HCPCS 'A' Codes (670)

Transportation Services Including Ambulance, Medical & Surgical Supplies
Code Description
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
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
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
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
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
A4450 Tape, non-waterproof, per 18 square inches
A4452 Tape, waterproof, per 18 square inches
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
Terminated December 31, 2016.
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
A4561 Pessary, rubber, any type
A4562 Pessary, non rubber, any type
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)
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 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
A5054 Ostomy pouch, closed; for use on barrier with flange (2 piece), each
A5055 Stoma cap
A5056 Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each
A5057 Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each
A5061 Ostomy pouch, drainable; with barrier attached, (1 piece), each
A5062 Ostomy pouch, drainable; without barrier attached (1 piece), each
A5063 Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each
A5071 Ostomy pouch, urinary; with barrier attached (1 piece), each
A5072 Ostomy pouch, urinary; without barrier attached (1 piece), each
A5073 Ostomy pouch, urinary; for use on barrier with flange (2 piece), each
A5081 Stoma plug or seal, any type
A5082 Continent device; catheter for continent stoma
A5083 Continent device, stoma absorptive cover for continent stoma
A5093 Ostomy accessory; convex insert
A5102 Bedside drainage bottle with or without tubing, rigid or expandable, each
A5105 Urinary suspensory with leg bag, with or without tube, each
A5112 Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each
A5113 Leg strap; latex, replacement only, per set
A5114 Leg strap; foam or fabric, replacement only, per set
A5120 Skin barrier, wipes or swabs, each
A5121 Skin barrier; solid, 6 x 6 or equivalent, each
A5122 Skin barrier; solid, 8 x 8 or equivalent, each
A5126 Adhesive or non-adhesive; disk or foam pad
A5131 Appliance cleaner, incontinence and ostomy appliances, per 16 oz.
A5200 Percutaneous catheter/tube anchoring device, adhesive skin attachment
A5500 For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
A5501 For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe
A5504 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
A5505 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
A5506 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
A5507 For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5508 For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5510 For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe
A5512 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, each
A5513 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, each
A6000 Non-contact wound warming wound cover for use with the non-contact wound warming device and warming card
A6010 Collagen based wound filler, dry form, sterile, per gram of collagen
A6011 Collagen based wound filler, gel/paste, per gram of collagen
A6021 Collagen dressing, sterile, size 16 sq. in. or less, each
A6022 Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each
A6023 Collagen dressing, sterile, size more than 48 sq. in., each
A6024 Collagen dressing wound filler, sterile, per 6 inches
A6025 Gel sheet for dermal or epidermal application, (e.g., silicone, hydrogel, other), each
A6154 Wound pouch, each
A6196 Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing
A6197 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
A6198 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing
A6199 Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches
A6203 Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6204 Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6205 Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
A6206 Contact layer, sterile, 16 sq. in. or less, each dressing
A6207 Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
A6208 Contact layer, sterile, more than 48 sq. in., each dressing
A6209 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6210 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6211 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6212 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6213 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6214 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
A6215 Foam dressing, wound filler, sterile, per gram
A6216 Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6217 Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6218 Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6219 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6220 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6221 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
A6222 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6223 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing
A6224 Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6228 Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6229 Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6230 Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6231 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing
A6232 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing
A6233 Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing
A6234 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6235 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6236 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6237 Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6238 Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6239 Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
A6240 Hydrocolloid dressing, wound filler, paste, sterile, per ounce
A6241 Hydrocolloid dressing, wound filler, dry form, sterile, per gram
A6242 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6243 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6244 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6245 Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6246 Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6247 Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
A6248 Hydrogel dressing, wound filler, gel, per fluid ounce
A6250 Skin sealants, protectants, moisturizers, ointments, any type, any size
A6251 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6252 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6253 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6254 Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6255 Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6256 Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing
A6257 Transparent film, sterile, 16 sq. in. or less, each dressing
A6258 Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
A6259 Transparent film, sterile, more than 48 sq. in., each dressing
A6260 Wound cleansers, any type, any size
A6261 Wound filler, gel/paste, per fluid ounce, not otherwise specified
A6262 Wound filler, dry form, per gram, not otherwise specified
A6266 Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard
A6402 Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6403 Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing
A6404 Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6407 Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard
A6410 Eye pad, sterile, each
A6411 Eye pad, non-sterile, each
A6412 Eye patch, occlusive, each
A6413 Adhesive bandage, first-aid type, any size, each
A6441 Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard
A6442 Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard
A6443 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard
A6444 Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard
A6445 Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard
A6446 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard
A6447 Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard
A6448 Light compression bandage, elastic, knitted/woven, width less than three inches, per yard
A6449 Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
A6450 Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard
A6451 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 yard
A6452 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 yard
A6453 Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard
A6454 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard
A6455 Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard
A6456 Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard
A6457 Tubular dressing with or without elastic, any width, per linear yard
A6501 Compression burn garment, bodysuit (head to foot), custom fabricated
A6502 Compression burn garment, chin strap, custom fabricated
A6503 Compression burn garment, facial hood, custom fabricated
A6504 Compression burn garment, glove to wrist, custom fabricated
A6505 Compression burn garment, glove to elbow, custom fabricated
A6506 Compression burn garment, glove to axilla, custom fabricated
A6507 Compression burn garment, foot to knee length, custom fabricated
A6508 Compression burn garment, foot to thigh length, custom fabricated
A6509 Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated
A6510 Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated
A6511 Compression burn garment, lower trunk including leg openings (panty), custom fabricated
A6512 Compression burn garment, not otherwise classified
A6513 Compression burn mask, face and/or neck, plastic or equal, custom fabricated
A6530 Gradient compression stocking, below knee, 18-30 mmhg, each
A6531 Gradient compression stocking, below knee, 30-40 mmhg, each
A6532 Gradient compression stocking, below knee, 40-50 mmhg, each
A6533 Gradient compression stocking, thigh length, 18-30 mmhg, each
A6534 Gradient compression stocking, thigh length, 30-40 mmhg, each
A6535 Gradient compression stocking, thigh length, 40-50 mmhg, each
A6536 Gradient compression stocking, full length/chap style, 18-30 mmhg, each
A6537 Gradient compression stocking, full length/chap style, 30-40 mmhg, each
A6538 Gradient compression stocking, full length/chap style, 40-50 mmhg, each
A6539 Gradient compression stocking, waist length, 18-30 mmhg, each
A6540 Gradient compression stocking, waist length, 30-40 mmhg, each
A6541 Gradient compression stocking, waist length, 40-50 mmhg, each
A6544 Gradient compression stocking, garter belt
A6545 Gradient compression wrap, non-elastic, below knee, 30-50 mm hg, each
A6549 Gradient compression stocking/sleeve, not otherwise specified
A6550 Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories
A7000 Canister, disposable, used with suction pump, each
A7001 Canister, non-disposable, used with suction pump, each
A7002 Tubing, used with suction pump, each
A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
A7004 Small volume nonfiltered pneumatic nebulizer, disposable
A7005 Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable
A7006 Administration set, with small volume filtered pneumatic nebulizer
A7007 Large volume nebulizer, disposable, unfilled, used with aerosol compressor
A7008 Large volume nebulizer, disposable, prefilled, used with aerosol compressor
A7009 Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer
A7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 feet
A7011 Corrugated tubing, non-disposable, used with large volume nebulizer, 10 feet
Terminated December 31, 2015.
A7012 Water collection device, used with large volume nebulizer
A7013 Filter, disposable, used with aerosol compressor or ultrasonic generator
A7014 Filter, nondisposable, used with aerosol compressor or ultrasonic generator
A7015 Aerosol mask, used with dme nebulizer
A7016 Dome and mouthpiece, used with small volume ultrasonic nebulizer
A7017 Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen
A7018 Water, distilled, used with large volume nebulizer, 1000 ml
A7020 Interface for cough stimulating device, includes all components, replacement only
A7025 High frequency chest wall oscillation system vest, replacement for use with patient owned equipment, each
A7026 High frequency chest wall oscillation system hose, replacement for use with patient owned equipment, each
A7027 Combination oral/nasal mask, used with continuous positive airway pressure device, each
A7028 Oral cushion for combination oral/nasal mask, replacement only, each
A7029 Nasal pillows for combination oral/nasal mask, replacement only, pair
A7030 Full face mask used with positive airway pressure device, each
A7031 Face mask interface, replacement for full face mask, each
A7032 Cushion for use on nasal mask interface, replacement only, each
A7033 Pillow for use on nasal cannula type interface, replacement only, pair
A7034 Nasal interface (mask or cannula type) used with positive airway pressure device, with or without head strap
A7035 Headgear used with positive airway pressure device
A7036 Chinstrap used with positive airway pressure device
A7037 Tubing used with positive airway pressure device
A7038 Filter, disposable, used with positive airway pressure device
A7039 Filter, non disposable, used with positive airway pressure device
A7040 One way chest drain valve
A7041 Water seal drainage container and tubing for use with implanted chest tube
A7042 Implanted pleural catheter, each
Terminated December 31, 2014.
A7043 Vacuum drainage bottle and tubing for use with implanted catheter
Terminated December 31, 2014.
A7044 Oral interface used with positive airway pressure device, each
A7045 Exhalation port with or without swivel used with accessories for positive airway devices, replacement only
A7046 Water chamber for humidifier, used with positive airway pressure device, replacement, each
A7047 Oral interface used with respiratory suction pump, each
A7048 Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each
A7501 Tracheostoma valve, including diaphragm, each
A7502 Replacement diaphragm/faceplate for tracheostoma valve, each
A7503 Filter holder or filter cap, reusable, for use in a tracheostoma heat and moisture exchange system, each
A7504 Filter for use in a tracheostoma heat and moisture exchange system, each
A7505 Housing, reusable without adhesive, for use in a heat and moisture exchange system and/or with a tracheostoma valve, each
A7506 Adhesive disc for use in a heat and moisture exchange system and/or with tracheostoma valve, any type each
A7507 Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each
A7508 Housing and integrated adhesive, for use in a tracheostoma heat and moisture exchange system and/or with a tracheostoma valve, each
A7509 Filter holder and integrated filter housing, and adhesive, for use as a tracheostoma heat and moisture exchange system, each
A7520 Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each
A7521 Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each
A7522 Tracheostomy/laryngectomy tube, stainless steel or equal (sterilizable and reusable), each
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 Hot water 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 interstitial continuous glucose monitoring system, one unit = 1 day supply
A9277 Transmitter; external, for use with interstitial continuous glucose monitoring system
A9278 Receiver (monitor); external, for use with 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
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
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
Terminated December 31, 2016.
A9545 Iodine i-131 tositumomab, therapeutic, per treatment dose
Terminated December 31, 2016.
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
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
Terminated December 31, 2017.
A9600 Strontium sr-89 chloride, therapeutic, per millicurie
A9604 Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
A9606 Radium ra-223 dichloride, therapeutic, per microcurie
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
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