| A7523 | Tracheostomy shower protector, each |
| A7524 | Tracheostoma stent/stud/button, each |
| A7525 | Tracheostomy mask, each |
| A7526 | Tracheostomy tube collar/holder, each |
| A7527 | Tracheostomy/laryngectomy tube plug/stop, each |
| A8000 | Helmet, protective, soft, prefabricated, includes all components and accessories |
| A8001 | Helmet, protective, hard, prefabricated, includes all components and accessories |
| A8002 | Helmet, protective, soft, custom fabricated, includes all components and accessories |
| A8003 | Helmet, protective, hard, custom fabricated, includes all components and accessories |
| A8004 | Soft interface for helmet, replacement only |
| A9150 | Non-prescription drugs |
| A9152 | Single vitamin/mineral/trace element, oral, per dose, not otherwise specified |
| A9153 | Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified |
| A9155 | Artificial saliva, 30 ml |
| A9180 | Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker |
| A9270 | Non-covered item or service |
| A9272 | Wound suction, disposable, includes dressing, all accessories and components, any type, each |
| A9273 | Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type |
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
| A9275 | Home glucose disposable monitor, includes test strips |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
| A9278 | Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system |
| A9279 | Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
| A9280 | Alert or alarm device, not otherwise classified |
| A9281 | Reaching/grabbing device, any type, any length, each |
| A9282 | Wig, any type, each |
| A9283 | Foot pressure off loading/supportive device, any type, each |
| A9284 | Spirometer, non-electronic, includes all accessories |
| A9285 | Inversion/eversion correction device |
| A9286 | Hygienic item or device, disposable or non-disposable, any type, each |
| A9291 | Prescription digital cognitive and/or behavioral therapy, fda cleared, per course of treatment |
| A9300 | Exercise equipment |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose |
| A9501 | Technetium tc-99m teboroxime, diagnostic, per study dose |
| A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose |
| A9503 | Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries |
| A9504 | Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries |
| A9505 | Thallium tl-201 thallous chloride, diagnostic, per millicurie |
| A9507 | Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries |
| A9508 | Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie |
| A9509 | Iodine i-123 sodium iodide, diagnostic, per millicurie |
| A9510 | Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries |
| A9512 | Technetium tc-99m pertechnetate, diagnostic, per millicurie |
| A9513 | Lutetium lu 177, dotatate, therapeutic, 1 millicurie |
| A9515 | Choline c-11, diagnostic, per study dose up to 20 millicuries |
| A9516 | Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries |
| A9517 | Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie |
| A9520 | Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries |
| A9521 | Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries |
| A9524 | Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries |
| A9526 | Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries |
| A9527 | Iodine i-125, sodium iodide solution, therapeutic, per millicurie |
| A9528 | Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie |
| A9529 | Iodine i-131 sodium iodide solution, diagnostic, per millicurie |
| A9530 | Iodine i-131 sodium iodide solution, therapeutic, per millicurie |
| A9531 | Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) |
| A9532 | Iodine i-125 serum albumin, diagnostic, per 5 microcuries |
| A9536 | Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries |
| A9537 | Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
| A9538 | Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries |
| A9539 | Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries |
| A9540 | Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries |
| A9541 | Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
| A9542 | Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries |
| A9543 | Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries |
| A9544 | Iodine i-131 tositumomab, diagnostic, per study dose |
| A9545 | Iodine i-131 tositumomab, therapeutic, per treatment dose |
| A9546 | Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie |
| A9547 | Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie |
| A9548 | Indium in-111 pentetate, diagnostic, per 0.5 millicurie |
| A9550 | Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie |
| A9551 | Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
| A9553 | Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries |
| A9554 | Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries |
| A9555 | Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries |
| A9556 | Gallium ga-67 citrate, diagnostic, per millicurie |
| A9557 | Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries |
| A9558 | Xenon xe-133 gas, diagnostic, per 10 millicuries |
| A9559 | Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie |
| A9560 | Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries |
| A9561 | Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries |
| A9562 | Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries |
| A9563 | Sodium phosphate p-32, therapeutic, per millicurie |
| A9564 | Chromic phosphate p-32 suspension, therapeutic, per millicurie |
| A9566 | Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries |
| A9567 | Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries |
| A9568 | Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries |
| A9569 | Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose |
| A9570 | Indium in-111 labeled autologous white blood cells, diagnostic, per study dose |
| A9571 | Indium in-111 labeled autologous platelets, diagnostic, per study dose |
| A9572 | Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries |
| A9575 | Injection, gadoterate meglumine, 0.1 ml |
| A9576 | Injection, gadoteridol, (prohance multipack), per ml |
| A9577 | Injection, gadobenate dimeglumine (multihance), per ml |
| A9578 | Injection, gadobenate dimeglumine (multihance multipack), per ml |
| A9579 | Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
| A9580 | Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries |
| A9581 | Injection, gadoxetate disodium, 1 ml |
| A9582 | Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries |
| A9583 | Injection, gadofosveset trisodium, 1 ml |
| A9584 | Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries |
| A9585 | Injection, gadobutrol, 0.1 ml |
| A9586 | Florbetapir f18, diagnostic, per study dose, up to 10 millicuries |
| A9587 | Gallium ga-68, dotatate, diagnostic, 0.1 millicurie |
| A9588 | Fluciclovine f-18, diagnostic, 1 millicurie |
| A9589 | Instillation, hexaminolevulinate hydrochloride, 100 mg |
| A9590 | Iodine i-131, iobenguane, 1 millicurie |
| A9591 | Fluoroestradiol f 18, diagnostic, 1 millicurie |
| A9592 | Copper cu-64, dotatate, diagnostic, 1 millicurie |
| A9593 | Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie |
| A9594 | Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie |
| A9595 | Piflufolastat f-18, diagnostic, 1 millicurie |
| A9596 | Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie |
| A9597 | Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified |
| A9598 | Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified |
| A9599 | Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified |
| A9600 | Strontium sr-89 chloride, therapeutic, per millicurie |
| A9601 | Flortaucipir f 18 injection, diagnostic, 1 millicurie |
| A9602 | Fluorodopa f-18, diagnostic, per millicurie |
| A9604 | Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries |
| A9606 | Radium ra-223 dichloride, therapeutic, per microcurie |
| A9607 | Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie |
| A9698 | Non-radioactive contrast imaging material, not otherwise classified, per study |
| A9699 | Radiopharmaceutical, therapeutic, not otherwise classified |
| A9700 | Supply of injectable contrast material for use in echocardiography, per study |
| A9800 | Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie |
| A9900 | Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
| A9901 | Dme delivery, set up, and/or dispensing service component of another hcpcs code |
| A9999 | Miscellaneous dme supply or accessory, not otherwise specified |
| A0021 | Ambulance service, outside state per mile, transport (medicaid only) |
| A0080 | Non-emergency transportation, per mile - vehicle provided by volunteer (individual or organization), with no vested interest |
| A0090 | Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interest |
| A0100 | Non-emergency transportation; taxi |
| A0110 | Non-emergency transportation and bus, intra or inter state carrier |
| A0120 | Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
| A0130 | Non-emergency transportation: wheelchair van |
| A0140 | Non-emergency transportation and air travel (private or commercial) intra or inter state |
| A0160 | Non-emergency transportation: per mile - case worker or social worker |
| A0170 | Transportation ancillary: parking fees, tolls, other |
| A0180 | Non-emergency transportation: ancillary: lodging-recipient |
| A0190 | Non-emergency transportation: ancillary: meals-recipient |
| A0200 | Non-emergency transportation: ancillary: lodging escort |
| A0210 | Non-emergency transportation: ancillary: meals-escort |
| A0225 | Ambulance service, neonatal transport, base rate, emergency transport, one way |
| A0380 | Bls mileage (per mile) |
| A0382 | Bls routine disposable supplies |
| A0384 | Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances) |
| A0390 | Als mileage (per mile) |
| A0392 | Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances) |
| A0394 | Als specialized service disposable supplies; iv drug therapy |
| A0396 | Als specialized service disposable supplies; esophageal intubation |
| A0398 | Als routine disposable supplies |
| A0420 | Ambulance waiting time (als or bls), one half (1/2) hour increments |
| A0422 | Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation |
| A0424 | Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review) |
| A0425 | Ground mileage, per statute mile |
| A0426 | Ambulance service, advanced life support, non-emergency transport, level 1 (als 1) |
| A0427 | Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) |
| A0428 | Ambulance service, basic life support, non-emergency transport, (bls) |
| A0429 | Ambulance service, basic life support, emergency transport (bls-emergency) |
| A0430 | Ambulance service, conventional air services, transport, one way (fixed wing) |
| A0431 | Ambulance service, conventional air services, transport, one way (rotary wing) |
| A0432 | Paramedic intercept (pi), rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers |
| A0433 | Advanced life support, level 2 (als 2) |
| A0434 | Specialty care transport (sct) |
| A0435 | Fixed wing air mileage, per statute mile |
| A0436 | Rotary wing air mileage, per statute mile |
| A0888 | Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility) |
| A0998 | Ambulance response and treatment, no transport |
| A0999 | Unlisted ambulance service |
| A2001 | Innovamatrix ac, per square centimeter |
| A2002 | Mirragen advanced wound matrix, per square centimeter |
| A2004 | Xcellistem, 1 mg |
| A2005 | Microlyte matrix, per square centimeter |
| A2006 | Novosorb synpath dermal matrix, per square centimeter |
| A2007 | Restrata, per square centimeter |
| A2008 | Theragenesis, per square centimeter |
| A2009 | Symphony, per square centimeter |
| A2010 | Apis, per square centimeter |
| A2011 | Supra sdrm, per square centimeter |
| A2012 | Suprathel, per square centimeter |
| A2013 | Innovamatrix fs, per square centimeter |
| A2014 | Omeza collagen matrix, per 100 mg |
| A2015 | Phoenix wound matrix, per square centimeter |
| A2016 | Permeaderm b, per square centimeter |
| A2017 | Permeaderm glove, each |
| A2018 | Permeaderm c, per square centimeter |
| A2019 | Kerecis omega3 marigen shield, per square centimeter |
| A2020 | Ac5 advanced wound system (ac5) |
| A2021 | Neomatrix, per square centimeter |
| A4100 | Skin substitute, fda cleared as a device, not otherwise specified |
| A4206 | Syringe with needle, sterile, 1 cc or less, each |
| A4207 | Syringe with needle, sterile 2 cc, each |
| A4208 | Syringe with needle, sterile 3 cc, each |
| A4209 | Syringe with needle, sterile 5 cc or greater, each |
| A4210 | Needle-free injection device, each |
| A4211 | Supplies for self-administered injections |
| A4212 | Non-coring needle or stylet with or without catheter |
| A4213 | Syringe, sterile, 20 cc or greater, each |
| A4215 | Needle, sterile, any size, each |
| A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml |
| A4217 | Sterile water/saline, 500 ml |
| A4218 | Sterile saline or water, metered dose dispenser, 10 ml |
| A4220 | Refill kit for implantable infusion pump |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) |
| A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) |
| A4224 | Supplies for maintenance of insulin infusion catheter, per week |
| A4225 | Supplies for external insulin infusion pump, syringe type cartridge, sterile, each |
| A4226 | Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per week |
| A4230 | Infusion set for external insulin pump, non needle cannula type |
| A4231 | Infusion set for external insulin pump, needle type |
| A4232 | Syringe with needle for external insulin pump, sterile, 3 cc |
| A4233 | Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, each |
| A4234 | Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each |
| A4235 | Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each |
| A4236 | Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each |
| A4238 | Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
| A4239 | Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
| A4244 | Alcohol or peroxide, per pint |
| A4245 | Alcohol wipes, per box |
| A4246 | Betadine or phisohex solution, per pint |
| A4247 | Betadine or iodine swabs/wipes, per box |
| A4248 | Chlorhexidine containing antiseptic, 1 ml |
| A4250 | Urine test or reagent strips or tablets (100 tablets or strips) |
| A4252 | Blood ketone test or reagent strip, each |
| A4253 | Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
| A4255 | Platforms for home blood glucose monitor, 50 per box |
| A4256 | Normal, low and high calibrator solution / chips |
| A4257 | Replacement lens shield cartridge for use with laser skin piercing device, each |
| A4258 | Spring-powered device for lancet, each |
| A4259 | Lancets, per box of 100 |
| A4261 | Cervical cap for contraceptive use |
| A4262 | Temporary, absorbable lacrimal duct implant, each |
| A4263 | Permanent, long term, non-dissolvable lacrimal duct implant, each |
| A4264 | Permanent implantable contraceptive intratubal occlusion device(s) and delivery system |
| A4265 | Paraffin, per pound |
| A4266 | Diaphragm for contraceptive use |
| A4267 | Contraceptive supply, condom, male, each |
| A4268 | Contraceptive supply, condom, female, each |
| A4269 | Contraceptive supply, spermicide (e.g., foam, gel), each |
| A4270 | Disposable endoscope sheath, each |
| A4280 | Adhesive skin support attachment for use with external breast prosthesis, each |
| A4281 | Tubing for breast pump, replacement |
| A4282 | Adapter for breast pump, replacement |
| A4283 | Cap for breast pump bottle, replacement |
| A4284 | Breast shield and splash protector for use with breast pump, replacement |
| A4285 | Polycarbonate bottle for use with breast pump, replacement |
| A4286 | Locking ring for breast pump, replacement |
| A4290 | Sacral nerve stimulation test lead, each |
| A4300 | Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access |
| A4301 | Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) |
| A4305 | Disposable drug delivery system, flow rate of 50 ml or greater per hour |
| A4306 | Disposable drug delivery system, flow rate of less than 50 ml per hour |
| A4310 | Insertion tray without drainage bag and without catheter (accessories only) |
| A4311 | Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
| A4312 | Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone |
| A4313 | Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation |
| A4314 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) |
| A4315 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone |
| A4316 | Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation |
| A4320 | Irrigation tray with bulb or piston syringe, any purpose |
| A4321 | Therapeutic agent for urinary catheter irrigation |
| A4322 | Irrigation syringe, bulb or piston, each |
| A4326 | Male external catheter with integral collection chamber, any type, each |
| A4327 | Female external urinary collection device; meatal cup, each |
| A4328 | Female external urinary collection device; pouch, each |
| A4330 | Perianal fecal collection pouch with adhesive, each |
| A4331 | Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each |
| A4332 | Lubricant, individual sterile packet, each |
| A4333 | Urinary catheter anchoring device, adhesive skin attachment, each |
| A4334 | Urinary catheter anchoring device, leg strap, each |
| A4335 | Incontinence supply; miscellaneous |
| A4336 | Incontinence supply, urethral insert, any type, each |
| A4337 | Incontinence supply, rectal insert, any type, each |
| A4338 | Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
| A4340 | Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each |
| A4341 | Indwelling intraurethral drainage device with valve, patient inserted, replacement only, each |
| A4342 | Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each |
| A4344 | Indwelling catheter, foley type, two-way, all silicone, each |
| A4346 | Indwelling catheter; foley type, three way for continuous irrigation, each |
| A4349 | Male external catheter, with or without adhesive, disposable, each |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each |
| A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each |
| A4353 | Intermittent urinary catheter, with insertion supplies |
| A4354 | Insertion tray with drainage bag but without catheter |
| A4355 | Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each |
| A4356 | External urethral clamp or compression device (not to be used for catheter clamp), each |
| A4357 | Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each |
| A4358 | Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
| A4360 | Disposable external urethral clamp or compression device, with pad and/or pouch, each |
| A4361 | Ostomy faceplate, each |
| A4362 | Skin barrier; solid, 4 x 4 or equivalent; each |
| A4363 | Ostomy clamp, any type, replacement only, each |
| A4364 | Adhesive, liquid or equal, any type, per oz |
| A4366 | Ostomy vent, any type, each |
| A4367 | Ostomy belt, each |
| A4368 | Ostomy filter, any type, each |
| A4369 | Ostomy skin barrier, liquid (spray, brush, etc.), per oz |
| A4371 | Ostomy skin barrier, powder, per oz |
| A4372 | Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each |
| A4373 | Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each |
| A4375 | Ostomy pouch, drainable, with faceplate attached, plastic, each |
| A4376 | Ostomy pouch, drainable, with faceplate attached, rubber, each |
| A4377 | Ostomy pouch, drainable, for use on faceplate, plastic, each |
| A4378 | Ostomy pouch, drainable, for use on faceplate, rubber, each |
| A4379 | Ostomy pouch, urinary, with faceplate attached, plastic, each |
| A4380 | Ostomy pouch, urinary, with faceplate attached, rubber, each |
| A4381 | Ostomy pouch, urinary, for use on faceplate, plastic, each |
| A4382 | Ostomy pouch, urinary, for use on faceplate, heavy plastic, each |
| A4383 | Ostomy pouch, urinary, for use on faceplate, rubber, each |
| A4384 | Ostomy faceplate equivalent, silicone ring, each |
| A4385 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each |
| A4387 | Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each |
| A4388 | Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each |
| A4389 | Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each |
| A4390 | Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each |
| A4391 | Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each |
| A4392 | Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each |
| A4393 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each |
| A4394 | Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce |
| A4395 | Ostomy deodorant for use in ostomy pouch, solid, per tablet |
| A4396 | Ostomy belt with peristomal hernia support |
| A4397 | Irrigation supply; sleeve, each |
| A4398 | Ostomy irrigation supply; bag, each |
| A4399 | Ostomy irrigation supply; cone/catheter, with or without brush |
| A4400 | Ostomy irrigation set |
| A4402 | Lubricant, per ounce |
| A4404 | Ostomy ring, each |
| A4405 | Ostomy skin barrier, non-pectin based, paste, per ounce |
| A4406 | Ostomy skin barrier, pectin-based, paste, per ounce |
| A4407 | Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each |
| A4408 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each |
| A4409 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each |
| A4410 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each |
| A4411 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each |
| A4412 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each |
| A4413 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each |
| A4414 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each |
| A4415 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each |
| A4416 | Ostomy pouch, closed, with barrier attached, with filter (1 piece), each |
| A4417 | Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each |
| A4418 | Ostomy pouch, closed; without barrier attached, with filter (1 piece), each |
| A4419 | Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each |
| A4420 | Ostomy pouch, closed; for use on barrier with locking flange (2 piece), each |
| A4421 | Ostomy supply; miscellaneous |
| A4422 | Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each |
| A4423 | Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each |
| A4424 | Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each |
| A4425 | Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each |
| A4426 | Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each |
| A4427 | Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each |
| A4428 | Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each |
| A4429 | Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
| A4430 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each |
| A4431 | Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each |
| A4432 | Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each |
| A4433 | Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each |
| A4434 | Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each |
| A4435 | Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each |
| A4436 | Irrigation supply; sleeve, reusable, per month |
| A4437 | Irrigation supply; sleeve, disposable, per month |
| A4450 | Tape, non-waterproof, per 18 square inches |
| A4452 | Tape, waterproof, per 18 square inches |
| A4453 | Rectal catheter for use with the manual pump-operated enema system, replacement only |
| A4455 | Adhesive remover or solvent (for tape, cement or other adhesive), per ounce |
| A4456 | Adhesive remover, wipes, any type, each |
| A4458 | Enema bag with tubing, reusable |
| A4459 | Manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type |
| A4461 | Surgical dressing holder, non-reusable, each |
| A4463 | Surgical dressing holder, reusable, each |
| A4465 | Non-elastic binder for extremity |
| A4466 | Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each |
| A4467 | Belt, strap, sleeve, garment, or covering, any type |
| A4470 | Gravlee jet washer |
| A4480 | Vabra aspirator |
| A4481 | Tracheostoma filter, any type, any size, each |
| A4483 | Moisture exchanger, disposable, for use with invasive mechanical ventilation |
| A4490 | Surgical stockings above knee length, each |
| A4495 | Surgical stockings thigh length, each |
| A4500 | Surgical stockings below knee length, each |
| A4510 | Surgical stockings full length, each |
| A4520 | Incontinence garment, any type, (e.g., brief, diaper), each |
| A4550 | Surgical trays |
| A4553 | Non-disposable underpads, all sizes |
| A4554 | Disposable underpads, all sizes |
| A4555 | Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only |
| A4556 | Electrodes, (e.g., apnea monitor), per pair |
| A4557 | Lead wires, (e.g., apnea monitor), per pair |
| A4558 | Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz |
| A4559 | Coupling gel or paste, for use with ultrasound device, per oz |
| A4560 | Neuromuscular electrical stimulator (nmes), disposable, replacement only |
| A4561 | Pessary, rubber, any type |
| A4562 | Pessary, non rubber, any type |
| A4563 | Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type each |
| A4565 | Slings |
| A4566 | Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustment |
| A4570 | Splint |
| A4575 | Topical hyperbaric oxygen chamber, disposable |
| A4580 | Cast supplies (e.g., plaster) |
| A4590 | Special casting material (e.g., fiberglass) |
| A4595 | Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
| A4596 | Cranial electrotherapy stimulation (ces) system supplies and accessories, per month |
| A4600 | Sleeve for intermittent limb compression device, replacement only, each |
| A4601 | Lithium ion battery, rechargeable, for non-prosthetic use, replacement |
| A4602 | Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each |
| A4604 | Tubing with integrated heating element for use with positive airway pressure device |
| A4605 | Tracheal suction catheter, closed system, each |
| A4606 | Oxygen probe for use with oximeter device, replacement |
| A4608 | Transtracheal oxygen catheter, each |
| A4611 | Battery, heavy duty; replacement for patient owned ventilator |
| A4612 | Battery cables; replacement for patient-owned ventilator |
| A4613 | Battery charger; replacement for patient-owned ventilator |
| A4614 | Peak expiratory flow rate meter, hand held |
| A4615 | Cannula, nasal |
| A4616 | Tubing (oxygen), per foot |
| A4617 | Mouth piece |
| A4618 | Breathing circuits |
| A4619 | Face tent |
| A4620 | Variable concentration mask |
| A4623 | Tracheostomy, inner cannula |
| A4624 | Tracheal suction catheter, any type other than closed system, each |
| A4625 | Tracheostomy care kit for new tracheostomy |
| A4626 | Tracheostomy cleaning brush, each |
| A4627 | Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler |
| A4628 | Oral and/or oropharyngeal suction catheter, each |
| A4629 | Tracheostomy care kit for established tracheostomy |
| A4630 | Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient |
| A4633 | Replacement bulb/lamp for ultraviolet light therapy system, each |
| A4634 | Replacement bulb for therapeutic light box, tabletop model |
| A4635 | Underarm pad, crutch, replacement, each |
| A4636 | Replacement, handgrip, cane, crutch, or walker, each |
| A4637 | Replacement, tip, cane, crutch, walker, each. |
| A4638 | Replacement battery for patient-owned ear pulse generator, each |
| A4639 | Replacement pad for infrared heating pad system, each |
| A4640 | Replacement pad for use with medically necessary alternating pressure pad owned by patient |
| A4641 | Radiopharmaceutical, diagnostic, not otherwise classified |
| A4642 | Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries |
| A4648 | Tissue marker, implantable, any type, each |
| A4649 | Surgical supply; miscellaneous |
| A4650 | Implantable radiation dosimeter, each |
| A4651 | Calibrated microcapillary tube, each |
| A4652 | Microcapillary tube sealant |
| A4653 | Peritoneal dialysis catheter anchoring device, belt, each |
| A4657 | Syringe, with or without needle, each |
| A4660 | Sphygmomanometer/blood pressure apparatus with cuff and stethoscope |
| A4663 | Blood pressure cuff only |
| A4670 | Automatic blood pressure monitor |
| A4671 | Disposable cycler set used with cycler dialysis machine, each |
| A4672 | Drainage extension line, sterile, for dialysis, each |
| A4673 | Extension line with easy lock connectors, used with dialysis |
| A4674 | Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 oz |
| A4680 | Activated carbon filter for hemodialysis, each |
| A4690 | Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, each |
| A4706 | Bicarbonate concentrate, solution, for hemodialysis, per gallon |
| A4707 | Bicarbonate concentrate, powder, for hemodialysis, per packet |
| A4708 | Acetate concentrate solution, for hemodialysis, per gallon |
| A4709 | Acid concentrate, solution, for hemodialysis, per gallon |
| A4714 | Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallon |
| A4719 | "y set" tubing for peritoneal dialysis |
| A4720 | Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis |
| A4721 | Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysis |
| A4722 | Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysis |
| A4723 | Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis |
| A4724 | Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis |
| A4725 | Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysis |
| A4726 | Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysis |
| A4728 | Dialysate solution, non-dextrose containing, 500 ml |
| A4730 | Fistula cannulation set for hemodialysis, each |
| A4736 | Topical anesthetic, for dialysis, per gram |
| A4737 | Injectable anesthetic, for dialysis, per 10 ml |
| A4740 | Shunt accessory, for hemodialysis, any type, each |
| A4750 | Blood tubing, arterial or venous, for hemodialysis, each |
| A4755 | Blood tubing, arterial and venous combined, for hemodialysis, each |
| A4760 | Dialysate solution test kit, for peritoneal dialysis, any type, each |
| A4765 | Dialysate concentrate, powder, additive for peritoneal dialysis, per packet |
| A4766 | Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 ml |
| A4770 | Blood collection tube, vacuum, for dialysis, per 50 |
| A4771 | Serum clotting time tube, for dialysis, per 50 |
| A4772 | Blood glucose test strips, for dialysis, per 50 |
| A4773 | Occult blood test strips, for dialysis, per 50 |
| A4774 | Ammonia test strips, for dialysis, per 50 |
| A4802 | Protamine sulfate, for hemodialysis, per 50 mg |
| A4860 | Disposable catheter tips for peritoneal dialysis, per 10 |
| A4870 | Plumbing and/or electrical work for home hemodialysis equipment |
| A4890 | Contracts, repair and maintenance, for hemodialysis equipment |
| A4911 | Drain bag/bottle, for dialysis, each |
| A4913 | Miscellaneous dialysis supplies, not otherwise specified |
| A4918 | Venous pressure clamp, for hemodialysis, each |
| A4927 | Gloves, non-sterile, per 100 |
| A4928 | Surgical mask, per 20 |
| A4929 | Tourniquet for dialysis, each |
| A4930 | Gloves, sterile, per pair |
| A4931 | Oral thermometer, reusable, any type, each |
| A4932 | Rectal thermometer, reusable, any type, each |
| A5051 | Ostomy pouch, closed; with barrier attached (1 piece), each |
| A5052 | Ostomy pouch, closed; without barrier attached (1 piece), each |
| A5053 | Ostomy pouch, closed; for use on faceplate, each |
