt | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 65-8; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1991 | 01/01/2006 | | N |
| A4632 | REPLACEMENT BATTERY FOR EXTERNAL INFUSION PUMP, ANY TYPE, EACH | Infus pump rplcemnt battery | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/2003 | 01/01/2007 | 12/31/2006 | N |
| A4633 | REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH | Uvl replacement bulb | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2003 | 01/01/2003 | | N |
| A4634 | REPLACEMENT BULB FOR THERAPEUTIC LIGHT BOX, TABLETOP MODEL | Replacement bulb th lightbox | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2003 | | N |
| A4635 | UNDERARM PAD, CRUTCH, REPLACEMENT, EACH | Underarm crutch pad | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1991 | 01/01/1996 | | N |
| A4250 | URINE TEST OR REAGENT STRIPS OR TABLETS (100 TABLETS OR STRIPS) | Urine reagent strips/tablets | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | 2100; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1990 | 01/01/1997 | | N |
| A4252 | BLOOD KETONE TEST OR REAGENT STRIP, EACH | Blood ketone test or strip | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1861(n) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/2008 | 01/01/2008 | | A |
| A4254 | REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD; GLUCOSE MONITOR OWNED BY PATIENT, EACH | Battery for glucose monitor | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-11; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1996 | 01/01/2006 | 12/31/2005 | N |
| A4255 | PLATFORMS FOR HOME BLOOD GLUCOSE MONITOR, 50 PER BOX | Glucose monitor platforms | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-11; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/2002 | | N |
| A4256 | NORMAL, LOW AND HIGH CALIBRATOR SOLUTION / CHIPS | Calibrator solution/chips | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-11; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/2002 | | N |
| A4257 | REPLACEMENT LENS SHIELD CARTRIDGE FOR USE WITH LASER SKIN PIERCING DEVICE, EACH | Replace Lensshield Cartridge | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/2002 | 01/01/2002 | | N |
| D7220 | REMOVAL OF IMPACTED TOOTH-SOFT TISSUE | Impact tooth remov soft tiss | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1984 | 01/01/1993 | | N |
| D7230 | REMOVAL OF IMPACTED TOOTH-PARTIALLY BONY | Impact tooth remov part bony | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1984 | 01/01/1993 | | N |
| D7240 | REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY | Impact tooth remov comp bony | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1984 | 01/01/1993 | | N |
| D7241 | REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH UNUSUAL SURGICAL COMPLICATIONS | Impact tooth rem bony w/comp | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1984 | 01/01/1993 | | N |
| D7250 | SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) | Tooth root removal | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1984 | 01/01/1993 | | N |
| D7260 | ORAL ANTRAL FISTULA CLOSURE | Oral antral fistula closure | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1984 | 01/01/1993 | | N |
| D7270 | TOOTH REIMPLANTATION AND/OR STABILIZATION OF ACCIDENTALLY EVULSED OR DISPLACED; TOOTH | Tooth reimplantation | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7272 | TOOTH TRANSPLANTATION (INCLUDES REIMPLANTATION FROM ONE SITE TO ANOTHER AND; SPLINTING AND/OR STABILIZATION) | Tooth transplantation | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7280 | SURGICAL ACCESS OF AN UNERUPTED TOOTH | Exposure impact tooth orthod | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7282 | MOBILIZATION OF ERUPTED OR MALPOSITIONED TOOTH TO AID ERUPTION | Mobilize erupted/malpos toot | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| D7283 | PLACEMENT OF DEVICE TO FACILITATE ERUPTION OF IMPACTED TOOTH | Place device impacted tooth | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2005 | 01/01/2005 | | N |
| D7285 | BIOPSY OF ORAL TISSUE - HARD (BONE, TOOTH) | Biopsy of oral tissue hard | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 20220 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2000 | | N |
| D7286 | BIOPSY OF ORAL TISSUE - SOFT | Biopsy of oral tissue soft | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 40808 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2005 | | N |
| D7287 | EXFOLIATIVE CYTOLOGICAL SAMPLE COLLECTION | Exfoliative cytolog collect | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2005 | | N |
| D7288 | BRUSH BIOPSY - TRANSEPITHELIAL SAMPLE COLLECTION | Brush biopsy | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2005 | 01/01/2005 | | N |
| D7290 | SURGICAL REPOSITIONING OF TEETH | Repositioning of teeth | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7291 | TRANSSEPTAL FIBEROTOMY/SUPRA CRESTAL FIBEROTOMY, BY REPORT | Transseptal fiberotomy | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2136; 2336; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1986 | 01/01/2003 | | N |
| D7292 | SURGICAL PLACEMENT: TEMPORARY ANCHORAGE DEVICE [SCREW RETAINED PLATE] REQUIRING; SURGICAL FLAP | Screw retained plate | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2007 | 01/01/2007 | | N |
| D7293 | SURGICAL PLACEMENT: TEMPORARY ANCHORAGE DEVICE REQUIRING SURGICAL FLAP | Temp anchorage dev w flap | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2007 | 01/01/2007 | | N |
| D7294 | SURGICAL PLACEMENT: TEMPORARY ANCHORAGE DEVICE WITHOUT SURGICAL FLAP | Temp anchorage dev w/o flap | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2007 | 01/01/2007 | | N |
| D7310 | ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH; SPACES, PER QUADRANT | Alveoplasty w/ extraction | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 41874 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2007 | | N |
| D7320 | ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH; SPACES, PER QUADRANT | Alveoplasty w/o extraction | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 41870 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2007 | | N |
| D7321 | ALVEOLOPLASTY NOT IN CONJUNCTION WITH EXTRACTIONS - ONE TO THREE TEETH OR TOOTH; SPACES, PER QUADRANT | Alveoloplasty not w/extracts | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2005 | 01/01/2005 | | N |
| D7340 | VESTIBULOPLASTY-RIDGE EXTENSION (SECOND EPITHELIALIZATION) | Vestibuloplasty ridge extens | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 40840 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7350 | VESTIBULOPLASTY-RIDGE EXTENSION (INCLUDING SOFT TISSUE GRAFTS, MUSCLE; RE-ATTACHMENTS, REVISION OF SOFT TISSUE ATTACHMENT, AND MANAGEMENT OF; HYPERTROPHIED AND HYPERPLASTIC TISSUE) | Vestibuloplasty exten graft | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 40845 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7410 | EXCISION OF BENIGN LESION UP TO 1.25 CM | Rad exc lesion up to 1.25 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 20 | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/2003 | | N |
| D7412 | EXCISION OF BENIGN LESION, COMPLICATED | Excision benign lesion compl | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| D7413 | EXCISION OF MALIGNANT LESION UP TO 1.25 CM | Excision malig lesion<=1.25c | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| D7414 | EXCISION OF MALIGNANT LESION GREATER THAN 1.25 CM | Excision malig lesion>1.25cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| D7440 | EXCISION OF MALIGNANT TUMOR-LESION DIAMETER UP TO 1.25 CM | Malig tumor exc to 1.25 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 21 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7441 | EXCISION OF MALIGNANT TUMOR-LESION DIAMETER GREATER THAN 1.25 CM | Malig tumor > 1.25 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 21 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7450 | REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER UP T0 1.25 CM | Rem odontogen cyst to 1.25cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 21 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7451 | REMOVAL OF BENIGN ODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN 1.25 CM | Rem odontogen cyst > 1.25 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 21 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7461 | REMOVAL OF BENIGN NONODONTOGENIC CYST OR TUMOR-LESION DIAMETER GREATER THAN; 1.25 CM | Rem nonodonto cyst > 1.25 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 21 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7465 | DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHODS, BY REPORT | Lesion destruction | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 41850 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7471 | REMOVAL OF LATERAL EXOSTOSIS (MAXILLA OR MANDIBLE) | Rem exostosis any site | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21031 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2000 | 01/01/2003 | | N |
| D7472 | REMOVAL OF TORUS PALATINUS | Removal of torus palatinus | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| D7485 | SURGICAL REDUCTION OF OSSEOUS TUBEROSITY | Surg reduct osseoustuberosit | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| E0746 | ELECTROMYOGRAPHY (EMG), BIOFEEDBACK DEVICE | Electromyograph biofeedback | 52 = Reasonable charge | 52 = Reasonable charge | A | 35-27; ; | ; ; | | | | | 52 = Reasonable charge | | | | | | | 52 = Reasonable charge | A | 01/01/1989 | 01/01/1996 | | N |
| E0747 | OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, OTHER THAN SPINAL; APPLICATIONS | Elec osteogen stim not spine | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 35-48; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1997 | | N |
| E0748 | OSTEOGENESIS STIMULATOR, ELECTRICAL, NON-INVASIVE, SPINAL APPLICATIONS | Elec osteogen stim spinal | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 35-48; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1996 | 01/01/1997 | | N |
| E0749 | OSTEOGENESIS STIMULATOR, ELECTRICAL, SURGICALLY IMPLANTED | Elec osteogen stim implanted | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 35-48; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | 9 | 01/01/1986 | 07/01/2000 | | N |
| E0752 | IMPLANTABLE NEUROSTIMULATOR ELECTRODE, EACH | Neurostimulator electrode | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | A | ; ; | 65-8; ; | | | | L8680 | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | | | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | P | 01/01/2002 | 01/01/2006 | 12/31/2005 | N |
| E0755 | ELECTRONIC SALIVARY REFLEX STIMULATOR (INTRA-ORAL/NON-INVASIVE) | Electronic salivary reflex s | 52 = Reasonable charge | 52 = Reasonable charge | A | ; ; | ; ; | | | | | 52 = Reasonable charge | | | | | | | 52 = Reasonable charge | A | 01/01/1990 | 04/01/1995 | | N |
| E0756 | IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR | Implantable pulse generator | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | A | 65-8; ; | ; ; | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | | | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2006 | 12/31/2005 | N |
| E0757 | IMPLANTABLE NEUROSTIMULATOR RADIOFREQUENCY RECEIVER | Implantable RF receiver | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | A | 65-8; ; | ; ; | | | | L8682 | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | | | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2006 | 12/31/2005 | N |
| E0758 | RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR; RADIOFREQUENCY RECEIVER | External RF transmitter | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | A | 65-8; ; | ; ; | | | | L8683 | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | | | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2006 | 12/31/2005 | N |
| E0759 | RADIOFREQUENCY TRANSMITTER (EXTERNAL) FOR USE WITH IMPLANTABLE SACRAL ROOT; NEUROSTIMULATOR RECEIVER FOR BOWEL AND BLADDER MANAGEMENT, REPLACEMENT | Replace rdfrquncy transmittr | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | A | ; ; | ; ; | | | | L8684 | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | | | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | P | 01/01/2002 | 01/01/2006 | 12/31/2005 | N |
| E0761 | NON-THERMAL PULSED HIGH FREQUENCY RADIOWAVES, HIGH PEAK POWER ELECTROMAGNETIC; ENERGY TREATMENT DEVICE | Nontherm electromgntc device | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 35-102; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2005 | | N |
| E0762 | TRANSCUTANEOUS ELECTRICAL JOINT STIMULATION DEVICE SYSTEM, INCLUDES ALL; ACCESSORIES | Trans elec jt stim dev sys | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | A | 01/01/2006 | 01/01/2006 | | N |
| E0764 | FUNCTIONAL NEUROMUSCULAR STIMULATOR, TRANSCUTANEOUS STIMULATION OF MUSCLES OF; AMBULATION WITH COMPUTER CONTROL, USED FOR WALKING BY SPINAL CORD INJURED,; ENTIRE SYSTEM, AFTER COMPLETION OF TRAINING PROGRAM | Functional neuromuscularstim | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 35-77; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2006 | 01/01/2006 | | N |
| E0765 | FDA APPROVED NERVE STIMULATOR, WITH REPLACEABLE BATTERIES, FOR TREATMENT OF; NAUSEA AND VOMITING | Nerve stimulator for tx n&v | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2001 | 01/01/2001 | | N |
| E0776 | IV POLE | Iv pole | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1985 | 04/01/1995 | | N |
| E0779 | AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION 8 HOURS OR GREATER | Amb infusion pump mechanical | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | A | 01/01/2000 | 01/01/2000 | | N |
| E0780 | AMBULATORY INFUSION PUMP, MECHANICAL, REUSABLE, FOR INFUSION LESS THAN 8 HOURS | Mech amb infusion pump <8hrs | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2000 | 01/01/2000 | | N |
| E0781 | AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, ELECTRIC OR BATTERY; OPERATED, WITH ADMINISTRATIVE EQUIPMENT, WORN BY PATIENT | External ambulatory infus pu | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-14; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | 9 | 01/01/1987 | 07/01/2000 | | N |
| E0783 | INFUSION PUMP SYSTEM, IMPLANTABLE, PROGRAMMABLE (INCLUDES ALL COMPONENTS, E.G.,; PUMP, CATHETER, CONNECTORS, ETC.) | Programmable infusion pump | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-14; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1995 | 01/01/1998 | | N |
| E0784 | EXTERNAL AMBULATORY INFUSION PUMP, INSULIN | Ext amb infusn pump insulin | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-14; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1996 | 07/01/2000 | | N |
| E0785 | IMPLANTABLE INTRASPINAL (EPIDURAL/INTRATHECAL) CATHETER USED WITH IMPLANTABLE; INFUSION PUMP, REPLACEMENT | Replacement impl pump cathet | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | 60-14; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | P | 01/01/1999 | 01/01/1999 | | N |
| E0786 | IMPLANTABLE PROGRAMMABLE INFUSION PUMP, REPLACEMENT (EXCLUDES IMPLANTABLE; INTRASPINAL CATHETER) | Implantable pump replacement | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-14; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 9 | 01/01/2001 | 01/01/2001 | | N |
| E0791 | PARENTERAL INFUSION PUMP, STATIONARY, SINGLE OR MULTI-CHANNEL | Parenteral infusion pump sta | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 65-10; ; | 2130; 4450; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1989 | 01/01/1996 | | N |
| E0840 | TRACTION FRAME, ATTACHED TO HEADBOARD, CERVICAL TRACTION | Tract frame attach headboard | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1984 | 01/01/1994 | | N |
| E0849 | TRACTION EQUIPMENT, CERVICAL, FREE-STANDING STAND/FRAME, PNEUMATIC, APPLYING; TRACTION FORCE TO OTHER THAN MANDIBLE | Cervical pneum trac equip | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2005 | 01/01/2005 | | N |
| E0850 | TRACTION STAND, FREE STANDING, CERVICAL TRACTION | Traction stand free standing | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1982 | 01/01/1994 | | N |
| E0855 | CERVICAL TRACTION EQUIPMENT NOT REQUIRING ADDITIONAL STAND OR FRAME | Cervical traction equipment | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1998 | 01/01/1998 | | N |
| E0856 | CERVICAL TRACTION DEVICE, CERVICAL COLLAR WITH INFLATABLE AIR BLADDER | Cervic collar w air bladder | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2008 | 01/01/2008 | | A |
| E0860 | TRACTION EQUIPMENT, OVERDOOR, CERVICAL | Tract equip cervical tract | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1989 | | N |
| E0870 | TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION, (E.G. BUCK'S) | Tract frame attach footboard | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1994 | | N |
| E0880 | TRACTION STAND, FREE STANDING, EXTREMITY TRACTION, (E.G., BUCK'S) | Trac stand free stand extrem | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1994 | | N |
| E0890 | TRACTION FRAME, ATTACHED TO FOOTBOARD, PELVIC TRACTION | Traction frame attach pelvic | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1994 | | N |
| E0900 | TRACTION STAND, FREE STANDING, PELVIC TRACTION, (E.G., BUCK'S) | Trac stand free stand pelvic | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1994 | | N |
| E0910 | TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITH GRAB BAR | Trapeze bar attached to bed | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/1984 | | N |
| E0911 | TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS,; ATTACHED TO BED, WITH GRAB BAR | HD trapeze bar attach to bed | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/2006 | 01/01/2006 | | N |
| E0912 | TRAPEZE BAR, HEAVY DUTY, FOR PATIENT WEIGHT CAPACITY GREATER THAN 250 POUNDS,; FREE STANDING, COMPLETE WITH GRAB BAR | HD trapeze bar free standing | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/2006 | 01/01/2006 | | N |
| E0920 | FRACTURE FRAME, ATTACHED TO BED, INCLUDES WEIGHTS | Fracture frame attached to b | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/1989 | | N |
| E0930 | FRACTURE FRAME, FREE STANDING, INCLUDES WEIGHTS | Fracture frame free standing | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/1989 | | N |
| E0935 | CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE ON KNEE ONLY | Cont pas motion exercise dev | 31 = Frequently serviced DME (price subject to floors and ceilings) | 31 = Frequently serviced DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 31 = Frequently serviced DME (price subject to floors and ceilings) | | | | | | | 31 = Frequently serviced DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/2006 | | N |
| E0936 | CONTINUOUS PASSIVE MOTION EXERCISE DEVICE FOR USE OTHER THAN KNEE | CPM device, other than knee | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | 137 | 0 = Service not separately priced by part B | R | 01/01/2007 | 01/01/2007 | | N |
| E0941 | GRAVITY ASSISTED TRACTION DEVICE, ANY TYPE | Gravity assisted traction de | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/1989 | | N |
| E0942 | CERVICAL HEAD HARNESS/HALTER | Cervical head harness/halter | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1986 | | N |
| E0944 | PELVIC BELT/HARNESS/BOOT | Pelvic belt/harness/boot | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1985 | 01/01/1996 | | N |
| E0945 | EXTREMITY BELT/HARNESS | Belt/harness extremity | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1985 | 01/01/1996 | | N |
| E0947 | FRACTURE FRAME, ATTACHMENTS FOR COMPLEX PELVIC TRACTION | Fracture frame attachmnts pe | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1989 | | N |
| E0948 | FRACTURE FRAME, ATTACHMENTS FOR COMPLEX CERVICAL TRACTION | Fracture frame attachmnts ce | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1989 | | N |
| E0950 | WHEELCHAIR ACCESSORY, TRAY, EACH | Tray | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2004 | | N |
| E0951 | HEEL LOOP/HOLDER, ANY TYPE, WITH OR WITHOUT ANKLE STRAP, EACH | Loop heel | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2005 | | N |
| E0953 | PNEUMATIC TIRE, EACH | Pneumatic tire | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | E2211 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2006 | 12/31/2005 | N |
| E0954 | SEMI-PNEUMATIC CASTER, EACH | Wheelchair semi-pneumatic ca | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | E2219 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2006 | 12/31/2005 | N |
| E0955 | WHEELCHAIR ACCESSORY, HEADREST, CUSHIONED, ANY TYPE, INCLUDING FIXED MOUNTING; HARDWARE, EACH | Cushioned headrest | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2004 | 01/01/2005 | | N |
| E0957 | WHEELCHAIR ACCESSORY, MEDIAL THIGH SUPPORT, ANY TYPE, INCLUDING FIXED MOUNTING; HARDWARE, EACH | W/c medial thigh support | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2004 | 01/01/2005 | | N |
| E0958 | MANUAL WHEELCHAIR ACCESSORY, ONE-ARM DRIVE ATTACHMENT, EACH | Whlchr att- conv 1 arm drive | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | R | 01/01/1986 | 01/01/2004 | | N |
| E0959 | MANUAL WHEELCHAIR ACCESSORY, ADAPTER FOR AMPUTEE, EACH | Amputee adapter | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2004 | | N |
| E0960 | WHEELCHAIR ACCESSORY, SHOULDER HARNESS/STRAPS OR CHEST STRAP, INCLUDING ANY; TYPE MOUNTING HARDWARE | W/c shoulder harness/straps | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/2004 | 01/01/2004 | | N |
| E0961 | MANUAL WHEELCHAIR ACCESSORY, WHEEL LOCK BRAKE EXTENSION (HANDLE), EACH | Wheelchair brake extension | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2004 | | N |
| E0963 | 2" CUSHION, FOR WHEELCHAIR | Wheelchair 2 inch cushion | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2005 | 12/31/2004 | N |
| E0964 | 3" CUSHION, FOR WHEELCHAIR | Wheelchair 3 inch cushion | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2005 | 12/31/2004 | N |
| E0965 | 4" CUSHION, FOR WHEELCHAIR | Wheelchair 4 inch cushion | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2005 | 12/31/2004 | N |
| E0966 | MANUAL WHEELCHAIR ACCESSORY, HEADREST EXTENSION, EACH | Wheelchair head rest extensi | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 01/01/2004 | | N |
| E0967 | MANUAL WHEELCHAIR ACCESSORY, HAND RIM WITH PROJECTIONS, ANY TYPE, EACH | Manual wc hand rim w project | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/2007 | | N |
| E0968 | COMMODE SEAT, WHEELCHAIR | Wheelchair commode seat | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/1989 | | N |
| E0969 | NARROWING DEVICE, WHEELCHAIR | Wheelchair narrowing device | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | | | | | | | 32 = Inexpensive & routinely purchased DME (price subject to floors and ceilings) | A | 01/01/1986 | 01/01/1989 | | N |
| E0970 | NO.2 FOOTPLATES, EXCEPT FOR ELEVATING LEG REST | Wheelchair no. 2 footplates | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | K0037 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | A | 01/01/1986 | 04/01/2001 | | N |
| D7856 | MYOTOMY | Tmj cutting of a muscle | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21299 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7858 | JOINT RECONSTRUCTION | Tmj reconstruction | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21242 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7860 | ARTHROTOMY | Tmj cutting into joint | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | 2336; 2136; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7865 | ARTHROPLASTY | Tmj reshaping components | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21240 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7870 | ARTHROCENTESIS | Tmj aspiration joint fluid | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21060 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7871 | NON-ARTHROSCOPIC LYSIS AND LAVAGE | Lysis + lavage w catheters | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a(12) | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2000 | 01/01/2000 | | N |
| D7872 | ARTHROSCOPY-DIAGNOSIS, WITH OR WITHOUT BIOPSY | Tmj diagnostic arthroscopy | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 29800 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7873 | ARTHROSCOPY-SURGICAL: LAVAGE AND LYSIS OF ADHESIONS | Tmj arthroscopy lysis adhesn | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 29804 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7874 | ARTHROSCOPY-SURGICAL: DISC REPOSITIONING AND STABILIZATION | Tmj arthroscopy disc reposit | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 29804 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7876 | ARTHROSCOPY-SURGICAL: DISCECTOMY | Tmj arthroscopy discectomy | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 29804 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7877 | ARTHROSCOPY-SURGICAL: DEBRIDEMENT | Tmj arthroscopy debridement | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 29804 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| D7880 | OCCLUSAL ORTHOTIC APPLIANCE | Occlusal orthotic appliance | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21499 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1986 | 01/01/1996 | | N |
| D7910 | SUTURE OF RECENT SMALL WOUNDS UP TO 5 CM | Dent sutur recent wnd to 5cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 12011 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7911 | COMPLICATED SUTURE-UP TO 5 CM | Dental suture wound to 5 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 12051 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7912 | COMPLICATED SUTURE-GREATER THAN 5 CM | Suture complicate wnd > 5 cm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 13132 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7940 | OSTEOPLASTY-FOR ORTHOGNATHIC DEFORMITIES | Reshaping bone orthognathic | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | A | ; ; | 2336; 2136; | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | | | | | | | 13 = Price established by carriers (e.G., not otherwise classified, individual determination, Clinical Lab Fee Schedule) | 2 | 01/01/1982 | 01/01/1993 | | N |
| D7941 | OSTEOTOMY - MANDIBULAR RAMI | Bone cutting ramus closed | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21193 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2000 | | N |
| D7943 | OSTEOTOMY - MANDIBULAR RAMI WITH BONE GRAFT; INCLUDES OBTAINING THE GRAFT | Cutting ramus open w/graft | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21194 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2000 | | N |
| D7944 | OSTEOTOMY-SEGMENTED OR SUBAPICAL | Bone cutting segmented | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21198 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2007 | | N |
| D7946 | LEFORT I (MAXILLA-TOTAL) | Reconstruction maxilla total | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21147 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7947 | LEFORT I (MAXILLA-SEGMENTED) | Reconstruct maxilla segment | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21145 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7948 | LEFORT II OR LEFORT III (OSTEOPLASTY OF FACIAL BONES FOR MIDFACE HYPOPLASIA OR; RETRUSION)-WITHOUT BONE GRAFT | Reconstruct midface no graft | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21150 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7949 | LEFORT II OR LEFORT III-WITH BONE GRAFT | Reconstruct midface w/graft | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 31 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7490 | RADICAL RESECTION OF MAXILLA OR MANDIBLE | Maxilla or mandible resectio | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21095 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/2005 | | N |
| D7510 | INCISION AND DRAINAGE OF ABSCESS-INTRAORAL SOFT TISSUE | I&d absc intraoral soft tiss | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 41800 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7511 | INCISION AND DRAINAGE OF ABSCESS - INTRAORAL SOFT TISSUE - COMPLICATED; (INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES) | Incision/drain abscess intra | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2005 | 01/01/2005 | | N |
| D7520 | INCISION AND DRAINAGE OF ABSCESS-EXTRAORAL SOFT TISSUE | I&d abscess extraoral | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 40800 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7521 | INCISION AND DRAINAGE OF ABSCESS - EXTRAORAL SOFT TISSUE - COMPLICATED; (INCLUDES DRAINAGE OF MULTIPLE FASCIAL SPACES) | Incision/drain abscess extra | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2005 | 01/01/2005 | | N |
| D7530 | REMOVAL OF FOREIGN BODY FROM MUCOSA, SKIN, OR SUBCUTANEOUS ALVEOLAR TISSUE | Removal fb skin/areolar tiss | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 41805 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7540 | REMOVAL OF REACTION-PRODUCING FOREIGN BODIES-MUSCULOSKELETAL SYSTEM | Removal of fb reaction | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 20520 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7550 | PARTIAL OSTECTOMY/SEQUESTRECTOMY FOR REMOVAL OF NON-VITAL BONE | Removal of sloughed off bone | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 20999 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/2003 | | N |
| D7560 | MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY | Maxillary sinusotomy | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 31020 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7610 | MAXILLA-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT) | Maxilla open reduct simple | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 22 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7620 | MAXILLA-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT) | Clsd reduct simpl maxilla fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 23 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7630 | MANDIBLE-OPEN REDUCTION (TEETH IMMOBILIZED IF PRESENT) | Open red simpl mandible fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 24 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7640 | MANDIBLE-CLOSED REDUCTION (TEETH IMMOBILIZED IF PRESENT) | Clsd red simpl mandible fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 25 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7650 | MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION | Open red simp malar/zygom fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 26 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7660 | MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION | Clsd red simp malar/zygom fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 27 | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7671 | ALVEOLUS - OPEN REDUCTION, MAY INCLUDE STABILIZATION OF TEETH | Alveolus open reduction | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/2003 | 01/01/2003 | | N |
| D7680 | FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL; APPROACHES | Reduct simple facial bone fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | CPT | 0 = Service not separately priced by part B | | | | | | 29 | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7710 | MAXILLA-OPEN REDUCTION | Maxilla open reduct compound | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21346 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7720 | MAXILLA-CLOSED REDUCTION | Clsd reduct compd maxilla fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21345 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7740 | MANDIBLE-CLOSED REDUCTION | Clsd reduct compd mandble fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21455 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7750 | MALAR AND/OR ZYGOMATIC ARCH-OPEN REDUCTION | Open red comp malar/zygma fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21360 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7760 | MALAR AND/OR ZYGOMATIC ARCH-CLOSED REDUCTION | Clsd red comp malar/zygma fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21355 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7770 | ALVEOLUS - OPEN REDUCTION STABILIZATION OF TEETH | Open reduc compd alveolus fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21422 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/2003 | | N |
| D7780 | FACIAL BONES-COMPLICATED REDUCTION WITH FIXATION AND MULTIPLE SURGICAL; APPROACHES | Reduct compnd facial bone fx | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21433 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7810 | OPEN REDUCTION OF DISLOCATION | Tmj open reduct-dislocation | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21490 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7820 | CLOSED REDUCTION OF DISLOCATION | Closed tmp manipulation | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21480 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7840 | CONDYLECTOMY | Removal of tmj condyle | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21050 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1982 | 01/01/1996 | | N |
| D7850 | SURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT | Tmj meniscectomy | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21060 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1984 | 01/01/1996 | | N |
| D7852 | DISC REPAIR | Tmj repair of joint disc | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | 21299 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 2 | 01/01/1992 | 01/01/1996 | | N |
| E0745 | NEUROMUSCULAR STIMULATOR, ELECTRONIC SHOCK UNIT | Neuromuscular stim for shock | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | 35-77; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | R | 01/01/1986 | 01/01/1996 | | N |
| A6506 | COMPRESSION BURN GARMENT, GLOVE TO AXILLA, CUSTOM FABRICATED | Cmprsburngrmnt glove-axilla | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6507 | COMPRESSION BURN GARMENT, FOOT TO KNEE LENGTH, CUSTOM FABRICATED | Cmprs burngarment foot-knee | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6508 | COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED | Cmprs burngarment foot-thigh | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6509 | COMPRESSION BURN GARMENT, UPPER TRUNK TO WAIST INCLUDING ARM OPENINGS (VEST),; CUSTOM FABRICATED | Compres burn garment jacket | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6510 | COMPRESSION BURN GARMENT, TRUNK, INCLUDING ARMS DOWN TO LEG OPENINGS (LEOTARD),; CUSTOM FABRICATED | Compres burn garment leotard | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6511 | COMPRESSION BURN GARMENT, LOWER TRUNK INCLUDING LEG OPENINGS (PANTY), CUSTOM; FABRICATED | Compres burn garment panty | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6512 | COMPRESSION BURN GARMENT, NOT OTHERWISE CLASSIFIED | Compres burn garment, noc | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | S | 01/01/2003 | 01/01/2003 | | N |
| A6513 | COMPRESSION BURN MASK, FACE AND/OR NECK, PLASTIC OR EQUAL, CUSTOM FABRICATED | Compress burn mask face/neck | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/2006 | 01/01/2006 | | N |
| A6530 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH | Compression stocking BK18-30 | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | 72 | 0 = Service not separately priced by part B | P | 01/01/2006 | 01/01/2006 | | N |
| A6531 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH | Compression stocking BK30-40 | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | 72 | 35 = Surgical dressings (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A6532 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH | Compression stocking BK40-50 | 35 = Surgical dressings (price subject to floors and ceilings) | 35 = Surgical dressings (price subject to floors and ceilings) | A | ; ; | 2079; ; | | | | | 35 = Surgical dressings (price subject to floors and ceilings) | | | | | | 72 | 35 = Surgical dressings (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A6533 | GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 18-30 MMHG, EACH | Gc stocking thighlngth 18-30 | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | 2133; ; | | | | | 0 = Service not separately priced by part B | | | | | | 72 | 0 = Service not separately priced by part B | P | 01/01/2006 | 01/01/2006 | | N |
| A4258 | SPRING-POWERED DEVICE FOR LANCET, EACH | Lancet device each | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-11; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1996 | 01/01/2002 | | N |
| A4260 | LEVONORGESTREL (CONTRACEPTIVE) IMPLANTS SYSTEM, INCLUDING IMPLANTS AND SUPPLIES | Levonorgestrel implant | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a1A | | | J7306 | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1993 | 01/01/2006 | 12/31/2005 | N |
| A4261 | CERVICAL CAP FOR CONTRACEPTIVE USE | Cervical cap contraceptive | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | 1862a1 | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1999 | 01/01/1999 | | N |
| A4262 | TEMPORARY, ABSORBABLE LACRIMAL DUCT IMPLANT, EACH | Temporary tear duct plug | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | 52 | 0 = Service not separately priced by part B | 9 | 01/01/1994 | 01/01/1998 | | N |
| A4265 | PARAFFIN, PER POUND | Paraffin | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-9; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | 9 | 01/01/1986 | 01/01/2002 | | N |
| A4266 | DIAPHRAGM FOR CONTRACEPTIVE USE | Diaphragm | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2003 | | N |
| A4267 | CONTRACEPTIVE SUPPLY, CONDOM, MALE, EACH | Male condom | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2003 | | N |
| A4268 | CONTRACEPTIVE SUPPLY, CONDOM, FEMALE, EACH | Female condom | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2003 | | N |
| A4270 | DISPOSABLE ENDOSCOPE SHEATH, EACH | Disposable endoscope sheath | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1994 | 04/01/1995 | | N |
| A4280 | ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH | Brst prsths adhsv attchmnt | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | | | | | | | 38 = Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2000 | | N |
| A4281 | TUBING FOR BREAST PUMP, REPLACEMENT | Replacement breastpump tube | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2007 | | N |
| A4283 | CAP FOR BREAST PUMP BOTTLE, REPLACEMENT | Replacement breastpump cap | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2007 | | N |
| A4284 | BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT | Replcmnt breast pump shield | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2007 | | N |
| A4285 | POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT | Replcmnt breast pump bottle | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2007 | | N |
| A4286 | LOCKING RING FOR BREAST PUMP, REPLACEMENT | Replcmnt breastpump lok ring | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/2003 | 01/01/2007 | | N |
| A4300 | IMPLANTABLE ACCESS CATHETER, (E,G., VENOUS, ARTERIAL, EPIDURAL SUBARACHNOID, OR; PERITONEAL, ETC.) EXTERNAL ACCESS | Cath impl vasc access portal | 11 = Price established using national rvu's (Physician Fee Schedule) | 11 = Price established using national rvu's (Physician Fee Schedule) | A | ; ; | 2130; ; | | | | | 11 = Price established using national rvu's (Physician Fee Schedule) | | | | | | | 11 = Price established using national rvu's (Physician Fee Schedule) | S | 01/01/1986 | 01/01/2002 | | N |
| A4301 | IMPLANTABLE ACCESS TOTAL CATHETER, PORT/RESERVOIR (E.G., VENOUS, ARTERIAL,; EPIDURAL, SUBARACHNOID, PERITONEAL, ETC.) | Implantable access syst perc | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1996 | 01/01/2003 | | N |
| A4305 | DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR | Drug delivery system >=50 ML | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1993 | 01/01/2006 | | N |
| A4306 | DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF LESS THAN 50 ML PER HOUR | Drug delivery system <=50 ml | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | 9 | 01/01/1993 | 01/01/2007 | | N |
| A4310 | INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY) | Insert tray w/o bag/cath | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4311 | INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,; TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR; HYDROPHILIC, ETC.) | Catheter w/o bag 2-way latex | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4312 | INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,; TWO-WAY, ALL SILICONE | Cath w/o bag 2-way silicone | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4313 | INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,; THREE-WAY, FOR CONTINUOUS IRRIGATION | Catheter w/bag 3-way | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4314 | INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY; LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC, ETC.) | Cath w/drainage 2-way latex | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4315 | INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY,; ALL SILICONE | Cath w/drainage 2-way silcne | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4316 | INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE,; THREE-WAY, FOR CONTINUOUS IRRIGATION | Cath w/drainage 3-way | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4321 | THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION | Cath therapeutic irrig agent | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/2003 | | N |
| A4322 | IRRIGATION SYRINGE, BULB OR PISTON, EACH | Irrigation syringe | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1996 | | N |
| A4324 | MALE EXTERNAL CATHETER, WITH ADHESIVE COATING, EACH | Male ext cath w/adh coating | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | A4349 | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2005 | 12/31/2004 | N |
| A4326 | MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH | Male external catheter | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/2007 | | N |
| A4327 | FEMALE EXTERNAL URINARY COLLECTION DEVICE; MEATAL CUP, EACH | Fem urinary collect dev cup | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4328 | FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH | Fem urinary collect pouch | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1990 | | N |
| A4330 | PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH | Stool collection pouch | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1996 | | N |
| A4332 | LUBRICANT, INDIVIDUAL STERILE PACKET, EACH | Lube sterile packet | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2005 | | N |
| A4333 | URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH | Urinary cath anchor device | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2003 | | N |
| A4334 | URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH | Urinary cath leg strap | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2003 | | N |
| A4335 | INCONTINENCE SUPPLY; MISCELLANEOUS | Incontinence supply | 46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) | 46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) | A | ; ; | 2130; ; | | | | | 46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) | | | | | | | 46 = Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) | P | 01/01/1990 | 01/01/1990 | | N |
| A4338 | INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE,; SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH | Indwelling catheter latex | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1996 | | N |
| A4344 | INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH | Cath indw foley 2 way silicn | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1983 | 01/01/1996 | | N |
| A4346 | INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH | Cath indw foley 3 way | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1983 | 01/01/1996 | | N |
| A4347 | MALE EXTERNAL CATHETER WITH OR WITHOUT ADHESIVE, WITH OR WITHOUT ANTI-REFLUX; DEVICE; PER DOZEN | Male external catheter | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1983 | 01/01/2005 | 12/31/2004 | N |
| A4348 | MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION COMPARTMENT, EXTENDED WEAR,; EACH (E.G., 2 PER MONTH) | Male ext cath extended wear | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2007 | 12/31/2006 | N |
| A4349 | MALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE, DISPOSABLE, EACH | Disposable male external cat | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2005 | 01/01/2005 | | N |
| A4352 | INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING; (TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH | Coude tip urinary catheter | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/2002 | | N |
| A4353 | INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES | Intermittent urinary cath | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/2003 | | N |
| A4354 | INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER | Cath insertion tray w/bag | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1986 | 01/01/1990 | | N |
| A4355 | IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY; INDWELLING FOLEY CATHETER, EACH | Bladder irrigation tubing | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1984 | 01/01/1996 | | N |
| A4356 | EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER; CLAMP), EACH | Ext ureth clmp or compr dvc | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1996 | | N |
| A4357 | BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR; WITHOUT TUBE, EACH | Bedside drainage bag | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1996 | | N |
| A4358 | URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS,; EACH | Urinary leg or abdomen bag | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/2002 | | N |
| A4359 | URINARY SUSPENSORY WITHOUT LEG BAG, EACH | Urinary suspensory w/o leg b | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/2007 | 12/31/2006 | N |
| A4361 | OSTOMY FACEPLATE, EACH | Ostomy face plate | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1996 | | N |
| A4362 | SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH | Solid skin barrier | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1990 | | N |
| A4363 | OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH | Ostomy clamp, replacement | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | 124 | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A4364 | ADHESIVE, LIQUID OR EQUAL, ANY TYPE, PER OZ | Adhesive, liquid or equal | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/2003 | | N |
| A4365 | ADHESIVE REMOVER WIPES, ANY TYPE, PER 50 | Adhesive remover wipes | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/2003 | | N |
| A4366 | OSTOMY VENT, ANY TYPE, EACH | Ostomy vent | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4367 | OSTOMY BELT, EACH | Ostomy belt | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130A; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1996 | | N |
| A4368 | OSTOMY FILTER, ANY TYPE, EACH | Ostomy filter | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/1997 | | N |
| A4369 | OSTOMY SKIN BARRIER, LIQUID (SPRAY, BRUSH, ETC), PER OZ | Skin barrier liquid per oz | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4372 | OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, STANDARD WEAR, WITH BUILT-IN; CONVEXITY, EACH | Skin barrier solid 4x4 equiv | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2006 | | N |
| A4373 | OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDIAN), WITH BUILT-IN; CONVEXITY, ANY SIZE, EACH | Skin barrier with flange | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4375 | OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, PLASTIC, EACH | Drainable plastic pch w fcpl | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4376 | OSTOMY POUCH, DRAINABLE, WITH FACEPLATE ATTACHED, RUBBER, EACH | Drainable rubber pch w fcplt | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4378 | OSTOMY POUCH, DRAINABLE, FOR USE ON FACEPLATE, RUBBER, EACH | Drainable rubber pch w/o fp | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4379 | OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, PLASTIC, EACH | Urinary plastic pouch w fcpl | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4380 | OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH | Urinary rubber pouch w fcplt | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4381 | OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, PLASTIC, EACH | Urinary plastic pouch w/o fp | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4383 | OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, RUBBER, EACH | Urinary rubber pouch w/o fp | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4384 | OSTOMY FACEPLATE EQUIVALENT, SILICONE RING, EACH | Ostomy faceplt/silicone ring | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4385 | OSTOMY SKIN BARRIER, SOLID 4X4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN; CONVEXITY, EACH | Ost skn barrier sld ext wear | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4387 | OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1 PIECE),; EACH | Ost clsd pouch w att st barr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4389 | OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY (1; PIECE), EACH | Drainable pch w st wear barr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4390 | OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN; CONVEXITY (1 PIECE), EACH | Drainable pch ex wear convex | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4391 | OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED (1 PIECE), EACH | Urinary pouch w ex wear barr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4392 | OSTOMY POUCH, URINARY, WITH STANDARD WEAR BARRIER ATTACHED, WITH BUILT-IN; CONVEXITY (1 PIECE), EACH | Urinary pouch w st wear barr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4393 | OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN; CONVEXITY (1 PIECE), EACH | Urine pch w ex wear bar conv | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2003 | | N |
| A4394 | OSTOMY DEODORANT, WITH OR WITHOUT LUBRICANT, FOR USE IN OSTOMY POUCH, PER; FLUID OUNCE | Ostomy pouch liq deodorant | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2000 | 01/01/2007 | | N |
| A4396 | OSTOMY BELT WITH PERISTOMAL HERNIA SUPPORT | Peristomal hernia supprt blt | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2001 | 01/01/2003 | | N |
| A4397 | IRRIGATION SUPPLY; SLEEVE, EACH | Irrigation supply sleeve | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1990 | 01/01/1996 | | N |
| A4398 | OSTOMY IRRIGATION SUPPLY; BAG, EACH | Ostomy irrigation bag | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1989 | 01/01/1997 | | N |
| A4399 | OSTOMY IRRIGATION SUPPLY; CONE/CATHETER, INCLUDING BRUSH | Ostomy irrig cone/cath w brs | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1989 | 01/01/1997 | | N |
| A4402 | LUBRICANT, PER OUNCE | Lubricant per ounce | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1995 | | N |
| A4404 | OSTOMY RING, EACH | Ostomy ring each | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/1985 | 01/01/1995 | | N |
| A4405 | OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE | Nonpectin based ostomy paste | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2003 | | N |
| A4407 | OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE, OR ACCORDION), EXTENDED; WEAR, WITH BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH | Ext wear ost skn barr <=4sq" | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2003 | | N |
| A4408 | OSTOMY SKIN BARRIER, WTIH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,; WITH BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH | Ext wear ost skn barr >4sq" | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2003 | | N |
| A4409 | OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,; WITHOUT BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH | Ost skn barr convex <=4 sq i | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2006 | | N |
| A4410 | OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR,; WITHOUT BUILT-IN CONVEXITY, LARGER THAN 4 X 4 INCHES, EACH | Ost skn barr extnd >4 sq | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2006 | | N |
| A4412 | OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE; SYSTEM), WITHOUT FILTER, EACH | Ost pouch drain high output | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | 124 | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A4413 | OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE; SYSTEM), WITH FILTER, EACH | 2 pc drainable ost pouch | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2003 | | N |
| A4414 | OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT; BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH | Ost sknbar w/o conv<=4 sq in | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2006 | | N |
| A4415 | OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), WITHOUT; BUILT-IN CONVEXITY, LARGER THAN 4X4 INCHES, EACH | Ost skn barr w/o conv >4 sqi | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2006 | | N |
| A4417 | OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH; FILTER (1 PIECE), EACH | Ost pch w bar/bltinconv/fltr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4418 | OSTOMY POUCH, CLOSED; WITHOUT BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH | Ost pch clsd w/o bar w filtr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4419 | OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH FILTER; (2 PIECE), EACH | Ost pch for bar w flange/flt | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4420 | OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH | Ost pch clsd for bar w lk fl | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4422 | OSTOMY ABSORBENT MATERIAL (SHEET/PAD/CRYSTAL PACKET) FOR USE IN OSTOMY POUCH TO; THICKEN LIQUID STOMAL OUTPUT, EACH | Ost pouch absorbent material | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2003 | 01/01/2003 | | N |
| A4423 | OSTOMY POUCH, CLOSED; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2; PIECE), EACH | Ost pch for bar w lk fl/fltr | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4424 | OSTOMY POUCH, DRAINABLE, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH | Ost pch drain w bar & filter | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4426 | OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE; SYSTEM), EACH | Ost pch drain 2 piece system | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4427 | OSTOMY POUCH, DRAINABLE; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FILTER (2; PIECE SYSTEM), EACH | Ost pch drain/barr lk flng/f | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4428 | OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FAUCET-TYPE; TAP WITH VALVE (1 PIECE), EACH | Urine ost pouch w faucet/tap | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4429 | OSTOMY POUCH, URINARY, WITH BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH; FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH | Urine ost pouch w bltinconv | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4430 | OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN; CONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH | Ost urine pch w b/bltin conv | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4431 | OSTOMY POUCH, URINARY; WITH BARRIER ATTACHED, WITH FAUCET-TYPE TAP WITH VALVE; (1 PIECE), EACH | Ost pch urine w barrier/tapv | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4432 | OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH NON-LOCKING FLANGE, WITH; FAUCET-TYPE TAP WITH VALVE (2 PIECE), EACH | Os pch urine w bar/fange/tap | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4433 | OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH | Urine ost pch bar w lock fln | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4434 | OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE, WITH FAUCET-TYPE; TAP WITH VALVE (2 PIECE), EACH | Ost pch urine w lock flng/ft | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | P | 01/01/2004 | 01/01/2004 | | N |
| A4450 | TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES | Non-waterproof tape | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | L | 01/01/2003 | 01/01/2003 | | N |
| A4452 | TAPE, WATERPROOF, PER 18 SQUARE INCHES | Waterproof tape | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2130; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | L | 01/01/2003 | 01/01/2003 | | N |
| A0888 | NONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR MILES TRAVELED BEYOND CLOSEST; APPROPRIATE FACILITY) | Noncovered ambulance mileage | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | 2125; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | D | 01/01/1995 | 01/01/1995 | | N |
| A0998 | AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT | Ambulance response/treatment | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | D | 01/01/2006 | 01/01/2006 | | N |
| A4206 | SYRINGE WITH NEEDLE, STERILE, 1 CC OR LESS, EACH | 1 CC sterile syringe&needle | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1985 | 01/01/2008 | | C |
| A4207 | SYRINGE WITH NEEDLE, STERILE 2CC, EACH | 2 CC sterile syringe&needle | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1985 | 01/01/2007 | | N |
| A4208 | SYRINGE WITH NEEDLE, STERILE 3CC, EACH | 3 CC sterile syringe&needle | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1985 | 01/01/2007 | | N |
| A4210 | NEEDLE-FREE INJECTION DEVICE, EACH | Nonneedle injection device | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-9; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1989 | 01/01/1996 | | N |
| A4211 | SUPPLIES FOR SELF-ADMINISTERED INJECTIONS | Supp for self-adm injections | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | 2049; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1993 | 01/01/1997 | | N |
| A4212 | NON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER | Non coring needle or stylet | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | S | 01/01/1993 | 01/01/2000 | | N |
| A4213 | SYRINGE, STERILE, 20 CC OR GREATER, EACH | 20+ CC syringe only | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | S | 01/01/1985 | 01/01/2007 | | N |
| A4216 | STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML | Sterile water/saline, 10 ml | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2049; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 1 | 01/01/2004 | 01/01/2007 | | N |
| A4217 | STERILE WATER/SALINE, 500 ML | Sterile water/saline, 500 ml | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | A | ; ; | 2049; ; | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | | | | | | | 37 = Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) | 1 | 01/01/2004 | 01/01/2004 | | N |
| A4218 | STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML | Sterile saline or water | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | | | | | | 127 | 51 = Drugs | 1 | 01/01/2006 | 01/01/2006 | | N |
| A4221 | SUPPLIES FOR MAINTENANCE OF DRUG INFUSION CATHETER, PER WEEK (LIST DRUG; SEPARATELY) | Maint drug infus cath per wk | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/1997 | | N |
| A4222 | INFUSION SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE OR BAG (LIST; DRUGS SEPARATELY) | Infusion supplies with pump | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1997 | 01/01/2005 | | N |
| A4223 | INFUSION SUPPLIES NOT USED WITH EXTERNAL INFUSION PUMP, PER CASSETTE OR BAG; (LIST DRUGS SEPARATELY) | Infusion supplies w/o pump | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/2005 | 01/01/2007 | | N |
| A4230 | INFUSION SET FOR EXTERNAL INSULIN PUMP, NON NEEDLE CANNULA TYPE | Infus insulin pump non needl | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-14; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1996 | 01/01/2000 | | N |
| A4231 | INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE | Infusion insulin pump needle | 34 = DME supplies (price subject to floors and ceilings) | 34 = DME supplies (price subject to floors and ceilings) | A | 60-14; ; | ; ; | | | | | 34 = DME supplies (price subject to floors and ceilings) | | | | | | | 34 = DME supplies (price subject to floors and ceilings) | P | 01/01/1996 | 01/01/2000 | | N |
| A4232 | SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3CC | Syringe w/needle insulin 3cc | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | 60-14; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | P | 01/01/1996 | 04/01/2003 | | N |
| A4233 | REPLACEMENT BATTERY, ALKALINE (OTHER THAN J CELL), FOR USE WITH MEDICALLY; NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH | Alkalin batt for glucose mon | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A4234 | REPLACEMENT BATTERY, ALKALINE, J CELL, FOR USE WITH MEDICALLY NECESSARY HOME; BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH | J-cell batt for glucose mon | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A4235 | REPLACEMENT BATTERY, LITHIUM, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD; GLUCOSE MONITOR OWNED BY PATIENT, EACH | Lithium batt for glucose mon | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A4236 | REPLACEMENT BATTERY, SILVER OXIDE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD; GLUCOSE MONITOR OWNED BY PATIENT, EACH | Silvr oxide batt glucose mon | 36 = Capped rental DME (price subject to floors and ceilings) | 36 = Capped rental DME (price subject to floors and ceilings) | A | ; ; | ; ; | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | | | | | | | 36 = Capped rental DME (price subject to floors and ceilings) | P | 01/01/2006 | 01/01/2006 | | N |
| A4244 | ALCOHOL OR PEROXIDE, PER PINT | Alcohol or peroxide per pint | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | L | 01/01/1985 | 01/01/2007 | | N |
| A4245 | ALCOHOL WIPES, PER BOX | Alcohol wipes per box | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | L | 01/01/1985 | 01/01/2007 | | N |
| A4246 | BETADINE OR PHISOHEX SOLUTION, PER PINT | Betadine/phisohex solution | 0 = Service not separately priced by part B | 0 = Service not separately priced by part B | 9 | ; ; | ; ; | | | | | 0 = Service not separately priced by part B | | | | | | | 0 = Service not separately priced by part B | L | 01/01/1985 | 01/01/2007 | | N |
| A4248 | CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML | Chlorhexidine antisept | 52 = Reasonable charge | 52 = Reasonable charge | A | ; ; | ; ; | | | | | 52 = Reasonable charge | | | | | | | 52 = Reasonable charge | L | 01/01/2004 | 01/01/2004 | | N |
| B9999 | NOC FOR PARENTERAL SUPPLIES | Parenteral supp not othrws c | 57 = Other carrier priced | 57 = Other carrier priced | A | 65-10; ; | 2130; 4450; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | E | 01/01/1985 | 01/01/1996 | | N |
| C1079 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, CYANOCOBALAMIN CO; 57/58, PER 0.5 MICROCURIE | CO 57/58 per 0.5 uCi | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833(T) | | | A9546 | 53 = Statute | | | | | | 93 | 53 = Statute | 4 | 08/01/2000 | 01/01/2006 | 12/31/2005 | N |
| C1080 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER; DOSE | I-131 tositumomab, dx | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833T | | | A9544 | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2004 | 01/01/2006 | 12/31/2005 | N |
| C1081 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER; DOSE | I-131 tositumomab, tx | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833T | | | A9545 | 53 = Statute | | | | | | 93 | 53 = Statute | 6 | 01/01/2004 | 01/01/2006 | 12/31/2005 | N |
| C1082 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB; TIUXETAN, PER DOSE | In-111 ibritumomab tiuxetan | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833T | | | A9542 | 53 = Statute | | | | | | 93 | 53 = Statute | 4 | 01/01/2004 | 01/01/2006 | 12/31/2005 | N |
| C1083 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB; TIUXETAN, PER DOSE | Yttrium 90 ibritumomab tiuxe | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833T | | | A9543 | 53 = Statute | | | | | | 93 | 53 = Statute | 6 | 01/01/2004 | 01/01/2006 | 12/31/2005 | N |
| C1091 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111; OXYQUINOLINE, PER 0.5 MILLICURIE | IN111 oxyquinoline,per0.5mCi | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833(T) | | | A9547 | 53 = Statute | | | | | | 93 | 53 = Statute | 4 | 08/01/2000 | 01/01/2006 | 12/31/2005 | N |
| C1092 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 PENTETATE,; PER 0.5 MILLICURIE | IN 111 pentetate per 0.5 mCi | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833(T) | | | A9548 | 53 = Statute | | | | | | 93 | 53 = Statute | 4 | 08/01/2000 | 01/01/2006 | 12/31/2005 | N |
| C1093 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M; FANOLESOMAB, PER DOSE (10 - 20 MCI) | TC99M fanolesomab | 53 = Statute | 53 = Statute | A | ; ; | ; ; | 1833(T) | | | A9566 | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2005 | 01/01/2006 | 12/31/2005 | N |
| A9520 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M; SULFUR COLLOID, PER MCI | Technetiumtc-99m sulfur clld | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2003 | 01/01/2006 | 12/31/2005 | N |
| A9521 | TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | Tc99m exametazime | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2003 | 01/01/2006 | | N |
| A9522 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB; TIUXETAN, PER MCI | Indium111ibritumomabtiuxetan | 51 = Drugs | 51 = Drugs | A | ; ; | 15022; ; | | | | | 51 = Drugs | | | | | | | 51 = Drugs | 4 | 01/01/2003 | 01/01/2006 | 12/31/2005 | N |
| A9523 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, YTTRIUM 90 IBRITUMOMAB; TIUXETAN, PER MCI | Yttrium90ibritumomabtiuxetan | 51 = Drugs | 51 = Drugs | A | ; ; | 15022; ; | | | | | 51 = Drugs | | | | | | | 51 = Drugs | 6 | 01/01/2003 | 01/01/2006 | 12/31/2005 | N |
| A9524 | IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES | I131 serum albumin, dx | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2003 | 01/01/2006 | | N |
| A9526 | NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE, UP TO 40 MILLICURIES | Nitrogen N-13 ammonia | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2004 | 01/01/2006 | | N |
| A9527 | IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE | Iodine I-125 sodium iodide | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | YY | 01/01/2008 | | | | | 57 = Other carrier priced | 4 | 01/01/2007 | 01/01/2007 | | N |
| A9528 | IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC, PER MILLICURIE | Iodine I-131 iodide cap, dx | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2004 | 01/01/2006 | | N |
| A9529 | IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE | I131 iodide sol, dx | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2004 | 01/01/2006 | | N |
| A9531 | IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES) | I131 max 100uCi | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2004 | 01/01/2006 | | N |
| A9532 | IODINE I-125 SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES | I125 serum albumin, dx | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 6 | 01/01/2004 | 01/01/2006 | | N |
| A9533 | SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER; MILLICURIE | I-131 tositumomab diagnostic | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2004 | 01/01/2006 | 12/31/2005 | N |
| A9534 | SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER; MILLICURIE | I-131 tositumomab therapeut | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 6 | 01/01/2004 | 01/01/2006 | 12/31/2005 | N |
| A9536 | TECHNETIUM TC-99M DEPREOTIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 35 MILLICURIES | Tc99m depreotide | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9537 | TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES | Tc99m mebrofenin | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9538 | TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25; MILLICURIES | Tc99m pyrophosphate | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9540 | TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10; MILLICURIES | Tc99m MAA | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9541 | TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20; MILLICURIES | Tc99m sulfur colloid | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9542 | INDIUM IN-111 IBRITUMOMAB TIUXETAN, DIAGNOSTIC, PER STUDY DOSE, UP TO 5; MILLICURIES | In111 ibritumomab, dx | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | | | | | | | 51 = Drugs | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9543 | YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40; MILLICURIES | Y90 ibritumomab, rx | 51 = Drugs | 51 = Drugs | A | ; ; | ; ; | | | | | 51 = Drugs | | | | | | | 51 = Drugs | 6 | 01/01/2006 | 01/01/2006 | | N |
| A9544 | IODINE I-131 TOSITUMOMAB, DIAGNOSTIC, PER STUDY DOSE | I131 tositumomab, dx | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9545 | IODINE I-131 TOSITUMOMAB, THERAPEUTIC, PER TREATMENT DOSE | I131 tositumomab, rx | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 6 | 01/01/2006 | 01/01/2006 | | N |
| A9546 | COBALT CO-57/58, CYANOCOBALAMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 1 MICROCURIE | Co57/58 | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9547 | INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE | In111 oxyquinoline | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9548 | INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE | In111 pentetate | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9549 | TECHNETIUM TC-99M ARCITUMOMAB, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES | Tc99m arcitumomab | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2007 | 12/31/2006 | N |
| A9550 | TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25; MILLICURIE | Tc99m gluceptate | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9551 | TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES | Tc99m succimer | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9552 | FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES | F18 fdg | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9553 | CHROMIUM CR-51 SODIUM CHROMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 250; MICROCURIES | Cr51 chromate | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9554 | IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10; MICROCURIES | I125 iothalamate, dx | 53 = Statute | 53 = Statute | A | ; ; | ; ; | | | | | 53 = Statute | | | | | | | 53 = Statute | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9555 | RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES | Rb82 rubidium | 99 = Value not established | 99 = Value not established | 9 | ; ; | ; ; | | | | | 99 = Value not established | | | | | | | 99 = Value not established | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9556 | GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE | Ga67 gallium | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | | | 57 = Other carrier priced | | | | | | | 57 = Other carrier priced | 4 | 01/01/2006 | 01/01/2006 | | N |
| A9558 | XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES | Xe133 xenon 10mci | 57 = Other carrier priced | 57 = Other carrier priced | A | ; ; | ; ; | | | |
This report may not contain all data. Click here to view the complete interactive data set.