HCPCS A codes
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 interestA0090 Non-emergency transportation, per mile - vehicle provided by individual (family member, self, neighbor) with vested interestA0100 Non-emergency transportation; taxiA0110 Non-emergency transportation and bus, intra or inter state carrierA0120 Non-emergency transportation: mini-bus, mountain area transports, or other transportation systemsA0130 Non-emergency transportation: wheelchair vanA0140 Non-emergency transportation and air travel (private or commercial) intra or inter stateA0160 Non-emergency transportation: per mile - case worker or social workerA0170 Transportation ancillary: parking fees, tolls, otherA0180 Non-emergency transportation: ancillary: lodging-recipientA0190 Non-emergency transportation: ancillary: meals-recipientA0200 Non-emergency transportation: ancillary: lodging escortA0210 Non-emergency transportation: ancillary: meals-escortA0225 Ambulance service, neonatal transport, base rate, emergency transport, one wayA0380 Bls mileage (per mile)A0382 Bls routine disposable suppliesA0384 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 therapyA0396 Als specialized service disposable supplies; esophageal intubationA0398 Als routine disposable suppliesA0420 Ambulance waiting time (als or bls), one half (1/2) hour incrementsA0422 Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situationA0424 Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review)A0425 Ground mileage, per statute mileA0426 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 payersA0433 Advanced life support, level 2 (als 2)A0434 Specialty care transport (sct)A0435 Fixed wing air mileage, per statute mileA0436 Rotary wing air mileage, per statute mileA0888 Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)A0998 Ambulance response and treatment, no transportA0999 Unlisted ambulance serviceA2001 Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure)A2002 Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2004 Xcellistem, 1 mgA2005 Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2006 Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2007 Restrata, per square centimeter (add-on, list separately in addition to primary procedure)A2008 Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure)A2009 Symphony, per square centimeter (add-on, list separately in addition to primary procedure)A2010 Apis, per square centimeter (add-on, list separately in addition to primary procedure)A2011 Supra sdrm, per square centimeter (add-on, list separately in addition to primary procedure)A2012 Suprathel, per square centimeter (add-on, list separately in addition to primary procedure)A2013 Innovamatrix fs, per square centimeter (add-on, list separately in addition to primary procedure)A2014 Omeza collagen matrix or omeza complete matrix, per 100 mgA2015 Phoenix wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2016 Permeaderm b, per square centimeter (add-on, list separately in addition to primary procedure)A2017 Permeaderm glove, eachA2018 Permeaderm c, per square centimeter (add-on, list separately in addition to primary procedure)A2019 Kerecis omega3 marigen shield, per square centimeter (add-on, list separately in addition to primary procedure)A2020 Ac5 advanced wound system (ac5)A2021 Neomatrix, per square centimeter (add-on, list separately in addition to primary procedure)A2022 Innovaburn or innovamatrix xl, per square centimeter (add-on, list separately in addition to primary procedure)A2023 Innovamatrix pd, 1 mgA2024 Resolve matrix or xenopatch, per square centimeter (add-on, list separately in addition to primary procedure)A2025 Miro3d, per cubic centimeter (add-on, list separately in addition to primary procedure)A2026 Restrata minimatrix, 5 mgA2027 Matriderm, per square centimeter (add-on, list separately in addition to primary procedure)A2028 Micromatrix flex, per mgA2029 Mirotract wound matrix sheet, per cubic centimeter (add-on, list separately in addition to primary procedure)A2030 Miro3d fibers, per milligramA2031 Mirodry wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2032 Myriad matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2033 Myriad morcells, 4 milligramsA2034 Foundation drs solo, per square centimeter (add-on, list separately in addition to primary procedure)A2035 Corplex p or theracor p or allacor p, per milligramA2036 Cohealyx collagen dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)A2037 G4derm plus/suprello, per milliliterA2038 Marigen pacto, per square centimeter (add-on, list separately in addition to primary procedure)A2039 Innovamatrix fd, per square centimeter (add-on, list separately in addition to primary procedure)A2040 Microlyte painguard, per square centimeterA2041 Foundation drs+ duo, per square centimeterA2042 Foundation drs+ solo, per square centimeterA2043 Biobrane, per square centimeterA2044 Biobrane glove, eachA2045 Novashield or novogen wound matrix, per square centimeterA4100 Non-sheet form skin substitute, fda cleared as a device, not otherwise specified (list in addition to primary procedure)A4206 Syringe with needle, sterile, 1 cc or less, eachA4207 Syringe with needle, sterile 2 cc, eachA4208 Syringe with needle, sterile 3 cc, eachA4209 Syringe with needle, sterile 5 cc or greater, eachA4210 Needle-free injection device, eachA4211 Supplies for self-administered injectionsA4212 Non-coring needle or stylet with or without catheterA4213 Syringe, sterile, 20 cc or greater, eachA4215 Needle, sterile, any size, eachA4216 Sterile water, saline and/or dextrose, diluent/flush, 10 mlA4217 Sterile water/saline, 500 mlA4218 Sterile saline or water, metered dose dispenser, 10 mlA4220 Refill kit for implantable infusion pumpA4221 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 weekA4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, eachA4226 Supplies for maintenance of insulin infusion pump with dosage rate adjustment using therapeutic continuous glucose sensing, per weekA4230 Infusion set for external insulin pump, non needle cannula typeA4231 Infusion set for external insulin pump, needle typeA4232 Syringe with needle for external insulin pump, sterile, 3 ccA4233 Replacement battery, alkaline (other than j cell), for use with medically necessary home blood glucose monitor owned by patient, eachA4234 Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, eachA4235 Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, eachA4236 Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, eachA4238 Supply allowance for adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of serviceA4239 Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of serviceA4244 Alcohol or peroxide, per pintA4245 Alcohol wipes, per boxA4246 Betadine or phisohex solution, per pintA4247 Betadine or iodine swabs/wipes, per boxA4248 Chlorhexidine containing antiseptic, 1 mlA4250 Urine test or reagent strips or tablets (100 tablets or strips)A4252 Blood ketone test or reagent strip, eachA4253 Blood glucose test or reagent strips for home blood glucose monitor, per 50 stripsA4255 Platforms for home blood glucose monitor, 50 per boxA4256 Normal, low and high calibrator solution / chipsA4257 Replacement lens shield cartridge for use with laser skin piercing device, eachA4258 Spring-powered device for lancet, eachA4259 Lancets, per box of 100A4261 Cervical cap for contraceptive useA4262 Temporary, absorbable lacrimal duct implant, eachA4263 Permanent, long term, non-dissolvable lacrimal duct implant, eachA4264 Permanent implantable contraceptive intratubal occlusion device(s) and delivery systemA4265 Paraffin, per poundA4266 Diaphragm for contraceptive useA4267 Contraceptive supply, condom, male, eachA4268 Contraceptive supply, condom, female, eachA4269 Contraceptive supply, spermicide (e.g., foam, gel), eachA4270 Disposable endoscope sheath, eachA4271 Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 testsA4280 Adhesive skin support attachment for use with external breast prosthesis, eachA4281 Tubing for breast pump, replacementA4282 Adapter for breast pump, replacementA4283 Cap for breast pump bottle, replacementA4284 Breast shield and splash protector for use with breast pump, replacementA4285 Polycarbonate bottle for use with breast pump, replacementA4286 Locking ring for breast pump, replacementA4287 Disposable collection and storage bag for breast milk, any size, any type, eachA4288 Valve for breast pump, replacementA4290 Sacral nerve stimulation test lead, eachA4295 Intermittent urinary catheter; straight tip, hydrophilic coating, eachA4296 Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, eachA4297 Intermittent urinary catheter; hydrophilic coating, with insertion suppliesA4300 Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external accessA4301 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 hourA4306 Disposable drug delivery system, flow rate of less than 50 ml per hourA4310 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 siliconeA4313 Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigationA4314 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 siliconeA4316 Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigationA4318 Female external urinary collection cup, with or without ring attachment, per dayA4320 Irrigation tray with bulb or piston syringe, any purposeA4321 Therapeutic agent for urinary catheter irrigationA4322 Irrigation syringe, bulb or piston, eachA4326 Male external catheter with integral collection chamber, any type, eachA4327 Female external urinary collection device; meatal cup, eachA4328 Female external urinary collection device; pouch, eachA4330 Perianal fecal collection pouch with adhesive, eachA4331 Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, eachA4332 Lubricant, individual sterile packet, eachA4333 Urinary catheter anchoring device, adhesive skin attachment, eachA4334 Urinary catheter anchoring device, leg strap, eachA4335 Incontinence supply; miscellaneousA4336 Incontinence supply, urethral insert, any type, eachA4337 Incontinence supply, rectal insert, any type, eachA4338 Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), eachA4340 Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), eachA4341 Indwelling intraurethral drainage device with valve, patient inserted, replacement only, eachA4342 Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, eachA4344 Indwelling catheter, foley type, two-way, all silicone or polyurethane, eachA4346 Indwelling catheter; foley type, three way for continuous irrigation, eachA4349 Male external catheter, with or without adhesive, disposable, eachA4351 Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), eachA4352 Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), eachA4353 Intermittent urinary catheter, with insertion suppliesA4354 Insertion tray with drainage bag but without catheterA4355 Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, eachA4356 External urethral clamp or compression device (not to be used for catheter clamp), eachA4357 Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, eachA4358 Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, eachA4360 Disposable external urethral clamp or compression device, with pad and/or pouch, eachA4361 Ostomy faceplate, eachA4362 Skin barrier; solid, 4 x 4 or equivalent; eachA4363 Ostomy clamp, any type, replacement only, eachA4364 Adhesive, liquid or equal, any type, per ozA4366 Ostomy vent, any type, eachA4367 Ostomy belt, eachA4368 Ostomy filter, any type, eachA4369 Ostomy skin barrier, liquid (spray, brush, etc.), per ozA4371 Ostomy skin barrier, powder, per ozA4372 Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, eachA4373 Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, eachA4375 Ostomy pouch, drainable, with faceplate attached, plastic, eachA4376 Ostomy pouch, drainable, with faceplate attached, rubber, eachA4377 Ostomy pouch, drainable, for use on faceplate, plastic, eachA4378 Ostomy pouch, drainable, for use on faceplate, rubber, eachA4379 Ostomy pouch, urinary, with faceplate attached, plastic, eachA4380 Ostomy pouch, urinary, with faceplate attached, rubber, eachA4381 Ostomy pouch, urinary, for use on faceplate, plastic, eachA4382 Ostomy pouch, urinary, for use on faceplate, heavy plastic, eachA4383 Ostomy pouch, urinary, for use on faceplate, rubber, eachA4384 Ostomy faceplate equivalent, silicone ring, eachA4385 Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, eachA4387 Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), eachA4388 Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), eachA4389 Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), eachA4390 Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), eachA4391 Ostomy pouch, urinary, with extended wear barrier attached (1 piece), eachA4392 Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), eachA4393 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), eachA4394 Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounceA4395 Ostomy deodorant for use in ostomy pouch, solid, per tabletA4396 Ostomy belt with peristomal hernia supportA4397 Irrigation supply; sleeve, eachA4398 Ostomy irrigation supply; bag, eachA4399 Ostomy irrigation supply; cone/catheter, with or without brushA4400 Ostomy irrigation setA4402 Lubricant, per ounceA4404 Ostomy ring, eachA4405 Ostomy skin barrier, non-pectin based, paste, per ounceA4406 Ostomy skin barrier, pectin-based, paste, per ounceA4407 Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, eachA4408 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, eachA4409 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, eachA4410 Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, eachA4411 Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, eachA4412 Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, eachA4413 Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, eachA4414 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, eachA4415 Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, eachA4416 Ostomy pouch, closed, with barrier attached, with filter (1 piece), eachA4417 Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), eachA4418 Ostomy pouch, closed; without barrier attached, with filter (1 piece), eachA4419 Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), eachA4420 Ostomy pouch, closed; for use on barrier with locking flange (2 piece), eachA4421 Ostomy supply; miscellaneousA4422 Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, eachA4423 Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), eachA4424 Ostomy pouch, drainable, with barrier attached, with filter (1 piece), eachA4425 Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), eachA4426 Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), eachA4427 Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), eachA4428 Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), eachA4429 Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), eachA4430 Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), eachA4431 Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), eachA4432 Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), eachA4433 Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), eachA4434 Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), eachA4435 Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, eachA4436 Irrigation supply; sleeve, reusable, per monthA4437 Irrigation supply; sleeve, disposable, per monthA4438 Adhesive clip applied to the skin to secure external electrical nerve stimulator controller, eachA4450 Tape, non-waterproof, per 18 square inchesA4452 Tape, waterproof, per 18 square inchesA4453 Rectal catheter with or without balloon, for use with any type transanal irrigation system, eachA4455 Adhesive remover or solvent (for tape, cement or other adhesive), per ounceA4456 Adhesive remover, wipes, any type, eachA4457 Enema tube, with or without adapter, any type, replacement only, eachA4458 Enema bag with tubing, reusableA4459 Manual transanal irrigation system, includes water reservoir, pump, tubing, and accessories, without catheter, any typeA4461 Surgical dressing holder, non-reusable, eachA4463 Surgical dressing holder, reusable, eachA4465 Non-elastic binder for extremityA4466 Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, eachA4467 Belt, strap, sleeve, garment, or covering, any typeA4468 Exsufflation belt, includes all supplies and accessoriesA4470 Gravlee jet washerA4479 Electronic transanal irrigation system, includes electronic pump, water reservoir, tubing, and accessories, without catheter, any typeA4480 Vabra aspiratorA4481 Tracheostoma filter, any type, any size, eachA4483 Moisture exchanger, disposable, for use with invasive mechanical ventilationA4490 Surgical stockings above knee length, eachA4495 Surgical stockings thigh length, eachA4500 Surgical stockings below knee length, eachA4510 Surgical stockings full length, eachA4520 Incontinence garment, any type, (e.g., brief, diaper), eachA4540 Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper armA4541 Monthly supplies for use of device coded at e0733A4542 Supplies and accessories for external upper limb tremor stimulator of the peripheral nerves of the wristA4543 Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per monthA4544 Electrode for external lower extremity nerve stimulator for restless legs syndromeA4545 Supplies and accessories for external tibial nerve stimulator (e.g., socks, gel pads, electrodes, etc.), needed for one monthA4550 Surgical traysA4553 Non-disposable underpads, all sizesA4554 Disposable underpads, all sizesA4555 Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement onlyA4556 Electrodes, (e.g., apnea monitor), per pairA4557 Lead wires, (e.g., apnea monitor), per pairA4558 Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per ozA4559 Coupling gel or paste, for use with ultrasound device, per ozA4560 Neuromuscular electrical stimulator (nmes), disposable, replacement onlyA4561 Pessary, reusable, rubber, any typeA4562 Pessary, reusable, non rubber, any typeA4563 Rectal control system for vaginal insertion, for long term use, includes pump and all supplies and accessories, any type eachA4564 Pessary, disposable, any typeA4565 SlingsA4566 Shoulder sling or vest design, abduction restrainer, with or without swathe control, prefabricated, includes fitting and adjustmentA4570 SplintA4575 Topical hyperbaric oxygen chamber, disposableA4580 Cast supplies (e.g., plaster)A4590 Special casting material (e.g., fiberglass)A4593 Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, controllerA4594 Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece eachA4595 Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)A4596 Cranial electrotherapy stimulation (ces) system supplies and accessories, per monthA4600 Sleeve for intermittent limb compression device, replacement only, eachA4601 Lithium ion battery, rechargeable, for non-prosthetic use, replacementA4602 Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, eachA4604 Tubing with integrated heating element for use with positive airway pressure deviceA4605 Tracheal suction catheter, closed system, eachA4606 Oxygen probe for use with oximeter device, replacementA4608 Transtracheal oxygen catheter, eachA4611 Battery, heavy duty; replacement for patient owned ventilatorA4612 Battery cables; replacement for patient-owned ventilatorA4613 Battery charger; replacement for patient-owned ventilatorA4614 Peak expiratory flow rate meter, hand heldA4615 Cannula, nasalA4616 Tubing (oxygen), per footA4617 Mouth pieceA4618 Breathing circuitsA4619 Face tentA4620 Variable concentration maskA4623 Tracheostomy, inner cannulaA4624 Tracheal suction catheter, any type other than closed system, eachA4625 Tracheostomy care kit for new tracheostomyA4626 Tracheostomy cleaning brush, eachA4627 Spacer, bag or reservoir, with or without mask, for use with metered dose inhalerA4628 Oral and/or oropharyngeal suction catheter, eachA4629 Tracheostomy care kit for established tracheostomyA4630 Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patientA4633 Replacement bulb/lamp for ultraviolet light therapy system, eachA4634 Replacement bulb for therapeutic light box, tabletop modelA4635 Underarm pad, crutch, replacement, eachA4636 Replacement, handgrip, cane, crutch, or walker, eachA4637 Replacement, tip, cane, crutch, walker, each.A4638 Replacement battery for patient-owned ear pulse generator, eachA4639 Replacement pad for infrared heating pad system, eachA4640 Replacement pad for use with medically necessary alternating pressure pad owned by patientA4641 Radiopharmaceutical, diagnostic, not otherwise classifiedA4642 Indium in-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuriesA4648 Tissue marker, implantable, any type, eachA4649 Surgical supply; miscellaneousA4650 Implantable radiation dosimeter, eachA4651 Calibrated microcapillary tube, eachA4652 Microcapillary tube sealantA4653 Peritoneal dialysis catheter anchoring device, belt, eachA4657 Syringe, with or without needle, eachA4660 Sphygmomanometer/blood pressure apparatus with cuff and stethoscopeA4663 Blood pressure cuff onlyA4670 Automatic blood pressure monitorA4671 Disposable cycler set used with cycler dialysis machine, eachA4672 Drainage extension line, sterile, for dialysis, eachA4673 Extension line with easy lock connectors, used with dialysisA4674 Chemicals/antiseptics solution used to clean/sterilize dialysis equipment, per 8 ozA4680 Activated carbon filter for hemodialysis, eachA4690 Dialyzer (artificial kidneys), all types, all sizes, for hemodialysis, eachA4706 Bicarbonate concentrate, solution, for hemodialysis, per gallonA4707 Bicarbonate concentrate, powder, for hemodialysis, per packetA4708 Acetate concentrate solution, for hemodialysis, per gallonA4709 Acid concentrate, solution, for hemodialysis, per gallonA4714 Treated water (deionized, distilled, or reverse osmosis) for peritoneal dialysis, per gallonA4719 "y set" tubing for peritoneal dialysisA4720 Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysisA4721 Dialysate solution, any concentration of dextrose, fluid volume greater than 999 cc but less than or equal to 1999 cc, for peritoneal dialysisA4722 Dialysate solution, any concentration of dextrose, fluid volume greater than 1999 cc but less than or equal to 2999 cc, for peritoneal dialysisA4723 Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysisA4724 Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysisA4725 Dialysate solution, any concentration of dextrose, fluid volume greater than 4999 cc but less than or equal to 5999 cc, for peritoneal dialysisA4726 Dialysate solution, any concentration of dextrose, fluid volume greater than 5999 cc, for peritoneal dialysisA4728 Dialysate solution, non-dextrose containing, 500 mlA4730 Fistula cannulation set for hemodialysis, eachA4736 Topical anesthetic, for dialysis, per gramA4737 Injectable anesthetic, for dialysis, per 10 mlA4740 Shunt accessory, for hemodialysis, any type, eachA4750 Blood tubing, arterial or venous, for hemodialysis, eachA4755 Blood tubing, arterial and venous combined, for hemodialysis, eachA4760 Dialysate solution test kit, for peritoneal dialysis, any type, eachA4765 Dialysate concentrate, powder, additive for peritoneal dialysis, per packetA4766 Dialysate concentrate, solution, additive for peritoneal dialysis, per 10 mlA4770 Blood collection tube, vacuum, for dialysis, per 50A4771 Serum clotting time tube, for dialysis, per 50A4772 Blood glucose test strips, for dialysis, per 50A4773 Occult blood test strips, for dialysis, per 50A4774 Ammonia test strips, for dialysis, per 50A4802 Protamine sulfate, for hemodialysis, per 50 mgA4860 Disposable catheter tips for peritoneal dialysis, per 10A4870 Plumbing and/or electrical work for home hemodialysis equipmentA4890 Contracts, repair and maintenance, for hemodialysis equipmentA4911 Drain bag/bottle, for dialysis, eachA4913 Miscellaneous dialysis supplies, not otherwise specifiedA4918 Venous pressure clamp, for hemodialysis, eachA4927 Gloves, non-sterile, per 100A4928 Surgical mask, per 20A4929 Tourniquet for dialysis, eachA4930 Gloves, sterile, per pairA4931 Oral thermometer, reusable, any type, eachA4932 Rectal thermometer, reusable, any type, eachA5051 Ostomy pouch, closed; with barrier attached (1 piece), eachA5052 Ostomy pouch, closed; without barrier attached (1 piece), eachA5053 Ostomy pouch, closed; for use on faceplate, eachA5054 Ostomy pouch, closed; for use on barrier with flange (2 piece), eachA5055 Stoma capA5056 Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), eachA5057 Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), eachA5061 Ostomy pouch, drainable; with barrier attached, (1 piece), eachA5062 Ostomy pouch, drainable; without barrier attached (1 piece), eachA5063 Ostomy pouch, drainable; for use on barrier with flange (2 piece system), eachA5071 Ostomy pouch, urinary; with barrier attached (1 piece), eachA5072 Ostomy pouch, urinary; without barrier attached (1 piece), eachA5073 Ostomy pouch, urinary; for use on barrier with flange (2 piece), eachA5081 Stoma plug or seal, any typeA5082 Continent device; catheter for continent stomaA5083 Continent device, stoma absorptive cover for continent stomaA5093 Ostomy accessory; convex insertA5102 Bedside drainage bottle with or without tubing, rigid or expandable, eachA5105 Urinary suspensory with leg bag, with or without tube, eachA5112 Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, eachA5113 Leg strap; latex, replacement only, per setA5114 Leg strap; foam or fabric, replacement only, per setA5120 Skin barrier, wipes or swabs, eachA5121 Skin barrier; solid, 6 x 6 or equivalent, eachA5122 Skin barrier; solid, 8 x 8 or equivalent, eachA5126 Adhesive or non-adhesive; disk or foam padA5131 Appliance cleaner, incontinence and ostomy appliances, per 16 oz.A5200 Percutaneous catheter/tube anchoring device, adhesive skin attachmentA5500 For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoeA5501 For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoeA5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoeA5504 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoeA5505 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoeA5506 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoeA5507 For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoeA5508 For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoeA5510 For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoeA5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, eachA5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, eachA5514 For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, eachA6000 Non-contact wound warming wound cover for use with the non-contact wound warming device and warming cardA6010 Collagen based wound filler, dry form, sterile, per gram of collagenA6011 Collagen based wound filler, gel/paste, per gram of collagenA6021 Collagen dressing, sterile, size 16 sq. in. or less, eachA6022 Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., eachA6023 Collagen dressing, sterile, size more than 48 sq. in., eachA6024 Collagen dressing wound filler, sterile, per 6 inchesA6025 Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), eachA6154 Wound pouch, eachA6196 Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressingA6197 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressingA6198 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressingA6199 Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inchesA6203 Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressingA6204 Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressingA6205 Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressingA6206 Contact layer, sterile, 16 sq. in. or less, each dressingA6207 Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressingA6208 Contact layer, sterile, more than 48 sq. in., each dressingA6209 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6210 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6211 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6212 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressingA6213 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressingA6214 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressingA6215 Foam dressing, wound filler, sterile, per gramA6216 Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6217 Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6218 Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6219 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressingA6220 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressingA6221 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressingA6222 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6223 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressingA6224 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6228 Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6229 Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6230 Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6231 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressingA6232 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressingA6233 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressingA6234 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6235 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6236 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6237 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressingA6238 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressingA6239 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressingA6240 Hydrocolloid dressing, wound filler, paste, sterile, per ounceA6241 Hydrocolloid dressing, wound filler, dry form, sterile, per gramA6242 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6243 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6244 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6245 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressingA6246 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressingA6247 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressingA6248 Hydrogel dressing, wound filler, gel, per fluid ounceA6250 Skin sealants, protectants, moisturizers, ointments, any type, any sizeA6251 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6252 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6253 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6254 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressingA6255 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressingA6256 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressingA6257 Transparent film, sterile, 16 sq. in. or less, each dressingA6258 Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressingA6259 Transparent film, sterile, more than 48 sq. in., each dressingA6260 Wound cleansers, any type, any sizeA6261 Wound filler, gel/paste, per fluid ounce, not otherwise specifiedA6262 Wound filler, dry form, per gram, not otherwise specifiedA6266 Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yardA6402 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6403 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressingA6404 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressingA6407 Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yardA6410 Eye pad, sterile, eachA6411 Eye pad, non-sterile, eachA6412 Eye patch, occlusive, eachA6413 Adhesive bandage, first-aid type, any size, eachA6441 Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yardA6442 Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yardA6443 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yardA6444 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yardA6445 Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yardA6446 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yardA6447 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yardA6448 Light compression bandage, elastic, knitted/woven, width less than three inches, per yardA6449 Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yardA6450 Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yardA6451 Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yardA6452 High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yardA6453 Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yardA6454 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yardA6455 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yardA6456 Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yardA6457 Tubular dressing with or without elastic, any width, per linear yardA6460 Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressingA6461 Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressingA6501 Compression burn garment, bodysuit (head to foot), custom fabricatedA6502 Compression burn garment, chin strap, custom fabricatedA6503 Compression burn garment, facial hood, custom fabricatedA6504 Compression burn garment, glove to wrist, custom fabricatedA6505 Compression burn garment, glove to elbow, custom fabricatedA6506 Compression burn garment, glove to axilla, custom fabricatedA6507 Compression burn garment, foot to knee length, custom fabricatedA6508 Compression burn garment, foot to thigh length, custom fabricatedA6509 Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricatedA6510 Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricatedA6511 Compression burn garment, lower trunk including leg openings (panty), custom fabricatedA6512 Compression burn garment, not otherwise classifiedA6513 Compression burn mask, face and/or neck, plastic or equal, custom fabricatedA6515 Gradient compression wrap with adjustable straps, full leg, each, customA6516 Gradient compression wrap with adjustable straps, foot, each, customA6517 Gradient compression wrap with adjustable straps, below knee, each, customA6518 Gradient compression wrap with adjustable straps, arm, each, customA6519 Gradient compression garment, not otherwise specified, for nighttime use, eachA6520 Gradient compression garment, glove, padded, for nighttime use, eachA6521 Gradient compression garment, glove, padded, for nighttime use, custom, eachA6522 Gradient compression garment, arm, padded, for nighttime use, eachA6523 Gradient compression garment, arm, padded, for nighttime use, custom, eachA6524 Gradient compression garment, lower leg and foot, padded, for nighttime use, eachA6525 Gradient compression garment, lower leg and foot, padded, for nighttime use, custom, eachA6526 Gradient compression garment, full leg and foot, padded, for nighttime use, eachA6527 Gradient compression garment, full leg and foot, padded, for nighttime use, custom, eachA6528 Gradient compression garment, bra, for nighttime use, eachA6529 Gradient compression garment, bra, for nighttime use, custom, eachA6530 Gradient compression stocking, below knee, 18-30 mmhg, eachA6531 Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, eachA6532 Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, eachA6533 Gradient compression stocking, thigh length, 18-30 mmhg, eachA6534 Gradient compression stocking, thigh length, 30-40 mmhg, eachA6535 Gradient compression stocking, thigh length, 40 mmhg or greater, eachA6536 Gradient compression stocking, full length/chap style, 18-30 mmhg, eachA6537 Gradient compression stocking, full length/chap style, 30-40 mmhg, eachA6538 Gradient compression stocking, full length/chap style, 40 mmhg or greater, eachA6539 Gradient compression stocking, waist length, 18-30 mmhg, eachA6540 Gradient compression stocking, waist length, 30-40 mmhg, eachA6541 Gradient compression stocking, waist length, 40 mmhg or greater, eachA6544 Gradient compression stocking, garter beltA6545 Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, eachA6548 Accessory to custom gradient compression garment, silicone band, any sizeA6549 Gradient compression garment, not otherwise specified, for daytime use, eachA6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessoriesA6552 Gradient compression stocking, below knee, 30-40 mmhg, eachA6553 Gradient compression stocking, below knee, 30-40 mmhg, custom, eachA6554 Gradient compression stocking, below knee, 40 mmhg or greater, eachA6555 Gradient compression stocking, below knee, 40 mmhg or greater, custom, eachA6556 Gradient compression stocking, thigh length, 18-30 mmhg, custom, eachA6557 Gradient compression stocking, thigh length, 30-40 mmhg, custom, eachA6558 Gradient compression stocking, thigh length, 40 mmhg or greater, custom, eachA6559 Gradient compression stocking, full length/chap style, 18-30 mmhg, custom, eachA6560 Gradient compression stocking, full length/chap style, 30-40 mmhg, custom, eachA6561 Gradient compression stocking, full length/chap style, 40 mmhg or greater, custom, eachA6562 Gradient compression stocking, waist length, 18-30 mmhg, custom, eachA6563 Gradient compression stocking, waist length, 30-40 mmhg, custom, eachA6564 Gradient compression stocking, waist length, 40 mmhg or greater, custom, eachA6565 Gradient compression gauntlet, custom, eachA6566 Gradient compression garment, neck/head, eachA6567 Gradient compression garment, neck/head, custom, eachA6568 Gradient compression garment, torso and shoulder, eachA6569 Gradient compression garment, torso/shoulder, custom, eachA6570 Gradient compression garment, genital region, eachA6571 Gradient compression garment, genital region, custom, eachA6572 Gradient compression garment, toe caps, eachA6573 Gradient compression garment, toe caps, custom, eachA6574 Gradient compression arm sleeve and glove combination, custom, eachA6575 Gradient compression arm sleeve and glove combination, eachA6576 Gradient compression arm sleeve, custom, medium weight, eachA6577 Gradient compression arm sleeve, custom, heavy weight, eachA6578 Gradient compression arm sleeve, eachA6579 Gradient compression glove, custom, medium weight, eachA6580 Gradient compression glove, custom, heavy weight, eachA6581 Gradient compression glove, eachA6582 Gradient compression gauntlet, eachA6583 Gradient compression wrap with adjustable straps, below knee, eachA6584 Gradient compression wrap with adjustable straps, not otherwise specifiedA6585 Gradient compression wrap with adjustable straps, above knee, eachA6586 Gradient compression wrap with adjustable straps, full leg, eachA6587 Gradient compression wrap with adjustable straps, foot, eachA6588 Gradient compression wrap with adjustable straps, arm, eachA6589 Gradient pressure wrap with adjustable straps, bra, eachA6590 External urinary catheters; disposable, with wicking material, for use with suction pump, per monthA6591 External urinary catheter; non-disposable, for use with suction pump, per monthA6593 Accessory for gradient compression garment or wrap with adjustable straps, not-otherwise specifiedA6594 Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, eachA6595 Gradient compression bandaging supply, bandage liner, upper extremity, any size or length, eachA6596 Gradient compression bandaging supply, conforming gauze, per linear yard, any width, eachA6597 Gradient compression bandage roll, elastic long stretch, linear yard, any width, eachA6598 Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, eachA6599 Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, eachA6600 Gradient compression bandaging supply, high density foam sheet, per 250 square centimeters, eachA6601 Gradient compression bandaging supply, high density foam pad, any size or shape, eachA6602 Gradient compression bandaging supply, high density foam roll for bandage, per linear yard, any width, eachA6603 Gradient compression bandaging supply, low density channel foam sheet, per 250 square centimeters, eachA6604 Gradient compression bandaging supply, low density flat foam sheet, per 250 square centimeters, eachA6605 Gradient compression bandaging supply, padded foam, per linear yard, any width, eachA6606 Gradient compression bandaging supply, padded textile, per linear yard, any width, eachA6607 Gradient compression bandaging supply, tubular protective absorption layer, per linear yard, any width, eachA6608 Gradient compression bandaging supply, tubular protective absorption padded layer, per linear yard, any width, eachA6609 Gradient compression bandaging supply, not otherwise specifiedA6610 Gradient compression stocking, below knee, 18-30 mmhg, custom, eachA6611 Gradient compression wrap with adjustable straps, above knee, each, customA7000 Canister, disposable, used with suction pump, eachA7001 Canister, non-disposable, used with suction pump, eachA7002 Tubing, used with suction pump, eachA7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposableA7004 Small volume nonfiltered pneumatic nebulizer, disposableA7005 Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposableA7006 Administration set, with small volume filtered pneumatic nebulizerA7007 Large volume nebulizer, disposable, unfilled, used with aerosol compressorA7008 Large volume nebulizer, disposable, prefilled, used with aerosol compressorA7009 Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizerA7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 feetA7011 Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feetA7012 Water collection device, used with large volume nebulizerA7013 Filter, disposable, used with aerosol compressor or ultrasonic generatorA7014 Filter, nondisposable, used with aerosol compressor or ultrasonic generatorA7015 Aerosol mask, used with dme nebulizerA7016 Dome and mouthpiece, used with small volume ultrasonic nebulizerA7017 Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygenA7018 Water, distilled, used with large volume nebulizer, 1000 mlA7020 Interface for cough stimulating device, includes all components, replacement onlyA7021 Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (e.g., handset, nebulizer kit, biofilter)A7023 Mechanical allergen particle barrier/inhalation filter, cream, nasal, topicalA7025 High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, eachA7026 High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, eachA7027 Combination oral/nasal mask, used with continuous positive airway pressure device, eachA7028 Oral cushion for combination oral/nasal mask, replacement only, eachA7029 Nasal pillows for combination oral/nasal mask, replacement only, pairA7030 Full face mask used with positive airway pressure device, eachA7031 Face mask interface, replacement for full face mask, eachA7032 Cushion for use on nasal mask interface, replacement only, eachA7033 Pillow for use on nasal cannula type interface, replacement only, pairA7034 Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strapA7035 Headgear used with positive airway pressure deviceA7036 Chinstrap used with positive airway pressure deviceA7037 Tubing used with positive airway pressure deviceA7038 Filter, disposable, used with positive airway pressure deviceA7039 Filter, non disposable, used with positive airway pressure deviceA7040 One way chest drain valveA7041 Water seal drainage container and tubing for use with implanted chest tubeA7042 Implanted pleural catheter, eachA7043 Vacuum drainage bottle and tubing for use with implanted catheterA7044 Oral interface used with positive airway pressure device, eachA7045 Exhalation port with or without swivel used with accessories for positive airway devices, replacement onlyA7046 Water chamber for humidifier, used with positive airway pressure device, replacement, eachA7047 Oral interface used with respiratory suction pump, eachA7048 Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, eachA7049 Expiratory positive airway pressure intranasal resistance valveA7501 Tracheostoma valve, including diaphragm, eachA7502 Replacement diaphragm/faceplate for tracheostoma valve, eachA7503 Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, eachA7504 Filter for use in a tracheostoma heat and moisture exchange system, eachA7505 Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, eachA7506 Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type eachA7507 Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, eachA7508 Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, eachA7509 Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, eachA7520 Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, eachA7521 Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, eachA7522 Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), eachA7523 Tracheostomy shower protector, eachA7524 Tracheostoma stent/stud/button, eachA7525 Tracheostomy mask, eachA7526 Tracheostomy tube collar/holder, eachA7527 Tracheostomy/laryngectomy tube plug/stop, eachA8000 Helmet, protective, soft, prefabricated, includes all components and accessoriesA8001 Helmet, protective, hard, prefabricated, includes all components and accessoriesA8002 Helmet, protective, soft, custom fabricated, includes all components and accessoriesA8003 Helmet, protective, hard, custom fabricated, includes all components and accessoriesA8004 Soft interface for helmet, replacement onlyA8005 Powered, cable driven grip assist glove, hand, finger, includes microprocessor, pressure sensors, all components and accessories, custom fittedA8006 Powered, cable driven grip assist glove, hand, finger, includes pressure sensors, glove replacement onlyA9150 Non-prescription drugsA9152 Single vitamin/mineral/trace element, oral, per dose, not otherwise specifiedA9153 Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specifiedA9154 Artificial saliva, 1 mlA9155 Artificial saliva, 30 mlA9156 Oral mucoadhesive, any type (liquid, gel, paste, etc.), per 1 mlA9180 Pediculosis (lice infestation) treatment, topical, for administration by patient/caretakerA9268 Programmer for transient, orally ingested capsuleA9269 Programable, transient, orally ingested capsule, for use with external programmer, per monthA9270 Non-covered item or serviceA9272 Wound suction, disposable, includes dressing, all accessories and components, any type, eachA9273 Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any typeA9274 External ambulatory insulin delivery system, disposable, each, includes all supplies and accessoriesA9275 Home glucose disposable monitor, includes test stripsA9276 Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supplyA9277 Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring systemA9278 Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring systemA9279 Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classifiedA9280 Alert or alarm device, not otherwise classifiedA9281 Reaching/grabbing device, any type, any length, eachA9282 Wig, any type, eachA9283 Foot pressure off loading/supportive device, any type, eachA9284 Spirometer, non-electronic, includes all accessoriesA9285 Inversion/eversion correction deviceA9286 Hygienic item or device, disposable or non-disposable, any type, eachA9291 Prescription digital cognitive and/or behavioral therapy, fda cleared, per course of treatmentA9292 Prescription digital visual therapy, software-only, fda cleared, per course of treatmentA9293 Fertility cycle (contraception & conception) tracking software application, fda cleared, per month, includes accessories (e.g., thermometer)A9294 Prescription digital cognitive and/or behavioral therapy, biofeedback, fda cleared, per course of treatmentA9300 Exercise equipmentA9500 Technetium tc-99m sestamibi, diagnostic, per study doseA9501 Technetium tc-99m teboroxime, diagnostic, per study doseA9502 Technetium tc-99m tetrofosmin, diagnostic, per study doseA9503 Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuriesA9504 Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuriesA9505 Thallium tl-201 thallous chloride, diagnostic, per millicurieA9506 Graphite crucible for preparation of technetium tc 99m-labeled carbon aerosol, one crucibleA9507 Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuriesA9508 Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurieA9509 Iodine i-123 sodium iodide, diagnostic, per millicurieA9510 Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuriesA9512 Technetium tc-99m pertechnetate, diagnostic, per millicurieA9513 Lutetium lu 177, dotatate, therapeutic, 1 millicurieA9515 Choline c-11, diagnostic, per study dose up to 20 millicuriesA9516 Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuriesA9517 Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurieA9520 Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuriesA9521 Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuriesA9524 Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuriesA9526 Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuriesA9527 Iodine i-125, sodium iodide solution, therapeutic, per millicurieA9528 Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurieA9529 Iodine i-131 sodium iodide solution, diagnostic, per millicurieA9530 Iodine i-131 sodium iodide solution, therapeutic, per millicurieA9531 Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)A9532 Iodine i-125 serum albumin, diagnostic, per 5 microcuriesA9536 Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuriesA9537 Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuriesA9538 Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuriesA9539 Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuriesA9540 Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuriesA9541 Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuriesA9542 Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuriesA9543 Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuriesA9544 Iodine i-131 tositumomab, diagnostic, per study doseA9545 Iodine i-131 tositumomab, therapeutic, per treatment doseA9546 Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurieA9547 Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurieA9548 Indium in-111 pentetate, diagnostic, per 0.5 millicurieA9550 Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurieA9551 Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuriesA9552 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuriesA9553 Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuriesA9554 Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuriesA9555 Rubidium rb-82, diagnostic, per study dose, up to 60 millicuriesA9556 Gallium ga-67 citrate, diagnostic, per millicurieA9557 Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuriesA9558 Xenon xe-133 gas, diagnostic, per 10 millicuriesA9559 Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurieA9560 Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuriesA9561 Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuriesA9562 Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuriesA9563 Sodium phosphate p-32, therapeutic, per millicurieA9564 Chromic phosphate p-32 suspension, therapeutic, per millicurieA9566 Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuriesA9567 Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuriesA9568 Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuriesA9569 Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study doseA9570 Indium in-111 labeled autologous white blood cells, diagnostic, per study doseA9571 Indium in-111 labeled autologous platelets, diagnostic, per study doseA9572 Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuriesA9573 Injection, gadopiclenol, 1 mlA9574 Injection, ferumoxytol, 1 mgA9575 Injection, gadoterate meglumine, 0.1 mlA9576 Injection, gadoteridol, (prohance multipack), per mlA9577 Injection, gadobenate dimeglumine (multihance), per mlA9578 Injection, gadobenate dimeglumine (multihance multipack), per mlA9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per mlA9580 Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuriesA9581 Injection, gadoxetate disodium, 1 mlA9582 Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuriesA9583 Injection, gadofosveset trisodium, 1 mlA9584 Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuriesA9585 Injection, gadobutrol, 0.1 mlA9586 Florbetapir f18, diagnostic, per study dose, up to 10 millicuriesA9587 Gallium ga-68, dotatate, diagnostic, 0.1 millicurieA9588 Fluciclovine f-18, diagnostic, 1 millicurieA9589 Instillation, hexaminolevulinate hydrochloride, 100 mgA9590 Iodine i-131, iobenguane, 1 millicurieA9591 Fluoroestradiol f 18, diagnostic, 1 millicurieA9592 Copper cu-64, dotatate, diagnostic, 1 millicurieA9593 Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurieA9594 Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurieA9595 Piflufolastat f-18, diagnostic, 1 millicurieA9596 Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurieA9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classifiedA9598 Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classifiedA9599 Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specifiedA9600 Strontium sr-89 chloride, therapeutic, per millicurieA9601 Flortaucipir f 18 injection, diagnostic, 1 millicurieA9602 Fluorodopa f-18, diagnostic, per millicurieA9603 Injection, pafolacianine, 0.1 mgA9604 Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuriesA9606 Radium ra-223 dichloride, therapeutic, per microcurieA9607 Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurieA9608 Flotufolastat f 18, diagnostic, 1 millicurieA9609 Fludeoxyglucose f18 up to 15 millicuriesA9610 Xenon xe-129 hyperpolarized gas, diagnostic, per study doseA9611 Flurpiridaz f 18, diagnostic, 1 millicurieA9612 Injection, fluorescein, 1 mgA9615 Injection, pegulicianine, 1 mgA9616 Gallium ga-68 gozetotide (gozellix), diagnostic, 1 millicurieA9697 Injection, carboxydextran-coated superparamagnetic iron oxide, per study doseA9698 Non-radioactive contrast imaging material, not otherwise classified, per studyA9699 Radiopharmaceutical, therapeutic, not otherwise classifiedA9700 Supply of injectable contrast material for use in echocardiography, per studyA9800 Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurieA9900 Miscellaneous dme supply, accessory, and/or service component of another hcpcs codeA9901 Dme delivery, set up, and/or dispensing service component of another hcpcs codeA9999 Miscellaneous dme supply or accessory, not otherwise specified