Home Health PPS Consolidated Billing Code History Health PPS Consolidated Billing Code History ......

Home Health PPS Consolidated Billing Code History

CMS Division of Institutional Claims Processing 1 October 29, 2004

HCPCS Code Descriptor

Date Included (1)

Included in Transmittal (7) Date Excluded (1)

Excluded in Transmittal (7)

Predecessor Code(s)

Successor Code(s) Code Type

A4212 Non coring needle or stylet 10/01/2000 B-00-50 n/a Non-Routine SupplyA4213 20+ cc syringe only 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a n/a Non-Routine SupplyA4215 sterile needle 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a n/a Non-Routine SupplyA4216 Sterile water/saline up to 10ml 01/01/2004 Tr.8 A4319, A4323 Non-Routine SupplyA4217 Sterile water/saline 500ml 01/01/2004 Tr.8 A4319, A4324 Non-Routine Supply

A4248 Chlorhexidine, containing anticeptic, 1ml 01/01/2004 Tr.8 n/a Non-Routine SupplyA4310 Insert tray w/o bag/cath 10/01/2000 B-00-50 n/a Non-Routine SupplyA4311 Catheter w/o bag 2-way latex 10/01/2000 B-00-50 n/a Non-Routine SupplyA4312 Cath w/o bag 2-way silicone 10/01/2000 B-00-50 n/a Non-Routine SupplyA4313 Catheter w/bag 3-way 10/01/2000 B-00-50 n/a Non-Routine SupplyA4314 Cath w/drainage 2-way latex 10/01/2000 B-00-50 n/a Non-Routine SupplyA4315 Cath w/drainage 2-way silcne 10/01/2000 B-00-50 n/a Non-Routine SupplyA4316 Cath w/drainage 3-way 10/01/2000 B-00-50 n/a Non-Routine SupplyA4319 Sterile H2O irrigation solut 01/01/2001 AB-01-65 01/01/2004 Tr.8 K0409 A4216, A4217 Non-Routine SupplyA4320 Irrigation tray 10/01/2000 B-00-50 n/a Non-Routine SupplyA4321 Cath therapeutic irrig agent 10/01/2000 B-00-50 n/a Non-Routine SupplyA4322 Irrigation syringe 10/01/2000 B-00-50 n/a Non-Routine SupplyA4323 Saline irrigation solution 10/01/2000 B-00-50 01/01/2004 Tr.8 n/a A4216, A4217 Non-Routine SupplyA4324 Male ext cath w/adh coating 01/01/2001 AB-01-65 01/01/2005 Tr.340 K0410 A4349 Non-Routine SupplyA4325 Male ext cath w/adh strip 01/01/2001 AB-01-65 01/01/2005 Tr.340 K0411 A4349 Non-Routine SupplyA4326 Male external catheter 10/01/2000 B-00-50 n/a Non-Routine SupplyA4327 Fem urinary collect dev cup 10/01/2000 B-00-50 n/a Non-Routine SupplyA4328 Fem urinary collect pouch 10/01/2000 B-00-50 n/a Non-Routine SupplyA4329 external catheter start set 10/01/2000 B-00-50 01/01/2002 AB-01-128 n/a n/a Non-Routine SupplyA4330 Stool collection pouch 10/01/2000 B-00-50 n/a Non-Routine SupplyA4331 Extension drainage tubing 01/01/2001 AB-01-65 K0280 Non-Routine SupplyA4332 Lubricant for cath insertion 01/01/2001 AB-01-65 K0281 Non-Routine SupplyA4333 Urinary cath anchor device 01/01/2001 AB-01-65 K0407 Non-Routine SupplyA4334 Urinary cath leg strap 01/01/2001 AB-01-65 K0408 Non-Routine SupplyA4335 Incontinence supply 10/01/2000 B-00-50 n/a Non-Routine SupplyA4338 Indwelling catheter latex 10/01/2000 B-00-50 n/a Non-Routine SupplyA4340 Indwelling catheter special 10/01/2000 B-00-50 n/a Non-Routine SupplyA4344 Cath index foley 2 way 10/01/2000 B-00-50 n/a Non-Routine SupplyA4346 Cath indw foley 3 way 10/01/2000 B-00-50 n/a Non-Routine SupplyA4347 Male external catheter 10/01/2000 B-00-50 01/01/2005 Tr.340 n/a A4349 Non-Routine SupplyA4348 Male ext cath extended wear 01/01/2001 AB-01-65 n/a Non-Routine Supply

A4349Male ext catheter, with or without adhesive, disposable, each 01/01/2005 Tr. 340

A4347, A4324, A4325 Non-Routine Supply

A4351 Straight tip urine catheter 10/01/2000 B-00-50 n/a Non-Routine SupplyA4352 Coude tip urinary catheter 10/01/2000 B-00-50 n/a Non-Routine Supply




Date Included (1)



Predecessor Code(s)


A4353 Intermittent urinary cath 10/01/2000 B-00-50 n/a Non-Routine SupplyA4354 Cath insertion tray w/bag 10/01/2000 B-00-50 n/a Non-Routine SupplyA4355 Bladder irrigation tubing 10/01/2000 B-00-50 n/a Non-Routine SupplyA4356 Ext ureth clmp or compr 10/01/2000 B-00-50 n/a Non-Routine SupplyA4357 Bedside drainage bag 10/01/2000 B-00-50 n/a Non-Routine SupplyA4358 Urinary leg bag 10/01/2000 B-00-50 n/a Non-Routine SupplyA4359 Urinary suspensory w/o leg bag 10/01/2000 B-00-50 n/a Non-Routine SupplyA4361 Ostomy face plate 10/01/2000 B-00-50 n/a Non-Routine SupplyA4362 Solid skin barrier 10/01/2000 B-00-50 n/a Non-Routine SupplyA4364 Ostomy/cath adhesive 10/01/2000 B-00-50 n/a Non-Routine SupplyA4365 Ostomy adhesive remover wipe 10/01/2000 B-00-50 n/a Non-Routine SupplyA4366 Ostomy vent, any type, each 01/01/2004 Tr.8 n/a Non-Routine SupplyA4367 Ostomy belt 10/01/2000 B-00-50 n/a Non-Routine SupplyA4368 Ostomy filter 10/01/2000 B-00-50 n/a Non-Routine SupplyA4369 Skin barrier liquid per oz 10/01/2000 B-00-50 n/a Non-Routine SupplyA4370 Skin barrier paste per oz 10/01/2000 B-00-50 10/01/2002 AB-02-092 n/a K0561, K0562 Non-Routine SupplyA4371 Skin barrier powder per oz 10/01/2000 B-00-50 n/a Non-Routine SupplyA4372 Skin barrier solid 4x4 equiv 10/01/2000 B-00-50 n/a Non-Routine SupplyA4373 Skin barrier with flange 10/01/2000 B-00-50 n/a Non-Routine SupplyA4374 Skin barrier extended wear 10/01/2000 B-00-50 10/01/2002 AB-02-092 n/a K0563, K0564 Non-Routine SupplyA4375 Drainable plastic pch w fcpl 10/01/2000 B-00-50 n/a Non-Routine SupplyA4376 Drainable rubber pch w fcplt 10/01/2000 B-00-50 n/a Non-Routine SupplyA4377 Drainable plstic pch w/o fp 10/01/2000 B-00-50 n/a Non-Routine SupplyA4378 Drainable rubber pch w/o fp 10/01/2000 B-00-50 n/a Non-Routine SupplyA4379 Urinary plastic pouch w fcpl 10/01/2000 B-00-50 n/a Non-Routine SupplyA4380 Urinary rubber pouch w fcplt 10/01/2000 B-00-50 n/a Non-Routine SupplyA4381 Urinary plastic pouch w/o fp 10/01/2000 B-00-50 n/a Non-Routine SupplyA4382 Urinary hvy plstc pch w/o fp 10/01/2000 B-00-50 n/a Non-Routine SupplyA4383 Urinary rubber pouch w/o fp 10/01/2000 B-00-50 n/a Non-Routine SupplyA4384 Ostomy faceplt/silicone ring 10/01/2000 B-00-50 n/a Non-Routine SupplyA4385 Ost skn barrier sld ext wear 10/01/2000 B-00-50 n/a Non-Routine SupplyA4386 Ost skn barrier w flng ex wr 10/01/2000 B-00-50 10/01/2002 AB-02-092 n/a K0565, K0566 Non-Routine SupplyA4387 Ost clsd pouch w att st barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA4388 Drainable pch w ex wear barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA4389 Drainable pch w st wear barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA4390 Drainable pch ex wear convex 10/01/2000 B-00-50 n/a Non-Routine SupplyA4391 Urinary pouch w ex wear barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA4392 Urinary pouch w st wear barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA4393 Urine pch w ex wear bar conv 10/01/2000 B-00-50 n/a Non-Routine SupplyA4394 Ostomy pouch liq deodorant 10/01/2000 B-00-50 n/a Non-Routine SupplyA4395 Ostomy pouch solid deodorant 10/01/2000 B-00-50 n/a Non-Routine Supply




Date Included (1)



Predecessor Code(s)


A4396 Peristomal hernia supprt blt 10/01/2000 B-00-50 n/a Non-Routine SupplyA4397 Irrigation supply sleeve 10/01/2000 B-00-50 n/a Non-Routine SupplyA4398 Ostomy irrigation bag 10/01/2000 B-00-50 n/a Non-Routine SupplyA4399 Ostomy irrig cone/cath w brs 10/01/2000 B-00-50 n/a Non-Routine SupplyA4400 Ostomy irrigation set 10/01/2000 B-00-50 n/a Non-Routine SupplyA4402 Lubricant per ounce 10/01/2000 B-00-50 n/a Non-Routine SupplyA4404 Ostomy ring each 10/01/2000 B-00-50 n/a Non-Routine SupplyA4405 Nonpectin based ostomy paste 01/01/2003 AB-02-137 K0561 Non-Routine SupplyA4406 Pectin based ostomy paste 01/01/2003 AB-02-137 K0562 Non-Routine SupplyA4407 Ext wear ost skn barr <=4sq” 01/01/2003 AB-02-137 K0563 Non-Routine SupplyA4408 Ext wear ost skn barr >4sq” 01/01/2003 AB-02-137 K0564 Non-Routine SupplyA4409 Ost skn barr w flng <=4 sq” 01/01/2003 AB-02-137 K0565 Non-Routine SupplyA4410 Ost skn barr w flng >4sq” 01/01/2003 AB-02-137 K0566 Non-Routine SupplyA4413 2 pc drainable ost pouch w/ filter 01/01/2003 AB-02-137 K0569 Non-Routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 01/01/2003 AB-02-137 K0570 Non-Routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 01/01/2003 AB-02-137 K0571 Non-Routine SupplyA4416 Ost pch clsd w barrier/filtr 01/01/2004 Tr. 8 K0581 Non-Routine SupplyA4417 Ost pch w bar/bltinconv/fltr 01/01/2004 Tr. 8 K0582 Non-Routine SupplyA4418 Ost pch clsd w/o bar w filtr 01/01/2004 Tr. 8 K0583 Non-Routine SupplyA4419 Ost pch for bar w flange/flt 01/01/2004 Tr. 8 K0584 Non-Routine SupplyA4420 Ost pch clsd for bar w lk fl 01/01/2004 Tr. 8 K0585 Non-Routine SupplyA4421 (6) Ostomy supply misc 10/01/2000 B-00-50 n/a n/a Non-Routine SupplyA4422 Ost pouch absorbent material 01/01/2003 AB-02-137 K0579 Non-Routine SupplyA4423 Ost pch for bar w lk fl/fltr 01/01/2004 Tr. 8 A4423 Non-Routine SupplyA4424 Ost pch drain w bar & filter 01/01/2004 Tr. 8 A4424 Non-Routine SupplyA4425 Ost pch drain for barrier fl 01/01/2004 Tr. 8 A4425 Non-Routine SupplyA4426 Ost pch drain 2 piece system 01/01/2004 Tr. 8 A4426 Non-Routine SupplyA4427 Ost pch drain/barr lk flng/f 01/01/2004 Tr. 8 A4427 Non-Routine SupplyA4428 Urine ost pouch w faucet/tap 01/01/2004 Tr. 8 A4428 Non-Routine SupplyA4429 Urine ost pouch w bltinconv 01/01/2004 Tr. 8 A4429 Non-Routine SupplyA4430 Ost urine pch w b/bltin conv 01/01/2004 Tr. 8 A4430 Non-Routine SupplyA4431 Ost pch urine w barrier/tapv 01/01/2004 Tr. 8 A4431 Non-Routine SupplyA4432 Os pch urine w bar/fange/tap 01/01/2004 Tr. 8 A4432 Non-Routine SupplyA4433 Urine ost pch bar w lock fln 01/01/2004 Tr. 8 A4433 Non-Routine SupplyA4434 Ost pch urine w lock flng/ft 01/01/2004 Tr. 8 A4434 Non-Routine SupplyA4455 Adhesive remover per ounce 10/01/2000 B-00-50 n/a Non-Routine SupplyA4458 Reusable enema bag 01/01/2003 AB-02-137 n/a Non-Routine SupplyA4460 Elastic compression bandage 10/01/2000 B-00-50 n/a Non-Routine SupplyA4462 Abdmnl drssng holder/binder 10/01/2000 B-00-50 n/a Non-Routine SupplyA4481 Tracheostoma filter 10/01/2000 B-00-50 n/a Non-Routine SupplyA4554 Disposable underpads 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a n/a Non-Routine Supply




Date Included (1)



Predecessor Code(s)


A4622 Tracheostomy or larngectomy 10/01/2000 B-00-50 01/01/2004 Tr.8 n/aA7520, A7521, A7522 Non-Routine Supply

A4623 Tracheostomy inner cannula 10/01/2000 B-00-50 n/a Non-Routine SupplyA4625 Trach care kit for new 10/01/2000 B-00-50 n/a Non-Routine SupplyA4626 Tracheostomy cleaning brush 10/01/2000 B-00-50 n/a Non-Routine SupplyA4649 Surgical supplies 10/01/2000 B-00-50 n/a Non-Routine SupplyA4656 Needle, any size, each 01/01/2003 AB-02-137 n/a Non-Routine SupplyA4657 Syringe, with or without needle, each 01/01/2003 AB-02-137 n/a Non-Routine SupplyA4712 Sterile water inj per 10 ml 01/01/2003 AB-02-137 01/01/2004 Tr.8 n/a n/a Non-Routine SupplyA4930 Sterile, gloves per pair 01/01/2003 AB-02-137 n/a Non-Routine SupplyA5051 Pouch clsd w barr attached 10/01/2000 B-00-50 n/a Non-Routine SupplyA5052 Clsd ostomy pouch w/o barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA5053 Clsd ostomy pouch faceplate 10/01/2000 B-00-50 n/a Non-Routine SupplyA5054 Clsd ostomy pouch w/flange 10/01/2000 B-00-50 n/a Non-Routine SupplyA5055 Stoma cap 10/01/2000 B-00-50 n/a Non-Routine SupplyA5061 Pouch drainable w barrier at 10/01/2000 B-00-50 10/01/2002 AB-02-092 n/a K0567, K0568 Non-Routine SupplyA5061 (5) Pouch drainable w barrier at 01/01/2003 AB-02-137 K0567, K0568 Non-Routine SupplyA5062 Drnble ostomy pouch w/o barr 10/01/2000 B-00-50 n/a Non-Routine SupplyA5063 Drain ostomy pouch w/flange 10/01/2000 B-00-50 n/a Non-Routine SupplyA5071 Urinary pouch w/barrier 10/01/2000 B-00-50 n/a Non-Routine SupplyA5072 Urinary pouch w/o barrier 10/01/2000 B-00-50 n/a Non-Routine SupplyA5073 Urinary pouch on barr w/flng 10/01/2000 B-00-50 n/a Non-Routine SupplyA5081 Continent stoma plug 10/01/2000 B-00-50 n/a Non-Routine SupplyA5082 Continent stoma catheter 10/01/2000 B-00-50 n/a Non-Routine SupplyA5093 Ostomy accessory convex inse 10/01/2000 B-00-50 n/a Non-Routine SupplyA5102 Beside drain btl w/wo tube 10/01/2000 B-00-50 n/a Non-Routine SupplyA5105 Urinary suspensory 10/01/2000 B-00-50 n/a Non-Routine SupplyA5112 Urinary leg bag 10/01/2000 B-00-50 n/a Non-Routine SupplyA5113 Latex leg strap 10/01/2000 B-00-50 n/a Non-Routine SupplyA5114 Foam/fabric leg strap 10/01/2000 B-00-50 n/a Non-Routine SupplyA5119 Skin barrier wipes box pr 10/01/2000 B-00-50 n/a Non-Routine SupplyA5121 Solid skin barrier 6x6 10/01/2000 B-00-50 n/a Non-Routine SupplyA5122 Solid skin barrier 8x8 10/01/2000 B-00-50 n/a Non-Routine SupplyA5123 Skin barrier with flange 10/01/2000 B-00-50 10/01/2002 AB-02-092 n/a K0570, K0571 Non-Routine SupplyA5126 Disk / foam pad +or- 10/01/2000 B-00-50 n/a Non-Routine SupplyA5131 Appliance cleaner 10/01/2000 B-00-50 n/a Non-Routine SupplyA5149 Incontinence / ostomy supply 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4335, A4421 Non-Routine SupplyA6010 Collagen based wound filler, dry foam 01/01/2002 AB-01-128 n/a Non-Routine SupplyA6011 Collagen gel/paste wound fil 01/01/2003 AB-02-137 n/a Non-Routine SupplyA6020 Collagen wound dressing 10/01/2000 B-00-50 n/a Non-Routine SupplyA6021 Collagen dressing <=16 sq in 01/01/2001 AB-01-65 n/a Non-Routine Supply




Date Included (1)



Predecessor Code(s)


A6022 Collagen drsg>6<=48 sq in 01/01/2001 AB-01-65 n/a Non-Routine SupplyA6023 Collagen dressing >48 sq in 01/01/2001 AB-01-65 n/a Non-Routine SupplyA6024 Collagen dsg wound filler 01/01/2001 AB-01-65 n/a Non-Routine Supply

A6025Gel sheet for dermal or epidermal application (e.g. silicone, hydrogel, other) 01/01/2004 Tr.8 n/a Non-Routine Supply

A6154 Wound pouch each 10/01/2000 B-00-50 n/a Non-Routine SupplyA6196 Alginate dressing <=16 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6197 Alginate drsg >16 <=48 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6198 Alginate dressing > 48 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6199 Alginate drsg wound filler 10/01/2000 B-00-50 n/a Non-Routine SupplyA6200 Compos drsg <=16 no bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6201 Compos drsg >16<=48 no bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6202 Compos drsg >48 no bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6203 Composite drsg <= 16 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6204 Composite drsg >16<=48 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6205 Composite drsg > 48 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6206 Contact layer <= 16 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6207 Contact layer >16<= 48 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6208 Contact layer > 48 sq 10/01/2000 B-00-50 n/a Non-Routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6210 Foam drg >16<=48 sq in w/o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6211 Foam drg > 48 sq in w/o brdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6212 Foam drg <=16 sq in w/bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6214 Foam drg > 48 sq in w/bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6215 Foam dressing wound filler 10/01/2000 B-00-50 n/a Non-Routine SupplyA6219 Gauze <= 16 sq in w/bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6220 Gauze >16 <=48 sq in w/bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6221 Gauze > 48 sq in w/bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6222 Gauze <=16 in no w / sal w/ o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6223 Gauze >16<=48 no w / sal w/ o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6224 Gauze > 48 in no w /sal w/ o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6228 Gauze <= 16 sq in water / sal 10/01/2000 B-00-50 n/a Non-Routine SupplyA6229 Gauze >16<=48 sq in watr / sal 10/01/2000 B-00-50 n/a Non-Routine SupplyA6230 Gauze > 48 sq in water / salne 10/01/2000 B-00-50 n/a Non-Routine SupplyA6231 Hydrogel dsg<=16 sq in 01/01/2001 AB-01-65 n/a Non-Routine SupplyA6232 Hydrogel dsg>16<=48 sq in 01/01/2001 AB-01-65 n/a Non-Routine SupplyA6233 Hydrogel dressing >48 sq in 01/01/2001 AB-01-65 n/a Non-Routine SupplyA6234 Hydrocolld drg <=16 w / o bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6235 Hydrocolld drg >16<=48 w / o b 10/01/2000 B-00-50 n/a Non-Routine Supply




Date Included (1)



Predecessor Code(s)


A6236 Hydrocolld drg > 48 in w / o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6237 Hydrocolld drg <=16 in w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6238 Hydrocolld drg >16<=48 w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6239 Hydrocolld drg > 48 in w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6240 Hydrocolld drg filler paste 10/01/2000 B-00-50 n/a Non-Routine SupplyA6241 Hydrocolloid drg filler dry 10/01/2000 B-00-50 n/a Non-Routine SupplyA6242 Hydrogel drg <=16 in w / o bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6243 Hydrogel drg >16<=48 w / o bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6244 Hydrogel drg >48 in w / o bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6245 Hydrogel drg <= 16 in w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6246 Hydrogel drg >16<=48 in w / b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6247 Hydrogel drg > 48 sq in w / b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6248 Hydrogel dressing 10/01/2000 B-00-50 n/a Non-Routine SupplyA6251 Absorpt drg <=16 sq in w / o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6252 Absorpt drg >16 <=48 w / o bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6253 Absorpt drg . 48 sq in w / o b 10/01/2000 B-00-50 n/a Non-Routine SupplyA6254 Absorpt drg <=16 sq in w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6255 Absorpt drg >16<=48 in w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6256 Absorpt drg > 48 sq in w / bdr 10/01/2000 B-00-50 n/a Non-Routine SupplyA6257 Transparent film <= 16 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6258 Transparent film >16<=48 in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6259 Transparent film > 48 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6261 Wound filler gel / paste / oz 10/01/2000 B-00-50 n/a Non-Routine SupplyA6262 Wound filler dry form / gram 10/01/2000 B-00-50 n/a Non-Routine SupplyA6266 Impreg gauze no h20 / sal / yard 10/01/2000 B-00-50 n/a Non-Routine SupplyA6402 Sterile gauze <= 16 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6403 Sterile gauze>16 <= 48 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6404 Sterile gauze > 48 sq in 10/01/2000 B-00-50 n/a Non-Routine SupplyA6405 Sterile elastic gauze / yd 10/01/2000 B-00-50 n/a Non-Routine SupplyA6406 Sterile non-elastic gauze / yd 10/01/2000 B-00-50 n/a Non-Routine Supply

A6407Packing strips, non-impregnated, up to 2 inches, per lin yd 01/01/2004 Tr. 8 K0621 Non-Routine Supply

A6410 Sterile eye pad 01/01/2003 AB-02-137 n/a Non-Routine SupplyA6440 Zinc Paste >=3"<5" w/roll 04/01/2003 AB-03-002 n/a Non-routine Supply

A6441

Padding bandage, non-elastic, non-woven/non-knitted, width > or = 3" and < 5", per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6442

Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply




Date Included (1)



Predecessor Code(s)


A6443

Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6444

Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6445

Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6446

Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6447

Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6448

Light compression bandage, elastic, knitted/woven, width less than three inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6449

Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6450

Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

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 01/01/2004 Tr. 8 n/a Non-routine Supply

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 01/01/2004 Tr. 8 n/a Non-routine Supply




Date Included (1)



Predecessor Code(s)


A6453

Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6454

Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6455

Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A6456

Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Tr. 8 n/a Non-routine Supply

A7040 One way chest drain valve 01/01/2005 Tr. 340 n/a Non-routine Supply

A7041Water seal drainage container and tubing for use with implanted chest tube 01/01/2005 Tr. 340 n/a Non-routine Supply

A7043 Vacuum drainage bottle & tubing 01/01/2003 AB-02-137 n/a Non-Routine Supply

A7045

Exhalation port with or without swivel used with accessories for postive airway devices, replacement only 01/01/2005 Tr. 340 n/a Non-Routine Supply

A7501 Tracheostoma valve w diaphra 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7502 Replacement diaphragm/fplate 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7503 HMES filter holder or cap 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7504 Tracheostoma HMES filter 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7505 HMES or trach valve housing 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7506 HMES/trachvalve adhesivedisk 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7507 Integrated filter & holder 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7508 Housing & Integrated Adhesiv 01/01/2001 AB-01-65 n/a Non-Routine SupplyA7509 Heat & moisture exchange sys 01/01/2001 AB-01-65 n/a Non-Routine Supply

A7520Tracheostomy/larynectomy tube, non-cuffed 01/01/2004 Tr. 8 A4622 Non-Routine Supply

A7521 Tracheostomy/larynectomy tube, cuffed 01/01/2004 Tr. 8 A4622 Non-Routine Supply

A7522Tracheostomy/larynectomy tube, stainless steel 01/01/2004 Tr. 8 A4622 Non-Routine Supply

A7523 Tracheostomy shower protector, each 01/01/2004 Tr. 8 n/a Non-Routine SupplyA7524 Tracheostomy stent/stud/button, each 01/01/2004 Tr. 8 n/a Non-Routine SupplyA7525 (8) Tracheostomy mask, each 01/01/2004 Tr. 8 01/01/2004 Tr. 62 n/a Non-Routine SupplyA7526 (8) Tracheostomy tube collar/holder, each 01/01/2004 Tr. 8 01/01/2004 Tr. 62 n/a Non-Routine Supply

A7527Tracheostomy/laryngectomy tube plug/stop, each 01/01/2005 Tr. 340 n/a Non-Routine Supply




Date Included (1)



Predecessor Code(s)


G0193 Endoscopic study swallow functn 01/01/2001 AB-01-65 n/a TherapyG0194 Sensory testing endoscopic stud 01/01/2001 AB-01-65 n/a TherapyG0195 Clinical eval swallowing funct 01/01/2001 AB-01-65 n/a TherapyG0196 Eval of swallowing with radio opa 01/01/2001 AB-01-65 n/a TherapyG0197 Eval of pt for prescip speech devi 01/01/2001 AB-01-65 n/a TherapyG0198 Patient adapation & train for spe 01/01/2001 AB-01-65 n/a TherapyG0199 Reevaluation of patient use spec 01/01/2001 AB-01-65 n/a TherapyG0200 Eval of patient prescip of voice p 01/01/2001 AB-01-65 n/a TherapyG0201 Modi for training in use voice pro 01/01/2001 AB-01-65 n/a TherapyG0279 Excorp shock tx, elbow epi 01/01/2003 AB-02-137 n/a TherapyG0280 Excorp shock tx other than 01/01/2003 AB-02-137 n/a TherapyG0281 Elec stim unattend for press 01/01/2003 AB-02-137 n/a TherapyG0282 Elect stim wound care not pd 01/01/2003 AB-02-137 n/a TherapyG0283 Elec stim other than wound 01/01/2003 AB-02-137 n/a TherapyG0329 Electromagntic tx for ulcers 10/01/2004 Tr. 226 n/a TherapyK0280 Extension drainage tubing 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4331 Non-Routine SupplyK0281 Lubricant catheter insertion 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4332 Non-Routine SupplyK0407 Urinary cath skin attachment 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4333 Non-Routine SupplyK0408 Urinary cath leg strap 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4334 Non-Routine SupplyK0409 Sterile H20 irrigation solut 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4319 Non-Routine SupplyK0410 Male ext cath w / adh coating 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4324 Non-Routine SupplyK0411 Male ext cath w / adh strip 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a A4325 Non-Routine SupplyK0561: Non-pectin based ostomy paste 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A4370 A4405 Non-Routine SupplyK0562: Pectin based ostomy paste 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A4370 A4406 Non-Routine SupplyK0563: Ext wear ost skn barr <4sq" 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A4374 A4407 Non-Routine SupplyK0564: Ext wear ost skn barr >4sq" 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A4374 A4408 Non-Routine SupplyK0565: Ost skn barr w flng <4sq" 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A4386 A4409 Non-Routine SupplyK0566: Ost skn barr w flng >4sq" 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A4386 A4410 Non-Routine SupplyK0567: 1 pc drainable ost pouch 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A5061 A5061 Non-Routine SupplyK0568: 1 pc cnvx drainabl ost pouch 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A5061 A5061 Non-Routine SupplyK0569: 2 pc drainable ost pouch 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a A4413 Non-Routine SupplyK0570: Ostomy skn barr w flng <4sq" 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A5123 A4414 Non-Routine SupplyK0571: Ostomy skn barr w flng >4sq" 10/01/2002 AB-02-092 01/01/2003 AB-02-137 A5123 A4415 Non-Routine SupplyK0574: Ostomy pouch filter 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a A4368 Non-Routine SupplyK0575: Ost pouch rustle free mat 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a n/a Non-Routine SupplyK0576: Ostomy pouch comfort panel 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a n/a Non-Routine SupplyK0577: Ostomy pouch odor barrier 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a n/a Non-Routine SupplyK0578: Urinary pouch faucet/drain 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a n/a Non-Routine SupplyK0579: Ost pouch absorbent material 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a A4422 Non-Routine SupplyK0580: Ost pouch locking flange 10/01/2002 AB-02-092 01/01/2003 AB-02-137 n/a n/a Non-Routine SupplyK0581 Ost pch clsd w barrier/filtr 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4416 Non-Routine Supply




Date Included (1)



Predecessor Code(s)


K0582 Ost pch w bar/bltinconv/fltr 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4417 Non-Routine SupplyK0583 Ost pch clsd w/o bar w filtr 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4418 Non-Routine SupplyK0584 Ost pch for bar w flange/flt 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4419 Non-Routine SupplyK0585 Ost pch clsd for bar w lk fl 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4420 Non-Routine SupplyK0586 Ost pch for bar w lk fl/fltr 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4423 Non-Routine SupplyK0587 Ost pch drain w bar & filter 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4424 Non-Routine SupplyK0588 Ost pch drain for barrier fl 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4425 Non-Routine SupplyK0589 Ost pch drain 2 piece system 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4426 Non-Routine SupplyK0590 Ost pch drain/barr lk flng/f 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4427 Non-Routine SupplyK0591 Urine ost pouch w faucet/tap 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4428 Non-Routine SupplyK0592 Urine ost pouch w bltinconv 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4429 Non-Routine SupplyK0593 Ost urine pch w b/bltin conv 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4430 Non-Routine SupplyK0594 Ost pch urine w barrier/tapv 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4431 Non-Routine SupplyK0595 Os pch urine w bar/fange/tap 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4432 Non-Routine SupplyK0596 Urine ost pch bar w lock fln 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4433 Non-Routine SupplyK0597 Ost pch urine w lock flng/ft 01/01/2003 AB-02-137 01/01/2004 Tr. 8 n/a A4434 Non-Routine SupplyK0614 chem/antiseptic solution, 8oz. 10/01/2003 AB-03-096 n/a Non-Routine SupplyK0620 tubular elastic dressing 10/01/2003 AB-03-096 n/a Non-Routine SupplyK0621 gauze, non-impreg pack strip 10/01/2003 AB-03-096 01/01/2004 Tr. 8 n/a A6407 Non-Routine Supply64550 Apply neurostimulator 01/01/2001 AB-01-65 n/a Therapy0019T Extracorp shock wave tx, ms 01/01/2003 AB-02-137 n/a Therapy0020T Extracorp shock wave tx, ft 01/01/2003 AB-02-137 n/a Therapy90901 Biofeedback train, any meth 10/01/2000 B-00-50 n/a Therapy90911 Biofeedback peri/uro/rectal 10/01/2000 B-00-50 n/a Therapy92506 Speech/hearing evaluation 10/01/2000 B-00-50 n/a Therapy92507 Speech/hearing therapy, individual 10/01/2000 B-00-50 n/a Therapy92508 Speech/hearing therapy, group 10/01/2000 B-00-50 n/a Therapy92510 Rehab for ear implant 10/01/2000 B-00-50 n/a Therapy92525 Oral function evaluation 10/01/2000 B-00-50 01/01/2003 AB-02-137 n/a 92610, 92611 Therapy92526 Oral function therapy 10/01/2000 B-00-50 n/a Therapy

92597 Oral speech device eval 10/01/2000 B-00-50 01/01/2003 AB-02-137 n/a92605, 92606, 92607 Therapy

92598 Modify oral speech device 10/01/2000 B-00-50 01/01/2003 AB-02-137 n/a n/a Therapy92601 Cochlear implt f/up exam < 7 01/01/2003 AB-02-137 n/a Therapy92602 Reprogram cochlear implt < 7 01/01/2003 AB-02-137 n/a Therapy92603 Cochlear implt f/up exam 7 > 01/01/2003 AB-02-137 n/a Therapy92604 Reprogram cochlear implt 7 > 01/01/2003 AB-02-137 n/a Therapy92605 Eval for nonspeech device rx 01/01/2003 AB-02-137 92597 Therapy92606 Non-speech device service 01/01/2003 AB-02-137 92597 Therapy92607 Ex for speech device rx, 1hr 01/01/2003 AB-02-137 92597 Therapy92608 Ex for speech device rx addl 01/01/2003 AB-02-137 n/a Therapy




Date Included (1)



Predecessor Code(s)


92609 Use of speech device service 01/01/2003 AB-02-137 n/a Therapy92610 Evaluate swallowing function 01/01/2003 AB-02-137 92525 Therapy92611 Motion fluoroscopy/swallow 01/01/2003 AB-02-137 92525 Therapy92612 Endoscopy swallow tst (fees) 01/01/2003 AB-02-137 n/a Therapy92614 Laryngoscopic sensory test 01/01/2003 AB-02-137 n/a Therapy92616 Fees w/laryngeal sense test 01/01/2003 AB-02-137 n/a Therapy95831 Limb muscle testing, manual 01/01/2001 AB-01-65 n/a Therapy95832 Hand muscle testing, manual 01/01/2001 AB-01-65 n/a Therapy95833 Body muscle testing, manual 01/01/2001 AB-01-65 n/a Therapy95834 Body muscle testing, manual 01/01/2001 AB-01-65 n/a Therapy95851 Range of motion measurements 01/01/2001 AB-01-65 n/a Therapy95852 Range of motion measurements 01/01/2001 AB-01-65 n/a Therapy96000 Motion analysis, video/3d 01/01/2003 AB-02-137 n/a Therapy96001 Motion test w/ft press meas 01/01/2003 AB-02-137 n/a Therapy96002 Dynamic surface emg 01/01/2003 AB-02-137 n/a Therapy96003 Dynamic fine wire emg 01/01/2003 AB-02-137 n/a Therapy96105 Assessment of aphasia 10/01/2000 B-00-50 n/a Therapy97001 Pt evaluation 10/01/2000 B-00-50 n/a Therapy97002 Pt re-evaluation 10/01/2000 B-00-50 n/a Therapy97003 Ot evaluation 10/01/2000 B-00-50 n/a Therapy97004 Ot re-evaluation 10/01/2000 B-00-50 n/a Therapy97012 Mechanical traction therapy 10/01/2000 B-00-50 n/a Therapy97014 Electric stimulation therapy 10/01/2000 B-00-50 10/01/2003 AB-03-096 n/a n/a Therapy97016 Vasopneumatic device therapy 10/01/2000 B-00-50 n/a Therapy97018 Paraffin bath therapy 10/01/2000 B-00-50 n/a Therapy97020 Microwave therapy 10/01/2000 B-00-50 n/a Therapy97022 Whirlpool therapy 10/01/2000 B-00-50 n/a Therapy97024 Diathermy treatment 10/01/2000 B-00-50 n/a Therapy97026 Infrared therapy 10/01/2000 B-00-50 n/a Therapy97028 Ultraviolet therapy 10/01/2000 B-00-50 n/a Therapy97032 Electrical stimulation 10/01/2000 B-00-50 n/a Therapy97033 Electric current therapy 10/01/2000 B-00-50 n/a Therapy97034 Contrast bath therapy 10/01/2000 B-00-50 n/a Therapy97035 Ultrasound therapy 10/01/2000 B-00-50 n/a Therapy97036 Hydrotherapy 10/01/2000 B-00-50 n/a Therapy97039 Physical therapy treatment 10/01/2000 B-00-50 n/a Therapy97110 Therapeutic exercises 10/01/2000 B-00-50 n/a Therapy97112 Neuromuscular reeducation 10/01/2000 B-00-50 n/a Therapy97113 Aquatic therapy/exercises 10/01/2000 B-00-50 n/a Therapy97116 Gait training therapy 10/01/2000 B-00-50 n/a Therapy97122 Manual traction therapy 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a 97140 Therapy




Date Included (1)



Predecessor Code(s)


97124 Massage therapy 10/01/2000 B-00-50 n/a Therapy97139 Physical medicine procedure 10/01/2000 B-00-50 n/a Therapy

97140 Manual therapy 01/01/2001 AB-01-65

97122, 97250, 97260, 97261, 97265 Therapy

97150 Group therapeutic procedures 10/01/2000 B-00-50 n/a Therapy97250 Myofascial release 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a 97140 Therapy97260 Regional manipulation 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a 97140 Therapy97261 Supplemental manipulations 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a 97140 Therapy97265 Joint mobilization 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a 97140 Therapy97504 Orthotic training 10/01/2000 B-00-50 n/a Therapy97520 Prosthetic training 10/01/2000 B-00-50 n/a Therapy97530 Therapeutic activities 10/01/2000 B-00-50 n/a Therapy97532 Cognitive skills development 01/01/2001 AB-01-65 97770 Therapy97533 Sensory integration 01/01/2001 AB-01-65 97770 Therapy97535 Self care mngment training 10/01/2000 B-00-50 n/a Therapy97537 Community/work reintegration 10/01/2000 B-00-50 n/a Therapy97542 Wheelchair mngment training 10/01/2000 B-00-50 n/a Therapy97545 Work hardening 10/01/2000 B-00-50 n/a Therapy97546 Work hardening add-on 10/01/2000 B-00-50 n/a Therapy

97597debridement;surface area less than or equal to 20 square centimeters 01/01/2005 Tr. 340 97601 Therapy

97598debridement; total wound(s) surface greater than 20 square centimeters 01/01/2005 Tr. 340 97601 Therapy

97601 Wound care selective 01/01/2001 AB-01-65 01/01/2005 Tr. 340 n/a 97507, 97598 Therapy97602 Wound care non-selective 01/01/2001 AB-01-65 n/a Therapy

97605

Negative pressure wound therapy (eg vacuum assisted drainage collection); total wound(s) surface area less than or equal to 50 square centimeters 01/01/2005 Tr. 340 n/a Therapy

97606

Negative pressure wound therapy (eg vacuum assisted drainage collection); total wound(s) surface area greater than 50 square centimeters 01/01/2005 Tr. 340 n/a Therapy

97703 Prosthetic checkout 10/01/2000 B-00-50 n/a Therapy97750 Physical performance test 10/01/2000 B-00-50 n/a Therapy




Date Included (1)



Predecessor Code(s)


97755

Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report, each 15 minutes 01/01/2004 Tr. 8 n/a Therapy

97770 Cognitive skills development 10/01/2000 B-00-50 01/01/2001 AB-01-65 n/a 97532, 97533 Therapy97799 Physical medicine procedure 10/01/2000 B-00-50 n/a Therapy

HH Consolidated Billing Code List -- As of PM B--00-50

CMS Division of Institutional Claims Processing 1 August 29, 2003

HCPCS Code (3) Descriptor

Effective Date Code Type

A4212 Non coring needle or stylet 10/01/2000 Non-routine SupplyA4213 20+ cc syringe only 10/01/2000 Non-routine SupplyA4215 sterile needle 10/01/2000 Non-routine SupplyA4310 Insert tray w/o bag/cath 10/01/2000 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 10/01/2000 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 10/01/2000 Non-routine SupplyA4313 Catheter w/bag 3-way 10/01/2000 Non-routine SupplyA4314 Cath w/drainage 2-way latex 10/01/2000 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 10/01/2000 Non-routine SupplyA4316 Cath w/drainage 3-way 10/01/2000 Non-routine SupplyA4320 Irrigation tray 10/01/2000 Non-routine SupplyA4321 Cath therapeutic irrig agent 10/01/2000 Non-routine SupplyA4322 Irrigation syringe 10/01/2000 Non-routine SupplyA4323 Saline irrigation solution 10/01/2000 Non-routine SupplyA4326 Male external catheter 10/01/2000 Non-routine SupplyA4327 Fem urinary collect dev cup 10/01/2000 Non-routine SupplyA4328 Fem urinary collect pouch 10/01/2000 Non-routine SupplyA4329 external catheter start set 10/01/2000 Non-routine SupplyA4330 Stool collection pouch 10/01/2000 Non-routine SupplyA4335 Incontinence supply 10/01/2000 Non-routine SupplyA4338 Indwelling catheter latex 10/01/2000 Non-routine SupplyA4340 Indwelling catheter special 10/01/2000 Non-routine SupplyA4344 Cath index foley 2 way 10/01/2000 Non-routine SupplyA4346 Cath indw foley 3 way 10/01/2000 Non-routine SupplyA4347 Male external catheter 10/01/2000 Non-routine SupplyA4351 Straight tip urine catheter 10/01/2000 Non-routine SupplyA4352 Coude tip urinary catheter 10/01/2000 Non-routine SupplyA4353 Intermittent urinary cath 10/01/2000 Non-routine SupplyA4354 Cath insertion tray w/bag 10/01/2000 Non-routine SupplyA4355 Bladder irrigation tubing 10/01/2000 Non-routine SupplyA4356 Ext ureth clmp or compr 10/01/2000 Non-routine SupplyA4357 Bedside drainage bag 10/01/2000 Non-routine SupplyA4358 Urinary leg bag 10/01/2000 Non-routine SupplyA4359 Urinary suspensory w/o leg bag 10/01/2000 Non-routine SupplyA4361 Ostomy face plate 10/01/2000 Non-routine SupplyA4362 Solid skin barrier 10/01/2000 Non-routine SupplyA4364 Ostomy/cath adhesive 10/01/2000 Non-routine SupplyA4365 Ostomy adhesive remover wipe 10/01/2000 Non-routine SupplyA4367 Ostomy belt 10/01/2000 Non-routine SupplyA4368 Ostomy filter 10/01/2000 Non-routine SupplyA4369 Skin barrier liquid per oz 10/01/2000 Non-routine SupplyA4370 Skin barrier paste per oz 10/01/2000 Non-routine SupplyA4371 Skin barrier powder per oz 10/01/2000 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 10/01/2000 Non-routine SupplyA4373 Skin barrier with flange 10/01/2000 Non-routine SupplyA4374 Skin barrier extended wear 10/01/2000 Non-routine SupplyA4375 Drainable plastic pch w fcpl 10/01/2000 Non-routine SupplyA4376 Drainable rubber pch w fcplt 10/01/2000 Non-routine SupplyA4377 Drainable plstic pch w/o fp 10/01/2000 Non-routine SupplyA4378 Drainable rubber pch w/o fp 10/01/2000 Non-routine Supply





A4379 Urinary plastic pouch w fcpl 10/01/2000 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 10/01/2000 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 10/01/2000 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 10/01/2000 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 10/01/2000 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 10/01/2000 Non-routine SupplyA4385 Ost skn barrier sld ext wear 10/01/2000 Non-routine SupplyA4386 Ost skn barrier w flng ex wr 10/01/2000 Non-routine SupplyA4387 Ost clsd pouch w att st barr 10/01/2000 Non-routine SupplyA4388 Drainable pch w ex wear barr 10/01/2000 Non-routine SupplyA4389 Drainable pch w st wear barr 10/01/2000 Non-routine SupplyA4390 Drainable pch ex wear convex 10/01/2000 Non-routine SupplyA4391 Urinary pouch w ex wear barr 10/01/2000 Non-routine SupplyA4392 Urinary pouch w st wear barr 10/01/2000 Non-routine SupplyA4393 Urine pch w ex wear bar conv 10/01/2000 Non-routine SupplyA4394 Ostomy pouch liq deodorant 10/01/2000 Non-routine SupplyA4395 Ostomy pouch solid deodorant 10/01/2000 Non-routine SupplyA4396 Peristomal hernia supprt blt 10/01/2000 Non-routine SupplyA4397 Irrigation supply sleeve 10/01/2000 Non-routine SupplyA4398 Ostomy irrigation bag 10/01/2000 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 10/01/2000 Non-routine SupplyA4400 Ostomy irrigation set 10/01/2000 Non-routine SupplyA4402 Lubricant per ounce 10/01/2000 Non-routine SupplyA4404 Ostomy ring each 10/01/2000 Non-routine SupplyA4421 Ostomy supply misc 10/01/2000 Non-routine SupplyA4455 Adhesive remover per ounce 10/01/2000 Non-routine SupplyA4460 Elastic compression bandage 10/01/2000 Non-routine SupplyA4462 Abdmnl drssng holder/binder 10/01/2000 Non-routine SupplyA4481 Tracheostoma filter 10/01/2000 Non-routine SupplyA4554 Disposable underpads 10/01/2000 Non-routine SupplyA4622 Tracheostomy or larngectomy 10/01/2000 Non-routine SupplyA4623 Tracheostomy inner cannula 10/01/2000 Non-routine SupplyA4625 Trach care kit for new 10/01/2000 Non-routine SupplyA4626 Tracheostomy cleaning brush 10/01/2000 Non-routine SupplyA4649 Surgical supplies 10/01/2000 Non-routine SupplyA5051 Pouch clsd w barr attached 10/01/2000 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 10/01/2000 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 10/01/2000 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 10/01/2000 Non-routine SupplyA5055 Stoma cap 10/01/2000 Non-routine SupplyA5061 Pouch drainable w barrier at 10/01/2000 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 10/01/2000 Non-routine SupplyA5063 Drain ostomy pouch w/flange 10/01/2000 Non-routine SupplyA5071 Urinary pouch w/barrier 10/01/2000 Non-routine SupplyA5072 Urinary pouch w/o barrier 10/01/2000 Non-routine SupplyA5073 Urinary pouch on barr w/flng 10/01/2000 Non-routine SupplyA5081 Continent stoma plug 10/01/2000 Non-routine SupplyA5082 Continent stoma catheter 10/01/2000 Non-routine SupplyA5093 Ostomy accessory convex inse 10/01/2000 Non-routine SupplyA5102 Beside drain btl w/wo tube 10/01/2000 Non-routine Supply





A5105 Urinary suspensory 10/01/2000 Non-routine SupplyA5112 Urinary leg bag 10/01/2000 Non-routine SupplyA5113 Latex leg strap 10/01/2000 Non-routine SupplyA5114 Foam/fabric leg strap 10/01/2000 Non-routine SupplyA5119 Skin barrier wipes box pr 10/01/2000 Non-routine SupplyA5121 Solid skin barrier 6x6 10/01/2000 Non-routine SupplyA5122 Solid skin barrier 8x8 10/01/2000 Non-routine SupplyA5123 Skin barrier with flange 10/01/2000 Non-routine SupplyA5126 Disk / foam pad +or- 10/01/2000 Non-routine SupplyA5131 Appliance cleaner 10/01/2000 Non-routine SupplyA5149 Incontinence / ostomy supply 10/01/2000 Non-routine SupplyA6020 Collagen wound dressing 10/01/2000 Non-routine SupplyA6154 Wound pouch each 10/01/2000 Non-routine SupplyA6196 Alginate dressing <=16 sq in 10/01/2000 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq 10/01/2000 Non-routine SupplyA6198 Alginate dressing > 48 sq 10/01/2000 Non-routine SupplyA6199 Alginate drsg wound filler 10/01/2000 Non-routine SupplyA6200 Compos drsg <=16 no bdr 10/01/2000 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 10/01/2000 Non-routine SupplyA6202 Compos drsg >48 no bdr 10/01/2000 Non-routine SupplyA6203 Composite drsg <= 16 sq 10/01/2000 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 10/01/2000 Non-routine SupplyA6205 Composite drsg > 48 sq 10/01/2000 Non-routine SupplyA6206 Contact layer <= 16 sq 10/01/2000 Non-routine SupplyA6207 Contact layer >16<= 48 sq 10/01/2000 Non-routine SupplyA6208 Contact layer > 48 sq 10/01/2000 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 10/01/2000 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 10/01/2000 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 10/01/2000 Non-routine SupplyA6212 Foam drg <=16 sq in w/bdr 10/01/2000 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 10/01/2000 Non-routine SupplyA6214 Foam drg > 48 sq in w/bdr 10/01/2000 Non-routine SupplyA6215 Foam dressing wound filler 10/01/2000 Non-routine SupplyA6219 Gauze <= 16 sq in w/bdr 10/01/2000 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bdr 10/01/2000 Non-routine SupplyA6221 Gauze > 48 sq in w/bdr 10/01/2000 Non-routine SupplyA6222 Gauze <=16 in no w / sal w/ o b 10/01/2000 Non-routine SupplyA6223 Gauze >16<=48 no w / sal w/ o b 10/01/2000 Non-routine SupplyA6224 Gauze > 48 in no w /sal w/ o b 10/01/2000 Non-routine SupplyA6228 Gauze <= 16 sq in water / sal 10/01/2000 Non-routine SupplyA6229 Gauze >16<=48 sq in watr / sal 10/01/2000 Non-routine SupplyA6230 Gauze > 48 sq in water / salne 10/01/2000 Non-routine SupplyA6234 Hydrocolld drg <=16 w / o bdr 10/01/2000 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w / o b 10/01/2000 Non-routine SupplyA6236 Hydrocolld drg > 48 in w / o b 10/01/2000 Non-routine SupplyA6237 Hydrocolld drg <=16 in w / bdr 10/01/2000 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w / bdr 10/01/2000 Non-routine SupplyA6239 Hydrocolld drg > 48 in w / bdr 10/01/2000 Non-routine SupplyA6240 Hydrocolld drg filler paste 10/01/2000 Non-routine SupplyA6241 Hydrocolloid drg filler dry 10/01/2000 Non-routine Supply





A6242 Hydrogel drg <=16 in w / o bdr 10/01/2000 Non-routine SupplyA6243 Hydrogel drg >16<=48 w / o bdr 10/01/2000 Non-routine SupplyA6244 Hydrogel drg >48 in w / o bdr 10/01/2000 Non-routine SupplyA6245 Hydrogel drg <= 16 in w / bdr 10/01/2000 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w / b 10/01/2000 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w / b 10/01/2000 Non-routine SupplyA6248 Hydrogel dressing 10/01/2000 Non-routine SupplyA6251 Absorpt drg <=16 sq in w / o b 10/01/2000 Non-routine SupplyA6252 Absorpt drg >16 <=48 w / o bdr 10/01/2000 Non-routine SupplyA6253 Absorpt drg . 48 sq in w / o b 10/01/2000 Non-routine SupplyA6254 Absorpt drg <=16 sq in w / bdr 10/01/2000 Non-routine SupplyA6255 Absorpt drg >16<=48 in w / bdr 10/01/2000 Non-routine SupplyA6256 Absorpt drg > 48 sq in w / bdr 10/01/2000 Non-routine SupplyA6257 Transparent film <= 16 sq in 10/01/2000 Non-routine SupplyA6258 Transparent film >16<=48 in 10/01/2000 Non-routine SupplyA6259 Transparent film > 48 sq in 10/01/2000 Non-routine SupplyA6261 Wound filler gel / paste / oz 10/01/2000 Non-routine SupplyA6262 Wound filler dry form / gram 10/01/2000 Non-routine SupplyA6266 Impreg gauze no h20 / sal / yard 10/01/2000 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 10/01/2000 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 10/01/2000 Non-routine SupplyA6404 Sterile gauze > 48 sq in 10/01/2000 Non-routine SupplyA6405 Sterile elastic gauze / yd 10/01/2000 Non-routine SupplyA6406 Sterile non-elastic gauze / yd 10/01/2000 Non-routine SupplyK0280 Extension drainage tubing 10/01/2000 Non-routine SupplyK0281 Lubricant catheter insertion 10/01/2000 Non-routine SupplyK0407 Urinary cath skin attachment 10/01/2000 Non-routine SupplyK0408 Urinary cath leg strap 10/01/2000 Non-routine SupplyK0409 Sterile H20 irrigation solut 10/01/2000 Non-routine SupplyK0410 Male ext cath w / adh coating 10/01/2000 Non-routine SupplyK0411 Male ext cath w / adh strip 10/01/2000 Non-routine Supply90901 Biofeedback train, any meth 10/01/2000 Therapy90911 Biofeedback peri/uro/rectal 10/01/2000 Therapy92506 Speech/hearing evaluation 10/01/2000 Therapy92507 Speech/hearing therapy, individual 10/01/2000 Therapy92508 Speech/hearing therapy, group 10/01/2000 Therapy92510 Rehab for ear implant 10/01/2000 Therapy92525 Oral function evaluation 10/01/2000 Therapy92526 Oral function therapy 10/01/2000 Therapy92597 Oral speech device eval 10/01/2000 Therapy92598 Modify oral speech device 10/01/2000 Therapy96105 Assessment of aphasia 10/01/2000 Therapy97001 Pt evaluation 10/01/2000 Therapy97002 Pt re-evaluation 10/01/2000 Therapy97003 Ot evaluation 10/01/2000 Therapy97004 Ot re-evaluation 10/01/2000 Therapy97012 Mechanical traction therapy 10/01/2000 Therapy97014 Electric stimulation therapy 10/01/2000 Therapy97016 Vasopneumatic device therapy 10/01/2000 Therapy97018 Paraffin bath therapy 10/01/2000 Therapy





97020 Microwave therapy 10/01/2000 Therapy97022 Whirlpool therapy 10/01/2000 Therapy97024 Diathermy treatment 10/01/2000 Therapy97026 Infrared therapy 10/01/2000 Therapy97028 Ultraviolet therapy 10/01/2000 Therapy97032 Electrical stimulation 10/01/2000 Therapy97033 Electric current therapy 10/01/2000 Therapy97034 Contrast bath therapy 10/01/2000 Therapy97035 Ultrasound therapy 10/01/2000 Therapy97036 Hydrotherapy 10/01/2000 Therapy97039 Physical therapy treatment 10/01/2000 Therapy97110 Therapeutic exercises 10/01/2000 Therapy97112 Neuromuscular reeducation 10/01/2000 Therapy97113 Aquatic therapy/exercises 10/01/2000 Therapy97116 Gait training therapy 10/01/2000 Therapy97122 Manual traction therapy 10/01/2000 Therapy97124 Massage therapy 10/01/2000 Therapy97139 Physical medicine procedure 10/01/2000 Therapy97150 Group therapeutic procedures 10/01/2000 Therapy97250 Myofascial release 10/01/2000 Therapy97260 Regional manipulation 10/01/2000 Therapy97261 Supplemental manipulations 10/01/2000 Therapy97265 Joint mobilization 10/01/2000 Therapy97504 Orthotic training 10/01/2000 Therapy97520 Prosthetic training 10/01/2000 Therapy97530 Therapeutic activities 10/01/2000 Therapy97535 Self care mngment training 10/01/2000 Therapy97537 Community/work reintegration 10/01/2000 Therapy97542 Wheelchair mngment training 10/01/2000 Therapy97545 Work hardening 10/01/2000 Therapy97546 Work hardening add-on 10/01/2000 Therapy97703 Prosthetic checkout 10/01/2000 Therapy97750 Physical performance test 10/01/2000 Therapy97770 Cognitive skills development 10/01/2000 Therapy97799 Physical medicine procedure 10/01/2000 Therapy

HH Consolidated Billing Code List -- As of PM AB-01-65



Effective Date (2) Code Type

A4212 Non coring needle or stylet 01/01/2001 Non-routine SupplyA4310 Insert tray w/o bag/cath 01/01/2001 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 01/01/2001 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 01/01/2001 Non-routine SupplyA4313 Catheter w/bag 3-way 01/01/2001 Non-routine SupplyA4314 Cath w/drainage 2-way latex 01/01/2001 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 01/01/2001 Non-routine SupplyA4316 Cath w/drainage 3-way 01/01/2001 Non-routine SupplyA4319 Sterile H2O irrigation solut 01/01/2001 Non-routine SupplyA4320 Irrigation tray 01/01/2001 Non-routine SupplyA4321 Cath therapeutic irrig agent 01/01/2001 Non-routine SupplyA4322 Irrigation syringe 01/01/2001 Non-routine SupplyA4323 Saline irrigation solution 01/01/2001 Non-routine SupplyA4324 Male ext cath w/adh coating 01/01/2001 Non-routine SupplyA4325 Male ext cath w/adh strip 01/01/2001 Non-routine SupplyA4326 Male external catheter 01/01/2001 Non-routine SupplyA4327 Fem urinary collect dev cup 01/01/2001 Non-routine SupplyA4328 Fem urinary collect pouch 01/01/2001 Non-routine SupplyA4329 External catheter start set 01/01/2001 Non-routine SupplyA4330 Stool collection pouch 01/01/2001 Non-routine SupplyA4331 Extension drainage tubing 01/01/2001 Non-routine SupplyA4332 Lubricant for cath insertion 01/01/2001 Non-routine SupplyA4333 Urinary cath anchor device 01/01/2001 Non-routine SupplyA4334 Urinary cath leg strap 01/01/2001 Non-routine SupplyA4335 Incontinence supply 01/01/2001 Non-routine SupplyA4338 Indwelling catheter latex 01/01/2001 Non-routine SupplyA4340 Indwelling catheter special 01/01/2001 Non-routine SupplyA4344 Cath indw foley 2 way silicn 01/01/2001 Non-routine SupplyA4346 Cath indw foley 3 way 01/01/2001 Non-routine SupplyA4347 Male external catheter 01/01/2001 Non-routine SupplyA4348 Male ext cath extended wear 01/01/2001 Non-routine SupplyA4351 Straight tip urine catheter 01/01/2001 Non-routine SupplyA4352 Coude tip urinary catheter 01/01/2001 Non-routine SupplyA4353 Intermittent urinary cath 01/01/2001 Non-routine SupplyA4354 Cath insertion tray w/bag 01/01/2001 Non-routine SupplyA4355 Bladder irrigation tubing 01/01/2001 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 01/01/2001 Non-routine SupplyA4357 Bedside drainage bag 01/01/2001 Non-routine SupplyA4358 Urinary leg bag 01/01/2001 Non-routine SupplyA4359 Urinary suspensory w/o leg b 01/01/2001 Non-routine SupplyA4361 Ostomy face plate 01/01/2001 Non-routine SupplyA4362 Solid skin barrier 01/01/2001 Non-routine SupplyA4364 Liq adhes for facial prosth 01/01/2001 Non-routine SupplyA4365 Adhesive remover wipes 01/01/2001 Non-routine SupplyA4367 Ostomy belt 01/01/2001 Non-routine SupplyA4368 Ostomy filter 01/01/2001 Non-routine SupplyA4369 Skin barrier liquid per oz 01/01/2001 Non-routine SupplyA4370 Skin barrier paste per oz 01/01/2001 Non-routine SupplyA4371 Skin barrier powder per oz 01/01/2001 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 01/01/2001 Non-routine Supply





A4373 Skin barrier with flange 01/01/2001 Non-routine SupplyA4374 Skin barrier extended wear 01/01/2001 Non-routine SupplyA4375 Drainable plastic pch w fcpl 01/01/2001 Non-routine SupplyA4376 Drainable rubber pch w fcplt 01/01/2001 Non-routine SupplyA4377 Drainable plstic pch w/o fp 01/01/2001 Non-routine SupplyA4378 Drainable rubber pch w/o fp 01/01/2001 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 01/01/2001 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 01/01/2001 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 01/01/2001 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 01/01/2001 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 01/01/2001 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 01/01/2001 Non-routine SupplyA4385 Ost skn barrier sld ext wear 01/01/2001 Non-routine SupplyA4386 Ost skn barrier w flng ex wr 01/01/2001 Non-routine SupplyA4387 Ost clsd pouch w att st barr 01/01/2001 Non-routine SupplyA4388 Drainable pch w ex wear barr 01/01/2001 Non-routine SupplyA4389 Drainable pch w st wear barr 01/01/2001 Non-routine SupplyA4390 Drainable pch ex wear convex 01/01/2001 Non-routine SupplyA4391 Urinary pouch w ex wear barr 01/01/2001 Non-routine SupplyA4392 Urinary pouch w st wear barr 01/01/2001 Non-routine SupplyA4393 Urine pch w ex wear bar conv 01/01/2001 Non-routine SupplyA4394 Ostomy pouch liq deodorant 01/01/2001 Non-routine SupplyA4395 Ostomy pouch solid deodorant 01/01/2001 Non-routine SupplyA4396 Peristomal hernia supprt blt 01/01/2001 Non-routine SupplyA4397 Irrigation supply sleeve 01/01/2001 Non-routine SupplyA4398 Ostomy irrigation bag 01/01/2001 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 01/01/2001 Non-routine SupplyA4400 Ostomy irrigation set 01/01/2001 Non-routine SupplyA4402 Lubricant per ounce 01/01/2001 Non-routine SupplyA4404 Ostomy ring each 01/01/2001 Non-routine SupplyA4421 Ostomy supply misc 01/01/2001 Non-routine SupplyA4455 Adhesive remover per ounce 01/01/2001 Non-routine SupplyA4460 Elastic compression bandage 01/01/2001 Non-routine SupplyA4462 Abdmnl drssng holder/binder 01/01/2001 Non-routine SupplyA4481 Tracheostoma filter 01/01/2001 Non-routine SupplyA4622 Tracheostomy or larngectomy 01/01/2001 Non-routine SupplyA4623 Tracheostomy inner cannula 01/01/2001 Non-routine SupplyA4625 Trach care kit for new trach 01/01/2001 Non-routine SupplyA4626 Tracheostomy cleaning brush 01/01/2001 Non-routine SupplyA4649 Surgical supplies 01/01/2001 Non-routine SupplyA5051 Pouch clsd w barr attached 01/01/2001 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 01/01/2001 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 01/01/2001 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 01/01/2001 Non-routine SupplyA5055 Stoma cap 01/01/2001 Non-routine SupplyA5061 Pouch drainable w barrier at 01/01/2001 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 01/01/2001 Non-routine SupplyA5063 Drain ostomy pouch w/flange 01/01/2001 Non-routine SupplyA5071 Urinary pouch w/barrier 01/01/2001 Non-routine SupplyA5072 Urinary pouch w/o barrier 01/01/2001 Non-routine Supply





A5073 Urinary pouch on barr w/flng 01/01/2001 Non-routine SupplyA5081 Continent stoma plug 01/01/2001 Non-routine SupplyA5082 Continent stoma catheter 01/01/2001 Non-routine SupplyA5093 Ostomy accessory convex inse 01/01/2001 Non-routine SupplyA5102 Bedside drain btl w/wo tube 01/01/2001 Non-routine SupplyA5105 Urinary suspensory 01/01/2001 Non-routine SupplyA5112 Urinary leg bag 01/01/2001 Non-routine SupplyA5113 Latex leg strap 01/01/2001 Non-routine SupplyA5114 Foam/fabric leg strap 01/01/2001 Non-routine SupplyA5119 Skin barrier wipes box pr 50 01/01/2001 Non-routine SupplyA5121 Solid skin barrier 6x6 01/01/2001 Non-routine SupplyA5122 Solid skin barrier 8x8 01/01/2001 Non-routine SupplyA5123 Skin barrier with flange 01/01/2001 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 01/01/2001 Non-routine SupplyA5131 Appliance cleaner 01/01/2001 Non-routine SupplyA6020 Collage wound dressing 01/01/2001 Non-routine SupplyA6021 Collagen dressing <=16 sq in 01/01/2001 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 01/01/2001 Non-routine SupplyA6023 Collagen dressing >48 sq in 01/01/2001 Non-routine SupplyA6024 Collagen dsg wound filler 01/01/2001 Non-routine SupplyA6154 Wound pouch each 01/01/2001 Non-routine SupplyA6196 Alginate dressing <=16 sq in 01/01/2001 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 01/01/2001 Non-routine SupplyA6198 alginate dressing > 48 sq in 01/01/2001 Non-routine SupplyA6199 Alginate drsg wound filler 01/01/2001 Non-routine SupplyA6200 Compos drsg <=16 no border 01/01/2001 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 01/01/2001 Non-routine SupplyA6202 Compos drsg >48 no border 01/01/2001 Non-routine SupplyA6203 Composite drsg <= 16 sq in 01/01/2001 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 01/01/2001 Non-routine SupplyA6205 Composite drsg > 48 sq in 01/01/2001 Non-routine SupplyA6206 Contact layer <= 16 sq in 01/01/2001 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 01/01/2001 Non-routine SupplyA6208 Contact layer > 48 sq in 01/01/2001 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 01/01/2001 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 01/01/2001 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 01/01/2001 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 01/01/2001 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 01/01/2001 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 01/01/2001 Non-routine SupplyA6215 Foam dressing wound filler 01/01/2001 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 01/01/2001 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 01/01/2001 Non-routine SupplyA6221 Gauze > 48 sq in w/border 01/01/2001 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 01/01/2001 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 01/01/2001 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 01/01/2001 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 01/01/2001 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 01/01/2001 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 01/01/2001 Non-routine Supply





A6231 Hydrogel dsg<=16 sq in 01/01/2001 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 01/01/2001 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 01/01/2001 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 01/01/2001 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 01/01/2001 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 01/01/2001 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 01/01/2001 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 01/01/2001 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 01/01/2001 Non-routine SupplyA6240 Hydrocolld drg filler paste 01/01/2001 Non-routine SupplyA6241 Hydrocolloid drg filler dry 01/01/2001 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 01/01/2001 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 01/01/2001 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 01/01/2001 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 01/01/2001 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 01/01/2001 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 01/01/2001 Non-routine SupplyA6248 Hydrogel drsg gel filler 01/01/2001 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 01/01/2001 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 01/01/2001 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 01/01/2001 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 01/01/2001 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 01/01/2001 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 01/01/2001 Non-routine SupplyA6257 Transparent film <= 16 sq in 01/01/2001 Non-routine SupplyA6258 Transparent film >16<=48 in 01/01/2001 Non-routine SupplyA6259 Transparent film > 48 sq in 01/01/2001 Non-routine SupplyA6261 Wound filler gel/paste /oz 01/01/2001 Non-routine SupplyA6262 Wound filler dry form / gram 01/01/2001 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 01/01/2001 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 01/01/2001 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 01/01/2001 Non-routine SupplyA6404 Sterile gauze > 48 sq in 01/01/2001 Non-routine SupplyA6405 Sterile elastic gauze /yd 01/01/2001 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 01/01/2001 Non-routine SupplyA7501 Tracheostoma valve w diaphra 01/01/2001 Non-routine SupplyA7502 Replacement diaphragm/fplate 01/01/2001 Non-routine SupplyA7503 HMES filter holder or cap 01/01/2001 Non-routine SupplyA7504 Tracheostoma HMES filter 01/01/2001 Non-routine SupplyA7505 HMES or trach valve housing 01/01/2001 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 01/01/2001 Non-routine SupplyA7507 Integrated filter & holder 01/01/2001 Non-routine SupplyA7508 Housing & Integrated Adhesiv 01/01/2001 Non-routine SupplyA7509 Heat & moisture exchange sys 01/01/2001 Non-routine SupplyG0193 Endoscopic study swallow functn 01/01/2001 TherapyG0194 Sensory testing endoscopic stud 01/01/2001 TherapyG0195 Clinical eval swallowing funct 01/01/2001 TherapyG0196 Eval of swallowing with radio opa 01/01/2001 TherapyG0197 Eval of pt for prescip speech devi 01/01/2001 TherapyG0198 Patient adapation & train for spe 01/01/2001 Therapy





G0199 Reevaluation of patient use spec 01/01/2001 TherapyG0200 Eval of patient prescip of voice p 01/01/2001 TherapyG0201 Modi for training in use voice pro 01/01/2001 Therapy64550 Apply neurostimulator 01/01/2001 Therapy90901 Biofeedback train, any meth 01/01/2001 Therapy90911 Biofeedback peri/uro/rectal 01/01/2001 Therapy92506 Speech/hearing evaluation 01/01/2001 Therapy92507 Speech/hearing therapy, individual 01/01/2001 Therapy92508 Speech/hearing therapy, group 01/01/2001 Therapy92510 Rehab for ear implant 01/01/2001 Therapy 92525 Oral function evaluation 01/01/2001 Therapy92526 Oral function therapy 01/01/2001 Therapy92597 Oral speech device eval 01/01/2001 Therapy92598 Modify oral speech device 01/01/2001 Therapy95831 Limb muscle testing, manual 01/01/2001 Therapy95832 Hand muscle testing, manual 01/01/2001 Therapy95833 Body muscle testing, manual 01/01/2001 Therapy95834 Body muscle testing, manual 01/01/2001 Therapy95851 Range of motion measurements 01/01/2001 Therapy95852 Range of motion measurements 01/01/2001 Therapy96105 Assessment of aphasia 01/01/2001 Therapy97001 Pt evaluation 01/01/2001 Therapy97002 Pt re-evaluation 01/01/2001 Therapy97003 Ot evaluation 01/01/2001 Therapy97004 Ot re-evaluation 01/01/2001 Therapy97012 Mechanical traction therapy 01/01/2001 Therapy97014 Electric stimulation therapy 01/01/2001 Therapy97016 Vasopneumatic device therapy 01/01/2001 Therapy97018 Paraffin bath therapy 01/01/2001 Therapy97020 Microwave therapy 01/01/2001 Therapy97022 Whirlpool therapy 01/01/2001 Therapy97024 Diathermy treatment 01/01/2001 Therapy97026 Infrared therapy 01/01/2001 Therapy97028 Ultraviolet therapy 01/01/2001 Therapy97032 Electrical stimulation 01/01/2001 Therapy97033 Electric current therapy 01/01/2001 Therapy97034 Contrast bath therapy 01/01/2001 Therapy97035 Ultrasound therapy 01/01/2001 Therapy97036 Hydrotherapy 01/01/2001 Therapy97039 Physical therapy treatment 01/01/2001 Therapy97110 Therapeutic exercises 01/01/2001 Therapy97112 Neuromuscular reeducation 01/01/2001 Therapy97113 Aquatic therapy/exercises 01/01/2001 Therapy97116 Gait training therapy 01/01/2001 Therapy97124 Massage therapy 01/01/2001 Therapy97139 Physical medicine procedure 01/01/2001 Therapy97140 Manual therapy 01/01/2001 Therapy97150 Group therapeutic procedures 01/01/2001 Therapy97504 Orthotic training 01/01/2001 Therapy97520 Prosthetic training 01/01/2001 Therapy





97530 Therapeutic activities 01/01/2001 Therapy97532 Cognitive skills development 01/01/2001 Therapy97533 Sensory integration 01/01/2001 Therapy97535 Self care mngment training 01/01/2001 Therapy97537 Community/work reintegration 01/01/2001 Therapy97542 Wheelchair mngment training 01/01/2001 Therapy97545 Work hardening 01/01/2001 Therapy97546 Work hardening add-on 01/01/2001 Therapy97601 Wound care selective 01/01/2001 Therapy97602 Wound care non-selective 01/01/2001 Therapy97703 Prosthetic checkout 01/01/2001 Therapy97750 Physical performance test 01/01/2001 Therapy97799 Physical medicine procedure 01/01/2001 Therapy





A4212 Non coring needle or stylet 01/01/2002 Non-routine SupplyA4310 Insert tray w/o bag/cath 01/01/2002 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 01/01/2002 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 01/01/2002 Non-routine SupplyA4313 Catheter w/bag 3-way 01/01/2002 Non-routine SupplyA4314 Cath w/drainage 2-way latex 01/01/2002 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 01/01/2002 Non-routine SupplyA4316 Cath w/drainage 3-way 01/01/2002 Non-routine SupplyA4319 Sterile H2O irrigation solut 01/01/2002 Non-routine SupplyA4320 Irrigation tray 01/01/2002 Non-routine SupplyA4321 Cath therapeutic irrig agent 01/01/2002 Non-routine SupplyA4322 Irrigation syringe 01/01/2002 Non-routine SupplyA4323 Saline irrigation solution 01/01/2002 Non-routine SupplyA4324 Male ext cath w/adh coating 01/01/2002 Non-routine SupplyA4325 Male ext cath w/adh strip 01/01/2002 Non-routine SupplyA4326 Male external catheter 01/01/2002 Non-routine SupplyA4327 Fem urinary collect dev cup 01/01/2002 Non-routine SupplyA4328 Fem urinary collect pouch 01/01/2002 Non-routine SupplyA4330 Stool collection pouch 01/01/2002 Non-routine SupplyA4331 Extension drainage tubing 01/01/2002 Non-routine SupplyA4332 Lubricant for cath insertion 01/01/2002 Non-routine SupplyA4333 Urinary cath anchor device 01/01/2002 Non-routine SupplyA4334 Urinary cath leg strap 01/01/2002 Non-routine SupplyA4335 Incontinence supply 01/01/2002 Non-routine SupplyA4338 Indwelling catheter latex 01/01/2002 Non-routine SupplyA4340 Indwelling catheter special 01/01/2002 Non-routine SupplyA4344 Cath indw foley 2 way silicn 01/01/2002 Non-routine SupplyA4346 Cath indw foley 3 way 01/01/2002 Non-routine SupplyA4347 Male external catheter 01/01/2002 Non-routine SupplyA4348 Male ext cath extended wear 01/01/2002 Non-routine SupplyA4351 Straight tip urine catheter 01/01/2002 Non-routine SupplyA4352 Coude tip urinary catheter 01/01/2002 Non-routine SupplyA4353 Intermittent urinary cath 01/01/2002 Non-routine SupplyA4354 Cath insertion tray w/bag 01/01/2002 Non-routine SupplyA4355 Bladder irrigation tubing 01/01/2002 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 01/01/2002 Non-routine SupplyA4357 Bedside drainage bag 01/01/2002 Non-routine SupplyA4358 Urinary leg bag 01/01/2002 Non-routine SupplyA4359 Urinary suspensory w/o leg b 01/01/2002 Non-routine SupplyA4361 Ostomy face plate 01/01/2002 Non-routine SupplyA4362 Solid skin barrier 01/01/2002 Non-routine SupplyA4364 Liq adhes for facial prosth 01/01/2002 Non-routine SupplyA4365 Adhesive remover wipes 01/01/2002 Non-routine SupplyA4367 Ostomy belt 01/01/2002 Non-routine SupplyA4368 Ostomy filter 01/01/2002 Non-routine SupplyA4369 Skin barrier liquid per oz 01/01/2002 Non-routine SupplyA4370 Skin barrier paste per oz 01/01/2002 Non-routine SupplyA4371 Skin barrier powder per oz 01/01/2002 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 01/01/2002 Non-routine SupplyA4373 Skin barrier with flange 01/01/2002 Non-routine Supply





A4374 Skin barrier extended wear 01/01/2002 Non-routine SupplyA4375 Drainable plastic pch w fcpl 01/01/2002 Non-routine SupplyA4376 Drainable rubber pch w fcplt 01/01/2002 Non-routine SupplyA4377 Drainable plstic pch w/o fp 01/01/2002 Non-routine SupplyA4378 Drainable rubber pch w/o fp 01/01/2002 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 01/01/2002 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 01/01/2002 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 01/01/2002 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 01/01/2002 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 01/01/2002 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 01/01/2002 Non-routine SupplyA4385 Ost skn barrier sld ext wear 01/01/2002 Non-routine SupplyA4386 Ost skn barrier w flng ex wr 01/01/2002 Non-routine SupplyA4387 Ost clsd pouch w att st barr 01/01/2002 Non-routine SupplyA4388 Drainable pch w ex wear barr 01/01/2002 Non-routine SupplyA4389 Drainable pch w st wear barr 01/01/2002 Non-routine SupplyA4390 Drainable pch ex wear convex 01/01/2002 Non-routine SupplyA4391 Urinary pouch w ex wear barr 01/01/2002 Non-routine SupplyA4392 Urinary pouch w st wear barr 01/01/2002 Non-routine SupplyA4393 Urine pch w ex wear bar conv 01/01/2002 Non-routine SupplyA4394 Ostomy pouch liq deodorant 01/01/2002 Non-routine SupplyA4395 Ostomy pouch solid deodorant 01/01/2002 Non-routine SupplyA4396 Peristomal hernia supprt blt 01/01/2002 Non-routine SupplyA4397 Irrigation supply sleeve 01/01/2002 Non-routine SupplyA4398 Ostomy irrigation bag 01/01/2002 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 01/01/2002 Non-routine SupplyA4400 Ostomy irrigation set 01/01/2002 Non-routine SupplyA4402 Lubricant per ounce 01/01/2002 Non-routine SupplyA4404 Ostomy ring each 01/01/2002 Non-routine SupplyA4421 Ostomy supply misc 01/01/2002 Non-routine SupplyA4455 Adhesive remover per ounce 01/01/2002 Non-routine SupplyA4460 Elastic compression bandage 01/01/2002 Non-routine SupplyA4462 Abdmnl drssng holder/binder 01/01/2002 Non-routine SupplyA4481 Tracheostoma filter 01/01/2002 Non-routine SupplyA4622 Tracheostomy or larngectomy 01/01/2002 Non-routine SupplyA4623 Tracheostomy inner cannula 01/01/2002 Non-routine SupplyA4625 Trach care kit for new trach 01/01/2002 Non-routine SupplyA4626 Tracheostomy cleaning brush 01/01/2002 Non-routine SupplyA4649 Surgical supplies 01/01/2002 Non-routine SupplyA5051 Pouch clsd w barr attached 01/01/2002 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 01/01/2002 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 01/01/2002 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 01/01/2002 Non-routine SupplyA5055 Stoma cap 01/01/2002 Non-routine SupplyA5061 Pouch drainable w barrier at 01/01/2002 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 01/01/2002 Non-routine SupplyA5063 Drain ostomy pouch w/flange 01/01/2002 Non-routine SupplyA5071 Urinary pouch w/barrier 01/01/2002 Non-routine SupplyA5072 Urinary pouch w/o barrier 01/01/2002 Non-routine SupplyA5073 Urinary pouch on barr w/flng 01/01/2002 Non-routine Supply





A5081 Continent stoma plug 01/01/2002 Non-routine SupplyA5082 Continent stoma catheter 01/01/2002 Non-routine SupplyA5093 Ostomy accessory convex inse 01/01/2002 Non-routine SupplyA5102 Bedside drain btl w/wo tube 01/01/2002 Non-routine SupplyA5105 Urinary suspensory 01/01/2002 Non-routine SupplyA5112 Urinary leg bag 01/01/2002 Non-routine SupplyA5113 Latex leg strap 01/01/2002 Non-routine SupplyA5114 Foam/fabric leg strap 01/01/2002 Non-routine SupplyA5119 Skin barrier wipes box pr 50 01/01/2002 Non-routine SupplyA5121 Solid skin barrier 6x6 01/01/2002 Non-routine SupplyA5122 Solid skin barrier 8x8 01/01/2002 Non-routine SupplyA5123 Skin barrier with flange 01/01/2002 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 01/01/2002 Non-routine SupplyA5131 Appliance cleaner 01/01/2002 Non-routine SupplyA6010 Collagen based wound filler, dry foam 01/01/2002 Non-routine SupplyA6020 Collage wound dressing 01/01/2002 Non-routine SupplyA6021 Collagen dressing <=16 sq in 01/01/2002 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 01/01/2002 Non-routine SupplyA6023 Collagen dressing >48 sq in 01/01/2002 Non-routine SupplyA6024 Collagen dsg wound filler 01/01/2002 Non-routine SupplyA6154 Wound pouch each 01/01/2002 Non-routine SupplyA6196 Alginate dressing <=16 sq in 01/01/2002 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 01/01/2002 Non-routine SupplyA6198 alginate dressing > 48 sq in 01/01/2002 Non-routine SupplyA6199 Alginate drsg wound filler 01/01/2002 Non-routine SupplyA6200 Compos drsg <=16 no border 01/01/2002 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 01/01/2002 Non-routine SupplyA6202 Compos drsg >48 no border 01/01/2002 Non-routine SupplyA6203 Composite drsg <= 16 sq in 01/01/2002 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 01/01/2002 Non-routine SupplyA6205 Composite drsg > 48 sq in 01/01/2002 Non-routine SupplyA6206 Contact layer <= 16 sq in 01/01/2002 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 01/01/2002 Non-routine SupplyA6208 Contact layer > 48 sq in 01/01/2002 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 01/01/2002 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 01/01/2002 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 01/01/2002 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 01/01/2002 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 01/01/2002 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 01/01/2002 Non-routine SupplyA6215 Foam dressing wound filler 01/01/2002 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 01/01/2002 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 01/01/2002 Non-routine SupplyA6221 Gauze > 48 sq in w/border 01/01/2002 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 01/01/2002 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 01/01/2002 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 01/01/2002 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 01/01/2002 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 01/01/2002 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 01/01/2002 Non-routine Supply





A6231 Hydrogel dsg<=16 sq in 01/01/2002 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 01/01/2002 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 01/01/2002 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 01/01/2002 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 01/01/2002 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 01/01/2002 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 01/01/2002 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 01/01/2002 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 01/01/2002 Non-routine SupplyA6240 Hydrocolld drg filler paste 01/01/2002 Non-routine SupplyA6241 Hydrocolloid drg filler dry 01/01/2002 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 01/01/2002 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 01/01/2002 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 01/01/2002 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 01/01/2002 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 01/01/2002 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 01/01/2002 Non-routine SupplyA6248 Hydrogel drsg gel filler 01/01/2002 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 01/01/2002 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 01/01/2002 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 01/01/2002 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 01/01/2002 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 01/01/2002 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 01/01/2002 Non-routine SupplyA6257 Transparent film <= 16 sq in 01/01/2002 Non-routine SupplyA6258 Transparent film >16<=48 in 01/01/2002 Non-routine SupplyA6259 Transparent film > 48 sq in 01/01/2002 Non-routine SupplyA6261 Wound filler gel/paste /oz 01/01/2002 Non-routine SupplyA6262 Wound filler dry form / gram 01/01/2002 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 01/01/2002 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 01/01/2002 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 01/01/2002 Non-routine SupplyA6404 Sterile gauze > 48 sq in 01/01/2002 Non-routine SupplyA6405 Sterile elastic gauze /yd 01/01/2002 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 01/01/2002 Non-routine SupplyA7501 Tracheostoma valve w diaphra 01/01/2002 Non-routine SupplyA7502 Replacement diaphragm/fplate 01/01/2002 Non-routine SupplyA7503 HMES filter holder or cap 01/01/2002 Non-routine SupplyA7504 Tracheostoma HMES filter 01/01/2002 Non-routine SupplyA7505 HMES or trach valve housing 01/01/2002 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 01/01/2002 Non-routine SupplyA7507 Integrated filter & holder 01/01/2002 Non-routine SupplyA7508 Housing & Integrated Adhesiv 01/01/2002 Non-routine SupplyA7509 Heat & moisture exchange sys 01/01/2002 Non-routine SupplyG0193 Endoscopic study swallow functn 01/01/2002 TherapyG0194 Sensory testing endoscopic stud 01/01/2002 TherapyG0195 Clinical eval swallowing funct 01/01/2002 TherapyG0196 Eval of swallowing with radio opa 01/01/2002 TherapyG0197 Eval of pt for prescip speech devi 01/01/2002 TherapyG0198 Patient adapation & train for spe 01/01/2002 Therapy





G0199 Reevaluation of patient use spec 01/01/2002 TherapyG0200 Eval of patient prescip of voice p 01/01/2002 TherapyG0201 Modi for training in use voice pro 01/01/2002 Therapy64550 Apply neurostimulator 01/01/2002 Therapy90901 Biofeedback train, any meth 01/01/2002 Therapy90911 Biofeedback peri/uro/rectal 01/01/2002 Therapy92506 Speech/hearing evaluation 01/01/2002 Therapy92507 Speech/hearing therapy, individual 01/01/2002 Therapy92508 Speech/hearing therapy, group 01/01/2002 Therapy92510 Rehab for ear implant 01/01/2002 Therapy92525 Oral function evaluation 01/01/2002 Therapy92526 Oral function therapy 01/01/2002 Therapy92597 Oral speech device eval 01/01/2002 Therapy92598 Modify oral speech device 01/01/2002 Therapy95831 Limb muscle testing, manual 01/01/2002 Therapy95832 Hand muscle testing, manual 01/01/2002 Therapy95833 Body muscle testing, manual 01/01/2002 Therapy95834 Body muscle testing, manual 01/01/2002 Therapy95851 Range of motion measurements 01/01/2002 Therapy95852 Range of motion measurements 01/01/2002 Therapy96105 Assessment of aphasia 01/01/2002 Therapy97001 Pt evaluation 01/01/2002 Therapy97002 Pt re-evaluation 01/01/2002 Therapy97003 Ot evaluation 01/01/2002 Therapy97004 Ot re-evaluation 01/01/2002 Therapy97012 Mechanical traction therapy 01/01/2002 Therapy97014 Electric stimulation therapy 01/01/2002 Therapy97016 Vasopneumatic device therapy 01/01/2002 Therapy97018 Paraffin bath therapy 01/01/2002 Therapy97020 Microwave therapy 01/01/2002 Therapy97022 Whirlpool therapy 01/01/2002 Therapy97024 Diathermy treatment 01/01/2002 Therapy97026 Infrared therapy 01/01/2002 Therapy97028 Ultraviolet therapy 01/01/2002 Therapy97032 Electrical stimulation 01/01/2002 Therapy97033 Electric current therapy 01/01/2002 Therapy97034 Contrast bath therapy 01/01/2002 Therapy97035 Ultrasound therapy 01/01/2002 Therapy97036 Hydrotherapy 01/01/2002 Therapy97039 Physical therapy treatment 01/01/2002 Therapy97110 Therapeutic exercises 01/01/2002 Therapy97112 Neuromuscular reeducation 01/01/2002 Therapy97113 Aquatic therapy/exercises 01/01/2002 Therapy97116 Gait training therapy 01/01/2002 Therapy97124 Massage therapy 01/01/2002 Therapy97139 Physical medicine procedure 01/01/2002 Therapy97140 Manual therapy 01/01/2002 Therapy97150 Group therapeutic procedures 01/01/2002 Therapy97504 Orthotic training 01/01/2002 Therapy97520 Prosthetic training 01/01/2002 Therapy





97530 Therapeutic activities 01/01/2002 Therapy97532 Cognitive skills development 01/01/2002 Therapy97533 Sensory integration 01/01/2002 Therapy97535 Self care mngment training 01/01/2002 Therapy97537 Community/work reintegration 01/01/2002 Therapy97542 Wheelchair mngment training 01/01/2002 Therapy97545 Work hardening 01/01/2002 Therapy97546 Work hardening add-on 01/01/2002 Therapy97601 Wound care selective 01/01/2002 Therapy97602 Wound care non-selective 01/01/2002 Therapy97703 Prosthetic checkout 01/01/2002 Therapy97750 Physical performance test 01/01/2002 Therapy97799 Physical medicine procedure 01/01/2002 Therapy





A4212 Non coring needle or stylet 10/01/2002 Non-routine SupplyA4310 Insert tray w/o bag/cath 10/01/2002 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 10/01/2002 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 10/01/2002 Non-routine SupplyA4313 Catheter w/bag 3-way 10/01/2002 Non-routine SupplyA4314 Cath w/drainage 2-way latex 10/01/2002 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 10/01/2002 Non-routine SupplyA4316 Cath w/drainage 3-way 10/01/2002 Non-routine SupplyA4319 Sterile H2O irrigation solut 10/01/2002 Non-routine SupplyA4320 Irrigation tray 10/01/2002 Non-routine SupplyA4321 Cath therapeutic irrig agent 10/01/2002 Non-routine SupplyA4322 Irrigation syringe 10/01/2002 Non-routine SupplyA4323 Saline irrigation solution 10/01/2002 Non-routine SupplyA4324 Male ext cath w/adh coating 10/01/2002 Non-routine SupplyA4325 Male ext cath w/adh strip 10/01/2002 Non-routine SupplyA4326 Male external catheter 10/01/2002 Non-routine SupplyA4327 Fem urinary collect dev cup 10/01/2002 Non-routine SupplyA4328 Fem urinary collect pouch 10/01/2002 Non-routine SupplyA4330 Stool collection pouch 10/01/2002 Non-routine SupplyA4331 Extension drainage tubing 10/01/2002 Non-routine SupplyA4332 Lubricant for cath insertion 10/01/2002 Non-routine SupplyA4333 Urinary cath anchor device 10/01/2002 Non-routine SupplyA4334 Urinary cath leg strap 10/01/2002 Non-routine SupplyA4335 Incontinence supply 10/01/2002 Non-routine SupplyA4338 Indwelling catheter latex 10/01/2002 Non-routine SupplyA4340 Indwelling catheter special 10/01/2002 Non-routine SupplyA4344 Cath indw foley 2 way silicn 10/01/2002 Non-routine SupplyA4346 Cath indw foley 3 way 10/01/2002 Non-routine SupplyA4347 Male external catheter 10/01/2002 Non-routine SupplyA4348 Male ext cath extended wear 10/01/2002 Non-routine SupplyA4351 Straight tip urine catheter 10/01/2002 Non-routine SupplyA4352 Coude tip urinary catheter 10/01/2002 Non-routine SupplyA4353 Intermittent urinary cath 10/01/2002 Non-routine SupplyA4354 Cath insertion tray w/bag 10/01/2002 Non-routine SupplyA4355 Bladder irrigation tubing 10/01/2002 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 10/01/2002 Non-routine SupplyA4357 Bedside drainage bag 10/01/2002 Non-routine SupplyA4358 Urinary leg bag 10/01/2002 Non-routine SupplyA4359 Urinary suspensory w/o leg b 10/01/2002 Non-routine SupplyA4361 Ostomy face plate 10/01/2002 Non-routine SupplyA4362 Solid skin barrier 10/01/2002 Non-routine SupplyA4364 Liq adhes for facial prosth 10/01/2002 Non-routine SupplyA4365 Adhesive remover wipes 10/01/2002 Non-routine SupplyA4367 Ostomy belt 10/01/2002 Non-routine SupplyA4368 Ostomy filter 10/01/2002 Non-routine SupplyA4369 Skin barrier liquid per oz 10/01/2002 Non-routine SupplyA4371 Skin barrier powder per oz 10/01/2002 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 10/01/2002 Non-routine SupplyA4373 Skin barrier with flange 10/01/2002 Non-routine SupplyA4375 Drainable plastic pch w fcpl 10/01/2002 Non-routine Supply





A4376 Drainable rubber pch w fcplt 10/01/2002 Non-routine SupplyA4377 Drainable plstic pch w/o fp 10/01/2002 Non-routine SupplyA4378 Drainable rubber pch w/o fp 10/01/2002 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 10/01/2002 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 10/01/2002 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 10/01/2002 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 10/01/2002 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 10/01/2002 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 10/01/2002 Non-routine SupplyA4385 Ost skn barrier sld ext wear 10/01/2002 Non-routine SupplyA4387 Ost clsd pouch w att st barr 10/01/2002 Non-routine SupplyA4388 Drainable pch w ex wear barr 10/01/2002 Non-routine SupplyA4389 Drainable pch w st wear barr 10/01/2002 Non-routine SupplyA4390 Drainable pch ex wear convex 10/01/2002 Non-routine SupplyA4391 Urinary pouch w ex wear barr 10/01/2002 Non-routine SupplyA4392 Urinary pouch w st wear barr 10/01/2002 Non-routine SupplyA4393 Urine pch w ex wear bar conv 10/01/2002 Non-routine SupplyA4394 Ostomy pouch liq deodorant 10/01/2002 Non-routine SupplyA4395 Ostomy pouch solid deodorant 10/01/2002 Non-routine SupplyA4396 Peristomal hernia supprt blt 10/01/2002 Non-routine SupplyA4397 Irrigation supply sleeve 10/01/2002 Non-routine SupplyA4398 Ostomy irrigation bag 10/01/2002 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 10/01/2002 Non-routine SupplyA4400 Ostomy irrigation set 10/01/2002 Non-routine SupplyA4402 Lubricant per ounce 10/01/2002 Non-routine SupplyA4404 Ostomy ring each 10/01/2002 Non-routine SupplyA4421 Ostomy supply misc 10/01/2002 Non-routine SupplyA4455 Adhesive remover per ounce 10/01/2002 Non-routine SupplyA4460 Elastic compression bandage 10/01/2002 Non-routine SupplyA4462 Abdmnl drssng holder/binder 10/01/2002 Non-routine SupplyA4481 Tracheostoma filter 10/01/2002 Non-routine SupplyA4622 Tracheostomy or larngectomy 10/01/2002 Non-routine SupplyA4623 Tracheostomy inner cannula 10/01/2002 Non-routine SupplyA4625 Trach care kit for new trach 10/01/2002 Non-routine SupplyA4626 Tracheostomy cleaning brush 10/01/2002 Non-routine SupplyA4649 Surgical supplies 10/01/2002 Non-routine SupplyA5051 Pouch clsd w barr attached 10/01/2002 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 10/01/2002 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 10/01/2002 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 10/01/2002 Non-routine SupplyA5055 Stoma cap 10/01/2002 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 10/01/2002 Non-routine SupplyA5063 Drain ostomy pouch w/flange 10/01/2002 Non-routine SupplyA5071 Urinary pouch w/barrier 10/01/2002 Non-routine SupplyA5072 Urinary pouch w/o barrier 10/01/2002 Non-routine SupplyA5073 Urinary pouch on barr w/flng 10/01/2002 Non-routine SupplyA5081 Continent stoma plug 10/01/2002 Non-routine SupplyA5082 Continent stoma catheter 10/01/2002 Non-routine SupplyA5093 Ostomy accessory convex inse 10/01/2002 Non-routine SupplyA5102 Bedside drain btl w/wo tube 10/01/2002 Non-routine Supply





A5105 Urinary suspensory 10/01/2002 Non-routine SupplyA5112 Urinary leg bag 10/01/2002 Non-routine SupplyA5113 Latex leg strap 10/01/2002 Non-routine SupplyA5114 Foam/fabric leg strap 10/01/2002 Non-routine SupplyA5119 Skin barrier wipes box pr 50 10/01/2002 Non-routine SupplyA5121 Solid skin barrier 6x6 10/01/2002 Non-routine SupplyA5122 Solid skin barrier 8x8 10/01/2002 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 10/01/2002 Non-routine SupplyA5131 Appliance cleaner 10/01/2002 Non-routine SupplyA6010 Collagen based wound filler, dry foam 10/01/2002 Non-routine SupplyA6020 Collage wound dressing 10/01/2002 Non-routine SupplyA6021 Collagen dressing <=16 sq in 10/01/2002 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 10/01/2002 Non-routine SupplyA6023 Collagen dressing >48 sq in 10/01/2002 Non-routine SupplyA6024 Collagen dsg wound filler 10/01/2002 Non-routine SupplyA6154 Wound pouch each 10/01/2002 Non-routine SupplyA6196 Alginate dressing <=16 sq in 10/01/2002 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 10/01/2002 Non-routine SupplyA6198 alginate dressing > 48 sq in 10/01/2002 Non-routine SupplyA6199 Alginate drsg wound filler 10/01/2002 Non-routine SupplyA6200 Compos drsg <=16 no border 10/01/2002 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 10/01/2002 Non-routine SupplyA6202 Compos drsg >48 no border 10/01/2002 Non-routine SupplyA6203 Composite drsg <= 16 sq in 10/01/2002 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 10/01/2002 Non-routine SupplyA6205 Composite drsg > 48 sq in 10/01/2002 Non-routine SupplyA6206 Contact layer <= 16 sq in 10/01/2002 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 10/01/2002 Non-routine SupplyA6208 Contact layer > 48 sq in 10/01/2002 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 10/01/2002 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 10/01/2002 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 10/01/2002 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 10/01/2002 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 10/01/2002 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 10/01/2002 Non-routine SupplyA6215 Foam dressing wound filler 10/01/2002 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 10/01/2002 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 10/01/2002 Non-routine SupplyA6221 Gauze > 48 sq in w/border 10/01/2002 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 10/01/2002 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 10/01/2002 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 10/01/2002 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 10/01/2002 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 10/01/2002 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 10/01/2002 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 10/01/2002 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 10/01/2002 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 10/01/2002 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 10/01/2002 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 10/01/2002 Non-routine Supply





A6236 Hydrocolld drg > 48 in w/o b 10/01/2002 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 10/01/2002 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 10/01/2002 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 10/01/2002 Non-routine SupplyA6240 Hydrocolld drg filler paste 10/01/2002 Non-routine SupplyA6241 Hydrocolloid drg filler dry 10/01/2002 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 10/01/2002 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 10/01/2002 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 10/01/2002 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 10/01/2002 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 10/01/2002 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 10/01/2002 Non-routine SupplyA6248 Hydrogel drsg gel filler 10/01/2002 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 10/01/2002 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 10/01/2002 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 10/01/2002 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 10/01/2002 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 10/01/2002 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 10/01/2002 Non-routine SupplyA6257 Transparent film <= 16 sq in 10/01/2002 Non-routine SupplyA6258 Transparent film >16<=48 in 10/01/2002 Non-routine SupplyA6259 Transparent film > 48 sq in 10/01/2002 Non-routine SupplyA6261 Wound filler gel/paste /oz 10/01/2002 Non-routine SupplyA6262 Wound filler dry form / gram 10/01/2002 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 10/01/2002 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 10/01/2002 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 10/01/2002 Non-routine SupplyA6404 Sterile gauze > 48 sq in 10/01/2002 Non-routine SupplyA6405 Sterile elastic gauze /yd 10/01/2002 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 10/01/2002 Non-routine SupplyA7501 Tracheostoma valve w diaphra 10/01/2002 Non-routine SupplyA7502 Replacement diaphragm/fplate 10/01/2002 Non-routine SupplyA7503 HMES filter holder or cap 10/01/2002 Non-routine SupplyA7504 Tracheostoma HMES filter 10/01/2002 Non-routine SupplyA7505 HMES or trach valve housing 10/01/2002 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 10/01/2002 Non-routine SupplyA7507 Integrated filter & holder 10/01/2002 Non-routine SupplyA7508 Housing & Integrated Adhesiv 10/01/2002 Non-routine SupplyA7509 Heat & moisture exchange sys 10/01/2002 Non-routine SupplyK0561: Non-pectin based ostomy paste 10/01/2002 Non-routine SupplyK0562: Pectin based ostomy paste 10/01/2002 Non-routine SupplyK0563: Ext wear ost skn barr <4sq" 10/01/2002 Non-routine SupplyK0564: Ext wear ost skn barr >4sq" 10/01/2002 Non-routine SupplyK0565: Ost skn barr w flng <4sq" 10/01/2002 Non-routine SupplyK0566: Ost skn barr w flng >4sq" 10/01/2002 Non-routine SupplyK0567: 1 pc drainable ost pouch 10/01/2002 Non-routine SupplyK0568: 1 pc cnvx drainabl ost pouch 10/01/2002 Non-routine SupplyK0569: 2 pc drainable ost pouch 10/01/2002 Non-routine SupplyK0570: Ostomy skn barr w flng <4sq" 10/01/2002 Non-routine SupplyK0571: Ostomy skn barr w flng >4sq" 10/01/2002 Non-routine Supply





K0574: Ostomy pouch filter 10/01/2002 Non-routine SupplyK0575: Ost pouch rustle free mat 10/01/2002 Non-routine SupplyK0576: Ostomy pouch comfort panel 10/01/2002 Non-routine SupplyK0577: Ostomy pouch odor barrier 10/01/2002 Non-routine SupplyK0578: Urinary pouch faucet/drain 10/01/2002 Non-routine SupplyK0579: Ost pouch absorbent material 10/01/2002 Non-routine SupplyK0580: Ost pouch locking flange 10/01/2002 Non-routine SupplyG0193 Endoscopic study swallow functn 10/01/2002 TherapyG0194 Sensory testing endoscopic stud 10/01/2002 TherapyG0195 Clinical eval swallowing funct 10/01/2002 TherapyG0196 Eval of swallowing with radio opa 10/01/2002 TherapyG0197 Eval of pt for prescip speech devi 10/01/2002 TherapyG0198 Patient adapation & train for spe 10/01/2002 TherapyG0199 Reevaluation of patient use spec 10/01/2002 TherapyG0200 Eval of patient prescip of voice p 10/01/2002 TherapyG0201 Modi for training in use voice pro 10/01/2002 Therapy64550 Apply neurostimulator 10/01/2002 Therapy90901 Biofeedback train, any meth 10/01/2002 Therapy90911 Biofeedback peri/uro/rectal 10/01/2002 Therapy92506 Speech/hearing therapy, individual 10/01/2002 Therapy92507 Speech/hearing therapy, group 10/01/2002 Therapy92508 Speech/hearing therapy 10/01/2002 Therapy92510 Rehab for ear implant 10/01/2002 Therapy92525 Oral function evaluation 10/01/2002 Therapy92526 Oral function therapy 10/01/2002 Therapy92597 Oral speech device eval 10/01/2002 Therapy92598 Modify oral speech device 10/01/2002 Therapy95831 Limb muscle testing, manual 10/01/2002 Therapy95832 Hand muscle testing, manual 10/01/2002 Therapy95833 Body muscle testing, manual 10/01/2002 Therapy95834 Body muscle testing, manual 10/01/2002 Therapy95851 Range of motion measurements 10/01/2002 Therapy95852 Range of motion measurements 10/01/2002 Therapy96105 Assessment of aphasia 10/01/2002 Therapy97001 Pt evaluation 10/01/2002 Therapy97002 Pt re-evaluation 10/01/2002 Therapy97003 Ot evaluation 10/01/2002 Therapy97004 Ot re-evaluation 10/01/2002 Therapy97012 Mechanical traction therapy 10/01/2002 Therapy97014 Electric stimulation therapy 10/01/2002 Therapy97016 Vasopneumatic device therapy 10/01/2002 Therapy97018 Paraffin bath therapy 10/01/2002 Therapy97020 Microwave therapy 10/01/2002 Therapy97022 Whirlpool therapy 10/01/2002 Therapy97024 Diathermy treatment 10/01/2002 Therapy97026 Infrared therapy 10/01/2002 Therapy97028 Ultraviolet therapy 10/01/2002 Therapy97032 Electrical stimulation 10/01/2002 Therapy97033 Electric current therapy 10/01/2002 Therapy97034 Contrast bath therapy 10/01/2002 Therapy





97035 Ultrasound therapy 10/01/2002 Therapy97036 Hydrotherapy 10/01/2002 Therapy97039 Physical therapy treatment 10/01/2002 Therapy97110 Therapeutic exercises 10/01/2002 Therapy97112 Neuromuscular reeducation 10/01/2002 Therapy97113 Aquatic therapy/exercises 10/01/2002 Therapy97116 Gait training therapy 10/01/2002 Therapy97124 Massage therapy 10/01/2002 Therapy97139 Physical medicine procedure 10/01/2002 Therapy97140 Manual therapy 10/01/2002 Therapy97150 Group therapeutic procedures 10/01/2002 Therapy97504 Orthotic training 10/01/2002 Therapy97520 Prosthetic training 10/01/2002 Therapy97530 Therapeutic activities 10/01/2002 Therapy97532 Cognitive skills development 10/01/2002 Therapy97533 Sensory integration 10/01/2002 Therapy97535 Self care mngment training 10/01/2002 Therapy97537 Community/work reintegration 10/01/2002 Therapy97542 Wheelchair mngment training 10/01/2002 Therapy97545 Work hardening 10/01/2002 Therapy97546 Work hardening add-on 10/01/2002 Therapy97601 Wound care selective 10/01/2002 Therapy97602 Wound care non-selective 10/01/2002 Therapy97703 Prosthetic checkout 10/01/2002 Therapy97750 Physical performance test 10/01/2002 Therapy97799 Physical medicine procedure 10/01/2002 Therapy





A4212 Non coring needle or stylet 01/01/2003 Non-routine SupplyA4310 Insert tray w/o bag/cath 01/01/2003 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 01/01/2003 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 01/01/2003 Non-routine SupplyA4313 Catheter w/bag 3-way 01/01/2003 Non-routine SupplyA4314 Cath w/drainage 2-way latex 01/01/2003 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 01/01/2003 Non-routine SupplyA4316 Cath w/drainage 3-way 01/01/2003 Non-routine SupplyA4319 Sterile H2O irrigation solut 01/01/2003 Non-routine SupplyA4320 Irrigation tray 01/01/2003 Non-routine SupplyA4321 Cath therapeutic irrig agent 01/01/2003 Non-routine SupplyA4322 Irrigation syringe 01/01/2003 Non-routine SupplyA4323 Saline irrigation solution 01/01/2003 Non-routine SupplyA4324 Male ext cath w/adh coating 01/01/2003 Non-routine SupplyA4325 Male ext cath w/adh strip 01/01/2003 Non-routine SupplyA4326 Male external catheter 01/01/2003 Non-routine SupplyA4327 Fem urinary collect dev cup 01/01/2003 Non-routine SupplyA4328 Fem urinary collect pouch 01/01/2003 Non-routine SupplyA4330 Stool collection pouch 01/01/2003 Non-routine SupplyA4331 Extension drainage tubing 01/01/2003 Non-routine SupplyA4332 Lubricant for cath insertion 01/01/2003 Non-routine SupplyA4333 Urinary cath anchor device 01/01/2003 Non-routine SupplyA4334 Urinary cath leg strap 01/01/2003 Non-routine SupplyA4335 Incontinence supply 01/01/2003 Non-routine SupplyA4338 Indwelling catheter latex 01/01/2003 Non-routine SupplyA4340 Indwelling catheter special 01/01/2003 Non-routine SupplyA4344 Cath indw foley 2 way silicn 01/01/2003 Non-routine SupplyA4346 Cath indw foley 3 way 01/01/2003 Non-routine SupplyA4347 Male external catheter 01/01/2003 Non-routine SupplyA4348 Male ext cath extended wear 01/01/2003 Non-routine SupplyA4351 Straight tip urine catheter 01/01/2003 Non-routine SupplyA4352 Coude tip urinary catheter 01/01/2003 Non-routine SupplyA4353 Intermittent urinary cath 01/01/2003 Non-routine SupplyA4354 Cath insertion tray w/bag 01/01/2003 Non-routine SupplyA4355 Bladder irrigation tubing 01/01/2003 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 01/01/2003 Non-routine SupplyA4357 Bedside drainage bag 01/01/2003 Non-routine SupplyA4358 Urinary leg bag 01/01/2003 Non-routine SupplyA4359 Urinary suspensory w/o leg b 01/01/2003 Non-routine SupplyA4361 Ostomy face plate 01/01/2003 Non-routine SupplyA4362 Solid skin barrier 01/01/2003 Non-routine SupplyA4364 Liq adhes for facial prosth 01/01/2003 Non-routine SupplyA4365 Adhesive remover wipes 01/01/2003 Non-routine SupplyA4367 Ostomy belt 01/01/2003 Non-routine SupplyA4368 Ostomy filter 01/01/2003 Non-routine SupplyA4368 Ostomy pouch filter 01/01/2003 Non-routine SupplyA4369 Skin barrier liquid per oz 01/01/2003 Non-routine SupplyA4371 Skin barrier powder per oz 01/01/2003 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 01/01/2003 Non-routine SupplyA4373 Skin barrier with flange 01/01/2003 Non-routine Supply





A4375 Drainable plastic pch w fcpl 01/01/2003 Non-routine SupplyA4376 Drainable rubber pch w fcplt 01/01/2003 Non-routine SupplyA4377 Drainable plstic pch w/o fp 01/01/2003 Non-routine SupplyA4378 Drainable rubber pch w/o fp 01/01/2003 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 01/01/2003 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 01/01/2003 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 01/01/2003 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 01/01/2003 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 01/01/2003 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 01/01/2003 Non-routine SupplyA4385 Ost skn barrier sld ext wear 01/01/2003 Non-routine SupplyA4387 Ost clsd pouch w att st barr 01/01/2003 Non-routine SupplyA4388 Drainable pch w ex wear barr 01/01/2003 Non-routine SupplyA4389 Drainable pch w st wear barr 01/01/2003 Non-routine SupplyA4390 Drainable pch ex wear convex 01/01/2003 Non-routine SupplyA4391 Urinary pouch w ex wear barr 01/01/2003 Non-routine SupplyA4392 Urinary pouch w st wear barr 01/01/2003 Non-routine SupplyA4393 Urine pch w ex wear bar conv 01/01/2003 Non-routine SupplyA4394 Ostomy pouch liq deodorant 01/01/2003 Non-routine SupplyA4395 Ostomy pouch solid deodorant 01/01/2003 Non-routine SupplyA4396 Peristomal hernia supprt blt 01/01/2003 Non-routine SupplyA4397 Irrigation supply sleeve 01/01/2003 Non-routine SupplyA4398 Ostomy irrigation bag 01/01/2003 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 01/01/2003 Non-routine SupplyA4400 Ostomy irrigation set 01/01/2003 Non-routine SupplyA4402 Lubricant per ounce 01/01/2003 Non-routine SupplyA4404 Ostomy ring each 01/01/2003 Non-routine SupplyA4405 Nonpectin based ostomy paste 01/01/2003 Non-routine SupplyA4406 Pectin based ostomy paste 01/01/2003 Non-routine SupplyA4407 Ext wear ost skn barr <=4sq” 01/01/2003 Non-routine SupplyA4408 Ext wear ost skn barr >4sq” 01/01/2003 Non-routine SupplyA4409 Ost skn barr w flng <=4 sq” 01/01/2003 Non-routine SupplyA4410 Ost skn barr w flng >4sq” 01/01/2003 Non-routine SupplyA4413 2 pc drainable ost pouch w/ filter 01/01/2003 Non-routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 01/01/2003 Non-routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 01/01/2003 Non-routine SupplyA4421 Ostomy supply misc 01/01/2003 Non-routine SupplyA4422 Ost pouch absorbent material 01/01/2003 Non-routine SupplyA4455 Adhesive remover per ounce 01/01/2003 Non-routine SupplyA4458 Reusable enema bag 01/01/2003 Non-routine SupplyA4460 Elastic compression bandage 01/01/2003 Non-routine SupplyA4462 Abdmnl drssng holder/binder 01/01/2003 Non-routine SupplyA4481 Tracheostoma filter 01/01/2003 Non-routine SupplyA4622 Tracheostomy or larngectomy 01/01/2003 Non-routine SupplyA4623 Tracheostomy inner cannula 01/01/2003 Non-routine SupplyA4625 Trach care kit for new trach 01/01/2003 Non-routine SupplyA4626 Tracheostomy cleaning brush 01/01/2003 Non-routine SupplyA4649 Surgical supplies 01/01/2003 Non-routine SupplyA4656 Needle, any size, each 01/01/2003 Non-routine SupplyA4657 Syringe, with or without needle, each 01/01/2003 Non-routine Supply





A4712 Sterile water inj per 10 ml 01/01/2003 Non-routine SupplyA4930 Sterile, gloves per pair 01/01/2003 Non-routine SupplyA5051 Pouch clsd w barr attached 01/01/2003 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 01/01/2003 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 01/01/2003 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 01/01/2003 Non-routine SupplyA5055 Stoma cap 01/01/2003 Non-routine SupplyA5061 Pouch drainable w barrier at 01/01/2003 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 01/01/2003 Non-routine SupplyA5063 Drain ostomy pouch w/flange 01/01/2003 Non-routine SupplyA5071 Urinary pouch w/barrier 01/01/2003 Non-routine SupplyA5072 Urinary pouch w/o barrier 01/01/2003 Non-routine SupplyA5073 Urinary pouch on barr w/flng 01/01/2003 Non-routine SupplyA5081 Continent stoma plug 01/01/2003 Non-routine SupplyA5082 Continent stoma catheter 01/01/2003 Non-routine SupplyA5093 Ostomy accessory convex inse 01/01/2003 Non-routine SupplyA5102 Bedside drain btl w/wo tube 01/01/2003 Non-routine SupplyA5105 Urinary suspensory 01/01/2003 Non-routine SupplyA5112 Urinary leg bag 01/01/2003 Non-routine SupplyA5113 Latex leg strap 01/01/2003 Non-routine SupplyA5114 Foam/fabric leg strap 01/01/2003 Non-routine SupplyA5119 Skin barrier wipes box pr 50 01/01/2003 Non-routine SupplyA5121 Solid skin barrier 6x6 01/01/2003 Non-routine SupplyA5122 Solid skin barrier 8x8 01/01/2003 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 01/01/2003 Non-routine SupplyA5131 Appliance cleaner 01/01/2003 Non-routine SupplyA6010 Collagen based wound filler, dry foam 01/01/2003 Non-routine SupplyA6011 Collagen gel/paste wound fil 01/01/2003 Non-routine SupplyA6020 Collage wound dressing 01/01/2003 Non-routine SupplyA6021 Collagen dressing <=16 sq in 01/01/2003 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 01/01/2003 Non-routine SupplyA6023 Collagen dressing >48 sq in 01/01/2003 Non-routine SupplyA6024 Collagen dsg wound filler 01/01/2003 Non-routine SupplyA6154 Wound pouch each 01/01/2003 Non-routine SupplyA6196 Alginate dressing <=16 sq in 01/01/2003 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 01/01/2003 Non-routine SupplyA6198 alginate dressing > 48 sq in 01/01/2003 Non-routine SupplyA6199 Alginate drsg wound filler 01/01/2003 Non-routine SupplyA6200 Compos drsg <=16 no border 01/01/2003 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 01/01/2003 Non-routine SupplyA6202 Compos drsg >48 no border 01/01/2003 Non-routine SupplyA6203 Composite drsg <= 16 sq in 01/01/2003 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 01/01/2003 Non-routine SupplyA6205 Composite drsg > 48 sq in 01/01/2003 Non-routine SupplyA6206 Contact layer <= 16 sq in 01/01/2003 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 01/01/2003 Non-routine SupplyA6208 Contact layer > 48 sq in 01/01/2003 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 01/01/2003 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 01/01/2003 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 01/01/2003 Non-routine Supply





A6212 Foam drg <=16 sq in w/border 01/01/2003 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 01/01/2003 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 01/01/2003 Non-routine SupplyA6215 Foam dressing wound filler 01/01/2003 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 01/01/2003 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 01/01/2003 Non-routine SupplyA6221 Gauze > 48 sq in w/border 01/01/2003 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 01/01/2003 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 01/01/2003 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 01/01/2003 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 01/01/2003 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 01/01/2003 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 01/01/2003 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 01/01/2003 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 01/01/2003 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 01/01/2003 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 01/01/2003 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 01/01/2003 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 01/01/2003 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 01/01/2003 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 01/01/2003 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 01/01/2003 Non-routine SupplyA6240 Hydrocolld drg filler paste 01/01/2003 Non-routine SupplyA6241 Hydrocolloid drg filler dry 01/01/2003 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 01/01/2003 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 01/01/2003 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 01/01/2003 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 01/01/2003 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 01/01/2003 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 01/01/2003 Non-routine SupplyA6248 Hydrogel drsg gel filler 01/01/2003 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 01/01/2003 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 01/01/2003 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 01/01/2003 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 01/01/2003 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 01/01/2003 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 01/01/2003 Non-routine SupplyA6257 Transparent film <= 16 sq in 01/01/2003 Non-routine SupplyA6258 Transparent film >16<=48 in 01/01/2003 Non-routine SupplyA6259 Transparent film > 48 sq in 01/01/2003 Non-routine SupplyA6261 Wound filler gel/paste /oz 01/01/2003 Non-routine SupplyA6262 Wound filler dry form / gram 01/01/2003 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 01/01/2003 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 01/01/2003 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 01/01/2003 Non-routine SupplyA6404 Sterile gauze > 48 sq in 01/01/2003 Non-routine SupplyA6405 Sterile elastic gauze /yd 01/01/2003 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 01/01/2003 Non-routine SupplyA6410 Sterile eye pad 01/01/2003 Non-routine SupplyA7043 Vacuum drainage bottle & tubing 01/01/2003 Non-routine Supply





A7501 Tracheostoma valve w diaphra 01/01/2003 Non-routine SupplyA7502 Replacement diaphragm/fplate 01/01/2003 Non-routine SupplyA7503 HMES filter holder or cap 01/01/2003 Non-routine SupplyA7504 Tracheostoma HMES filter 01/01/2003 Non-routine SupplyA7505 HMES or trach valve housing 01/01/2003 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 01/01/2003 Non-routine SupplyA7507 Integrated filter & holder 01/01/2003 Non-routine SupplyA7508 Housing & Integrated Adhesiv 01/01/2003 Non-routine SupplyA7509 Heat & moisture exchange sys 01/01/2003 Non-routine SupplyK0581 Ost pch clsd w barrier/filtr 01/01/2003 Non-routine SupplyK0582 Ost pch w bar/bltinconv/fltr 01/01/2003 Non-routine SupplyK0583 Ost pch clsd w/o bar w filtr 01/01/2003 Non-routine SupplyK0584 Ost pch for bar w flange/flt 01/01/2003 Non-routine SupplyK0585 Ost pch clsd for bar w lk fl 01/01/2003 Non-routine SupplyK0586 Ost pch for bar w lk fl/fltr 01/01/2003 Non-routine SupplyK0587 Ost pch drain w bar & filter 01/01/2003 Non-routine SupplyK0588 Ost pch drain for barrier fl 01/01/2003 Non-routine SupplyK0589 Ost pch drain 2 piece system 01/01/2003 Non-routine SupplyK0590 Ost pch drain/barr lk flng/f 01/01/2003 Non-routine SupplyK0591 Urine ost pouch w faucet/tap 01/01/2003 Non-routine SupplyK0592 Urine ost pouch w bltinconv 01/01/2003 Non-routine SupplyK0593 Ost urine pch w b/bltin conv 01/01/2003 Non-routine SupplyK0594 Ost pch urine w barrier/tapv 01/01/2003 Non-routine SupplyK0595 Os pch urine w bar/fange/tap 01/01/2003 Non-routine SupplyK0596 Urine ost pch bar w lock fln 01/01/2003 Non-routine SupplyK0597 Ost pch urine w lock flng/ft 01/01/2003 Non-routine SupplyG0193 Endoscopic study swallow functn 01/01/2003 TherapyG0194 Sensory testing endoscopic study 01/01/2003 TherapyG0195 Clinical eval swallowing funct 01/01/2003 TherapyG0196 Eval of swallowing with radioopa 01/01/2003 TherapyG0197 Eval of pt for prescip speech devi 01/01/2003 TherapyG0198 Patient adapation & train for spe 01/01/2003 TherapyG0199 Reevaluation of patient use spec 01/01/2003 TherapyG0200 Eval of patient prescip of voice p 01/01/2003 TherapyG0201 Modi for training in use voice pro 01/01/2003 TherapyG0279 Excorp shock tx, elbow epi 01/01/2003 TherapyG0280 Excorp shock tx other than 01/01/2003 TherapyG0281 Elec stim unattend for press 01/01/2003 TherapyG0282 Elect stim wound care not pd 01/01/2003 TherapyG0283 Elec stim other than wound 01/01/2003 Therapy0019T Extracorp shock wave tx, ms 01/01/2003 Therapy0020T Extracorp shock wave tx, ft 01/01/2003 Therapy64550 Apply neurostimulator 01/01/2003 Therapy90901 Biofeedback train, any meth 01/01/2003 Therapy90911 Biofeedback peri/uro/rectal 01/01/2003 Therapy92506 Speech/hearing evaluation 01/01/2003 Therapy92507 Speech/hearing therapy 01/01/2003 Therapy92508 Speech/hearing therapy 01/01/2003 Therapy92510 Rehab for ear implant 01/01/2003 Therapy92526 Oral function therapy 01/01/2003 Therapy





92601 Cochlear implt f/up exam < 7 01/01/2003 Therapy92602 Reprogram cochlear implt < 7 01/01/2003 Therapy92603 Cochlear implt f/up exam 7 > 01/01/2003 Therapy92604 Reprogram cochlear implt 7 > 01/01/2003 Therapy92605 Eval for nonspeech device rx 01/01/2003 Therapy92606 Non-speech device service 01/01/2003 Therapy92607 Ex for speech device rx, 1hr 01/01/2003 Therapy92608 Ex for speech device rx addl 01/01/2003 Therapy92609 Use of speech device service 01/01/2003 Therapy92610 Evaluate swallowing function 01/01/2003 Therapy92611 Motion fluoroscopy/swallow 01/01/2003 Therapy92612 Endoscopy swallow tst (fees) 01/01/2003 Therapy92614 Laryngoscopic sensory test 01/01/2003 Therapy92616 Fees w/laryngeal sense test 01/01/2003 Therapy95831 Limb muscle testing, manual 01/01/2003 Therapy95832 Hand muscle testing, manual 01/01/2003 Therapy95833 Body muscle testing, manual 01/01/2003 Therapy95834 Body muscle testing, manual 01/01/2003 Therapy95851 Range of motion measurements 01/01/2003 Therapy95852 Range of motion measurements 01/01/2003 Therapy96000 Motion analysis, video/3d 01/01/2003 Therapy96001 Motion test w/ft press meas 01/01/2003 Therapy96002 Dynamic surface emg 01/01/2003 Therapy96003 Dynamic fine wire emg 01/01/2003 Therapy96105 Assessment of aphasia 01/01/2003 Therapy97001 Pt evaluation 01/01/2003 Therapy97002 Pt re-evaluation 01/01/2003 Therapy97003 Ot evaluation 01/01/2003 Therapy97004 Ot re-evaluation 01/01/2003 Therapy97012 Mechanical traction therapy 01/01/2003 Therapy97014 Electric stimulation therapy 01/01/2003 Therapy97016 Vasopneumatic device therapy 01/01/2003 Therapy97018 Paraffin bath therapy 01/01/2003 Therapy97020 Microwave therapy 01/01/2003 Therapy97022 Whirlpool therapy 01/01/2003 Therapy97024 Diathermy treatment 01/01/2003 Therapy97026 Infrared therapy 01/01/2003 Therapy97028 Ultraviolet therapy 01/01/2003 Therapy97032 Electrical stimulation 01/01/2003 Therapy97033 Electric current therapy 01/01/2003 Therapy97034 Contrast bath therapy 01/01/2003 Therapy97035 Ultrasound therapy 01/01/2003 Therapy97036 Hydrotherapy 01/01/2003 Therapy97039 Physical therapy treatment 01/01/2003 Therapy97110 Therapeutic exercises 01/01/2003 Therapy97112 Neuromuscular reeducation 01/01/2003 Therapy97113 Aquatic therapy/exercises 01/01/2003 Therapy97116 Gait training therapy 01/01/2003 Therapy97124 Massage therapy 01/01/2003 Therapy97139 Physical medicine procedure 01/01/2003 Therapy





97140 Manual therapy 01/01/2003 Therapy97150 Group therapeutic procedures 01/01/2003 Therapy97504 Orthotic training 01/01/2003 Therapy97520 Prosthetic training 01/01/2003 Therapy97530 Therapeutic activities 01/01/2003 Therapy97532 Cognitive skills development 01/01/2003 Therapy97533 Sensory integration 01/01/2003 Therapy97535 Self care mngment training 01/01/2003 Therapy97537 Community/work reintegration 01/01/2003 Therapy97542 Wheelchair mngment training 01/01/2003 Therapy97545 Work hardening 01/01/2003 Therapy97546 Work hardening add-on 01/01/2003 Therapy97601 Wound care selective 01/01/2003 Therapy97602 Wound care non-selective 01/01/2003 Therapy97703 Prosthetic checkout 01/01/2003 Therapy97750 Physical performance test 01/01/2003 Therapy97799 Physical medicine procedure 01/01/2003 Therapy



A4375 Drainable plastic pch w fcpl 04/01/2003 Non-routine SupplyA4376 Drainable rubber pch w fcplt 04/01/2003 Non-routine SupplyA4377 Drainable plstic pch w/o fp 04/01/2003 Non-routine SupplyA4378 Drainable rubber pch w/o fp 04/01/2003 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 04/01/2003 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 04/01/2003 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 04/01/2003 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 04/01/2003 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 04/01/2003 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 04/01/2003 Non-routine SupplyA4385 Ost skn barrier sld ext wear 04/01/2003 Non-routine SupplyA4387 Ost clsd pouch w att st barr 04/01/2003 Non-routine SupplyA4388 Drainable pch w ex wear barr 04/01/2003 Non-routine SupplyA4389 Drainable pch w st wear barr 04/01/2003 Non-routine SupplyA4390 Drainable pch ex wear convex 04/01/2003 Non-routine SupplyA4391 Urinary pouch w ex wear barr 04/01/2003 Non-routine SupplyA4392 Urinary pouch w st wear barr 04/01/2003 Non-routine SupplyA4393 Urine pch w ex wear bar conv 04/01/2003 Non-routine SupplyA4394 Ostomy pouch liq deodorant 04/01/2003 Non-routine SupplyA4395 Ostomy pouch solid deodorant 04/01/2003 Non-routine SupplyA4396 Peristomal hernia supprt blt 04/01/2003 Non-routine SupplyA4397 Irrigation supply sleeve 04/01/2003 Non-routine SupplyA4398 Ostomy irrigation bag 04/01/2003 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 04/01/2003 Non-routine SupplyA4400 Ostomy irrigation set 04/01/2003 Non-routine SupplyA4402 Lubricant per ounce 04/01/2003 Non-routine SupplyA4404 Ostomy ring each 04/01/2003 Non-routine SupplyA4405 Nonpectin based ostomy paste 04/01/2003 Non-routine SupplyA4406 Pectin based ostomy paste 04/01/2003 Non-routine SupplyA4407 Ext wear ost skn barr <=4sq” 04/01/2003 Non-routine SupplyA4408 Ext wear ost skn barr >4sq” 04/01/2003 Non-routine SupplyA4409 Ost skn barr w flng <=4 sq” 04/01/2003 Non-routine SupplyA4410 Ost skn barr w flng >4sq” 04/01/2003 Non-routine SupplyA4413 2 pc drainable ost pouch w/ filter 04/01/2003 Non-routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 04/01/2003 Non-routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 04/01/2003 Non-routine SupplyA4421 Ostomy supply misc 04/01/2003 Non-routine SupplyA4422 Ost pouch absorbent material 04/01/2003 Non-routine SupplyA4455 Adhesive remover per ounce 04/01/2003 Non-routine SupplyA4458 Reusable enema bag 04/01/2003 Non-routine SupplyA4460 Elastic compression bandage 04/01/2003 Non-routine SupplyA4462 Abdmnl drssng holder/binder 04/01/2003 Non-routine SupplyA4481 Tracheostoma filter 04/01/2003 Non-routine SupplyA4622 Tracheostomy or larngectomy 04/01/2003 Non-routine SupplyA4623 Tracheostomy inner cannula 04/01/2003 Non-routine SupplyA4625 Trach care kit for new trach 04/01/2003 Non-routine SupplyA4626 Tracheostomy cleaning brush 04/01/2003 Non-routine SupplyA4649 Surgical supplies 04/01/2003 Non-routine SupplyA4656 Needle, any size, each 04/01/2003 Non-routine SupplyA4657 Syringe, with or without needle, each 04/01/2003 Non-routine SupplyA4712 Sterile water inj per 10 ml 04/01/2003 Non-routine SupplyA4930 Sterile, gloves per pair 04/01/2003 Non-routine Supply



A5051 Pouch clsd w barr attached 04/01/2003 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 04/01/2003 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 04/01/2003 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 04/01/2003 Non-routine SupplyA5055 Stoma cap 04/01/2003 Non-routine SupplyA5061 Pouch drainable w barrier at 04/01/2003 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 04/01/2003 Non-routine SupplyA5063 Drain ostomy pouch w/flange 04/01/2003 Non-routine SupplyA5071 Urinary pouch w/barrier 04/01/2003 Non-routine SupplyA5072 Urinary pouch w/o barrier 04/01/2003 Non-routine SupplyA5073 Urinary pouch on barr w/flng 04/01/2003 Non-routine SupplyA5081 Continent stoma plug 04/01/2003 Non-routine SupplyA5082 Continent stoma catheter 04/01/2003 Non-routine SupplyA5093 Ostomy accessory convex inse 04/01/2003 Non-routine SupplyA5102 Bedside drain btl w/wo tube 04/01/2003 Non-routine SupplyA5105 Urinary suspensory 04/01/2003 Non-routine SupplyA5112 Urinary leg bag 04/01/2003 Non-routine SupplyA5113 Latex leg strap 04/01/2003 Non-routine SupplyA5114 Foam/fabric leg strap 04/01/2003 Non-routine SupplyA5119 Skin barrier wipes box pr 50 04/01/2003 Non-routine SupplyA5121 Solid skin barrier 6x6 04/01/2003 Non-routine SupplyA5122 Solid skin barrier 8x8 04/01/2003 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 04/01/2003 Non-routine SupplyA5131 Appliance cleaner 04/01/2003 Non-routine SupplyA6010 Collagen based wound filler, dry foam 04/01/2003 Non-routine SupplyA6011 Collagen gel/paste wound fil 04/01/2003 Non-routine SupplyA6020 Collage wound dressing 04/01/2003 Non-routine SupplyA6021 Collagen dressing <=16 sq in 04/01/2003 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 04/01/2003 Non-routine SupplyA6023 Collagen dressing >48 sq in 04/01/2003 Non-routine SupplyA6024 Collagen dsg wound filler 04/01/2003 Non-routine SupplyA6154 Wound pouch each 04/01/2003 Non-routine SupplyA6196 Alginate dressing <=16 sq in 04/01/2003 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 04/01/2003 Non-routine SupplyA6198 alginate dressing > 48 sq in 04/01/2003 Non-routine SupplyA6199 Alginate drsg wound filler 04/01/2003 Non-routine SupplyA6200 Compos drsg <=16 no border 04/01/2003 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 04/01/2003 Non-routine SupplyA6202 Compos drsg >48 no border 04/01/2003 Non-routine SupplyA6203 Composite drsg <= 16 sq in 04/01/2003 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 04/01/2003 Non-routine SupplyA6205 Composite drsg > 48 sq in 04/01/2003 Non-routine SupplyA6206 Contact layer <= 16 sq in 04/01/2003 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 04/01/2003 Non-routine SupplyA6208 Contact layer > 48 sq in 04/01/2003 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 04/01/2003 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 04/01/2003 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 04/01/2003 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 04/01/2003 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 04/01/2003 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 04/01/2003 Non-routine SupplyA6215 Foam dressing wound filler 04/01/2003 Non-routine Supply



A6219 Gauze <= 16 sq in w/border 04/01/2003 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 04/01/2003 Non-routine SupplyA6221 Gauze > 48 sq in w/border 04/01/2003 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 04/01/2003 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 04/01/2003 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 04/01/2003 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 04/01/2003 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 04/01/2003 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 04/01/2003 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 04/01/2003 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 04/01/2003 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 04/01/2003 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 04/01/2003 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 04/01/2003 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 04/01/2003 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 04/01/2003 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 04/01/2003 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 04/01/2003 Non-routine SupplyA6240 Hydrocolld drg filler paste 04/01/2003 Non-routine SupplyA6241 Hydrocolloid drg filler dry 04/01/2003 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 04/01/2003 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 04/01/2003 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 04/01/2003 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 04/01/2003 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 04/01/2003 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 04/01/2003 Non-routine SupplyA6248 Hydrogel drsg gel filler 04/01/2003 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 04/01/2003 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 04/01/2003 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 04/01/2003 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 04/01/2003 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 04/01/2003 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 04/01/2003 Non-routine SupplyA6257 Transparent film <= 16 sq in 04/01/2003 Non-routine SupplyA6258 Transparent film >16<=48 in 04/01/2003 Non-routine SupplyA6259 Transparent film > 48 sq in 04/01/2003 Non-routine SupplyA6261 Wound filler gel/paste /oz 04/01/2003 Non-routine SupplyA6262 Wound filler dry form / gram 04/01/2003 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 04/01/2003 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 04/01/2003 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 04/01/2003 Non-routine SupplyA6404 Sterile gauze > 48 sq in 04/01/2003 Non-routine SupplyA6405 Sterile elastic gauze /yd 04/01/2003 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 04/01/2003 Non-routine SupplyA6410 Sterile eye pad 04/01/2003 Non-routine SupplyA6440 Zinc Paste >=3"<5" w/roll 04/01/2003 Non-routine SupplyA7043 Vacuum drainage bottle & tubing 04/01/2003 Non-routine SupplyA7501 Tracheostoma valve w diaphra 04/01/2003 Non-routine SupplyA7502 Replacement diaphragm/fplate 04/01/2003 Non-routine SupplyA7503 HMES filter holder or cap 04/01/2003 Non-routine SupplyA7504 Tracheostoma HMES filter 04/01/2003 Non-routine SupplyA7505 HMES or trach valve housing 04/01/2003 Non-routine Supply



A7506 HMES/trachvalve adhesivedisk 04/01/2003 Non-routine SupplyA7507 Integrated filter & holder 04/01/2003 Non-routine SupplyA7508 Housing & Integrated Adhesiv 04/01/2003 Non-routine SupplyA7509 Heat & moisture exchange sys 04/01/2003 Non-routine SupplyK0581 Ost pch clsd w barrier/filtr 04/01/2003 Non-routine SupplyK0582 Ost pch w bar/bltinconv/fltr 04/01/2003 Non-routine SupplyK0583 Ost pch clsd w/o bar w filtr 04/01/2003 Non-routine SupplyK0584 Ost pch for bar w flange/flt 04/01/2003 Non-routine SupplyK0585 Ost pch clsd for bar w lk fl 04/01/2003 Non-routine SupplyK0586 Ost pch for bar w lk fl/fltr 04/01/2003 Non-routine SupplyK0587 Ost pch drain w bar & filter 04/01/2003 Non-routine SupplyK0588 Ost pch drain for barrier fl 04/01/2003 Non-routine SupplyK0589 Ost pch drain 2 piece system 04/01/2003 Non-routine SupplyK0590 Ost pch drain/barr lk flng/f 04/01/2003 Non-routine SupplyK0591 Urine ost pouch w faucet/tap 04/01/2003 Non-routine SupplyK0592 Urine ost pouch w bltinconv 04/01/2003 Non-routine SupplyK0593 Ost urine pch w b/bltin conv 04/01/2003 Non-routine SupplyK0594 Ost pch urine w barrier/tapv 04/01/2003 Non-routine SupplyK0595 Os pch urine w bar/fange/tap 04/01/2003 Non-routine SupplyK0596 Urine ost pch bar w lock fln 04/01/2003 Non-routine SupplyK0597 Ost pch urine w lock flng/ft 04/01/2003 Non-routine SupplyG0193 Endoscopic study swallow functn 04/01/2003 TherapyG0194 Sensory testing endoscopic study 04/01/2003 TherapyG0195 Clinical eval swallowing funct 04/01/2003 TherapyG0196 Eval of swallowing with radioopa 04/01/2003 TherapyG0197 Eval of pt for prescip speech devi 04/01/2003 TherapyG0198 Patient adapation & train for spe 04/01/2003 TherapyG0199 Reevaluation of patient use spec 04/01/2003 TherapyG0200 Eval of patient prescip of voice p 04/01/2003 TherapyG0201 Modi for training in use voice pro 04/01/2003 TherapyG0279 Excorp shock tx, elbow epi 04/01/2003 TherapyG0280 Excorp shock tx other than 04/01/2003 TherapyG0281 Elec stim unattend for press 04/01/2003 TherapyG0282 Elect stim wound care not pd 04/01/2003 TherapyG0283 Elec stim other than wound 04/01/2003 Therapy0019T Extracorp shock wave tx, ms 04/01/2003 Therapy0020T Extracorp shock wave tx, ft 04/01/2003 Therapy64550 Apply neurostimulator 04/01/2003 Therapy90901 Biofeedback train, any meth 04/01/2003 Therapy90911 Biofeedback peri/uro/rectal 04/01/2003 Therapy92506 Speech/hearing evaluation 04/01/2003 Therapy92507 Speech/hearing therapy 04/01/2003 Therapy92508 Speech/hearing therapy 04/01/2003 Therapy92510 Rehab for ear implant 04/01/2003 Therapy92526 Oral function therapy 04/01/2003 Therapy92601 Cochlear implt f/up exam < 7 04/01/2003 Therapy92602 Reprogram cochlear implt < 7 04/01/2003 Therapy92603 Cochlear implt f/up exam 7 > 04/01/2003 Therapy92604 Reprogram cochlear implt 7 > 04/01/2003 Therapy92605 Eval for nonspeech device rx 04/01/2003 Therapy92606 Non-speech device service 04/01/2003 Therapy92607 Ex for speech device rx, 1hr 04/01/2003 Therapy



92608 Ex for speech device rx addl 04/01/2003 Therapy92609 Use of speech device service 04/01/2003 Therapy92610 Evaluate swallowing function 04/01/2003 Therapy92611 Motion fluoroscopy/swallow 04/01/2003 Therapy92612 Endoscopy swallow tst (fees) 04/01/2003 Therapy92614 Laryngoscopic sensory test 04/01/2003 Therapy92616 Fees w/laryngeal sense test 04/01/2003 Therapy95831 Limb muscle testing, manual 04/01/2003 Therapy95832 Hand muscle testing, manual 04/01/2003 Therapy95833 Body muscle testing, manual 04/01/2003 Therapy95834 Body muscle testing, manual 04/01/2003 Therapy95851 Range of motion measurements 04/01/2003 Therapy95852 Range of motion measurements 04/01/2003 Therapy96000 Motion analysis, video/3d 04/01/2003 Therapy96001 Motion test w/ft press meas 04/01/2003 Therapy96002 Dynamic surface emg 04/01/2003 Therapy96003 Dynamic fine wire emg 04/01/2003 Therapy96105 Assessment of aphasia 04/01/2003 Therapy97001 Pt evaluation 04/01/2003 Therapy97002 Pt re-evaluation 04/01/2003 Therapy97003 Ot evaluation 04/01/2003 Therapy97004 Ot re-evaluation 04/01/2003 Therapy97012 Mechanical traction therapy 04/01/2003 Therapy97014 Electric stimulation therapy 04/01/2003 Therapy97016 Vasopneumatic device therapy 04/01/2003 Therapy97018 Paraffin bath therapy 04/01/2003 Therapy97020 Microwave therapy 04/01/2003 Therapy97022 Whirlpool therapy 04/01/2003 Therapy97024 Diathermy treatment 04/01/2003 Therapy97026 Infrared therapy 04/01/2003 Therapy97028 Ultraviolet therapy 04/01/2003 Therapy97032 Electrical stimulation 04/01/2003 Therapy97033 Electric current therapy 04/01/2003 Therapy97034 Contrast bath therapy 04/01/2003 Therapy97035 Ultrasound therapy 04/01/2003 Therapy97036 Hydrotherapy 04/01/2003 Therapy97039 Physical therapy treatment 04/01/2003 Therapy97110 Therapeutic exercises 04/01/2003 Therapy97112 Neuromuscular reeducation 04/01/2003 Therapy97113 Aquatic therapy/exercises 04/01/2003 Therapy97116 Gait training therapy 04/01/2003 Therapy97124 Massage therapy 04/01/2003 Therapy97139 Physical medicine procedure 04/01/2003 Therapy97140 Manual therapy 04/01/2003 Therapy97150 Group therapeutic procedures 04/01/2003 Therapy97504 Orthotic training 04/01/2003 Therapy97520 Prosthetic training 04/01/2003 Therapy97530 Therapeutic activities 04/01/2003 Therapy97532 Cognitive skills development 04/01/2003 Therapy97533 Sensory integration 04/01/2003 Therapy97535 Self care mngment training 04/01/2003 Therapy97537 Community/work reintegration 04/01/2003 Therapy



97542 Wheelchair mngment training 04/01/2003 Therapy 97545 Work hardening 04/01/2003 Therapy97546 Work hardening add-on 04/01/2003 Therapy97601 Wound care selective 04/01/2003 Therapy97602 Wound care non-selective 04/01/2003 Therapy97703 Prosthetic checkout 04/01/2003 Therapy97750 Physical performance test 04/01/2003 Therapy97799 Physical medicine procedure 04/01/2003 Therapy



A4375 Drainable plastic pch w fcpl 10/01/2003 Non-routine SupplyA4376 Drainable rubber pch w fcplt 10/01/2003 Non-routine SupplyA4377 Drainable plstic pch w/o fp 10/01/2003 Non-routine SupplyA4378 Drainable rubber pch w/o fp 10/01/2003 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 10/01/2003 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 10/01/2003 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 10/01/2003 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 10/01/2003 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 10/01/2003 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 10/01/2003 Non-routine SupplyA4385 Ost skn barrier sld ext wear 10/01/2003 Non-routine SupplyA4387 Ost clsd pouch w att st barr 10/01/2003 Non-routine SupplyA4388 Drainable pch w ex wear barr 10/01/2003 Non-routine SupplyA4389 Drainable pch w st wear barr 10/01/2003 Non-routine SupplyA4390 Drainable pch ex wear convex 10/01/2003 Non-routine SupplyA4391 Urinary pouch w ex wear barr 10/01/2003 Non-routine SupplyA4392 Urinary pouch w st wear barr 10/01/2003 Non-routine SupplyA4393 Urine pch w ex wear bar conv 10/01/2003 Non-routine SupplyA4394 Ostomy pouch liq deodorant 10/01/2003 Non-routine SupplyA4395 Ostomy pouch solid deodorant 10/01/2003 Non-routine SupplyA4396 Peristomal hernia supprt blt 10/01/2003 Non-routine SupplyA4397 Irrigation supply sleeve 10/01/2003 Non-routine SupplyA4398 Ostomy irrigation bag 10/01/2003 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 10/01/2003 Non-routine SupplyA4400 Ostomy irrigation set 10/01/2003 Non-routine SupplyA4402 Lubricant per ounce 10/01/2003 Non-routine SupplyA4404 Ostomy ring each 10/01/2003 Non-routine SupplyA4405 Nonpectin based ostomy paste 10/01/2003 Non-routine SupplyA4406 Pectin based ostomy paste 10/01/2003 Non-routine SupplyA4407 Ext wear ost skn barr <=4sq” 10/01/2003 Non-routine SupplyA4408 Ext wear ost skn barr >4sq” 10/01/2003 Non-routine SupplyA4409 Ost skn barr w flng <=4 sq” 10/01/2003 Non-routine SupplyA4410 Ost skn barr w flng >4sq” 10/01/2003 Non-routine SupplyA4413 2 pc drainable ost pouch w/ filter 10/01/2003 Non-routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 10/01/2003 Non-routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 10/01/2003 Non-routine SupplyA4421 (6) Ostomy supply misc 10/01/2003 Non-routine SupplyA4422 Ost pouch absorbent material 10/01/2003 Non-routine SupplyA4455 Adhesive remover per ounce 10/01/2003 Non-routine SupplyA4458 Reusable enema bag 10/01/2003 Non-routine SupplyA4460 Elastic compression bandage 10/01/2003 Non-routine SupplyA4462 Abdmnl drssng holder/binder 10/01/2003 Non-routine SupplyA4481 Tracheostoma filter 10/01/2003 Non-routine SupplyA4622 Tracheostomy or larngectomy 10/01/2003 Non-routine SupplyA4623 Tracheostomy inner cannula 10/01/2003 Non-routine SupplyA4625 Trach care kit for new trach 10/01/2003 Non-routine SupplyA4626 Tracheostomy cleaning brush 10/01/2003 Non-routine SupplyA4649 Surgical supplies 10/01/2003 Non-routine SupplyA4656 Needle, any size, each 10/01/2003 Non-routine SupplyA4657 Syringe, with or without needle, each 10/01/2003 Non-routine SupplyA4712 Sterile water inj per 10 ml 10/01/2003 Non-routine SupplyA4930 Sterile, gloves per pair 10/01/2003 Non-routine Supply



A5051 Pouch clsd w barr attached 10/01/2003 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 10/01/2003 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 10/01/2003 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 10/01/2003 Non-routine SupplyA5055 Stoma cap 10/01/2003 Non-routine SupplyA5061 Pouch drainable w barrier at 10/01/2003 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 10/01/2003 Non-routine SupplyA5063 Drain ostomy pouch w/flange 10/01/2003 Non-routine SupplyA5071 Urinary pouch w/barrier 10/01/2003 Non-routine SupplyA5072 Urinary pouch w/o barrier 10/01/2003 Non-routine SupplyA5073 Urinary pouch on barr w/flng 10/01/2003 Non-routine SupplyA5081 Continent stoma plug 10/01/2003 Non-routine SupplyA5082 Continent stoma catheter 10/01/2003 Non-routine SupplyA5093 Ostomy accessory convex inse 10/01/2003 Non-routine SupplyA5102 Bedside drain btl w/wo tube 10/01/2003 Non-routine SupplyA5105 Urinary suspensory 10/01/2003 Non-routine SupplyA5112 Urinary leg bag 10/01/2003 Non-routine SupplyA5113 Latex leg strap 10/01/2003 Non-routine SupplyA5114 Foam/fabric leg strap 10/01/2003 Non-routine SupplyA5119 Skin barrier wipes box pr 50 10/01/2003 Non-routine SupplyA5121 Solid skin barrier 6x6 10/01/2003 Non-routine SupplyA5122 Solid skin barrier 8x8 10/01/2003 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 10/01/2003 Non-routine SupplyA5131 Appliance cleaner 10/01/2003 Non-routine SupplyA6010 Collagen based wound filler, dry foam 10/01/2003 Non-routine SupplyA6011 Collagen gel/paste wound fil 10/01/2003 Non-routine SupplyA6020 Collage wound dressing 10/01/2003 Non-routine SupplyA6021 Collagen dressing <=16 sq in 10/01/2003 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 10/01/2003 Non-routine SupplyA6023 Collagen dressing >48 sq in 10/01/2003 Non-routine SupplyA6024 Collagen dsg wound filler 10/01/2003 Non-routine SupplyA6154 Wound pouch each 10/01/2003 Non-routine SupplyA6196 Alginate dressing <=16 sq in 10/01/2003 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 10/01/2003 Non-routine SupplyA6198 alginate dressing > 48 sq in 10/01/2003 Non-routine SupplyA6199 Alginate drsg wound filler 10/01/2003 Non-routine SupplyA6200 Compos drsg <=16 no border 10/01/2003 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 10/01/2003 Non-routine SupplyA6202 Compos drsg >48 no border 10/01/2003 Non-routine SupplyA6203 Composite drsg <= 16 sq in 10/01/2003 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 10/01/2003 Non-routine SupplyA6205 Composite drsg > 48 sq in 10/01/2003 Non-routine SupplyA6206 Contact layer <= 16 sq in 10/01/2003 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 10/01/2003 Non-routine SupplyA6208 Contact layer > 48 sq in 10/01/2003 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 10/01/2003 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 10/01/2003 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 10/01/2003 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 10/01/2003 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 10/01/2003 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 10/01/2003 Non-routine SupplyA6215 Foam dressing wound filler 10/01/2003 Non-routine Supply



A6219 Gauze <= 16 sq in w/border 10/01/2003 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 10/01/2003 Non-routine SupplyA6221 Gauze > 48 sq in w/border 10/01/2003 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 10/01/2003 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 10/01/2003 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 10/01/2003 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 10/01/2003 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 10/01/2003 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 10/01/2003 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 10/01/2003 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 10/01/2003 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 10/01/2003 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 10/01/2003 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 10/01/2003 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 10/01/2003 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 10/01/2003 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 10/01/2003 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 10/01/2003 Non-routine SupplyA6240 Hydrocolld drg filler paste 10/01/2003 Non-routine SupplyA6241 Hydrocolloid drg filler dry 10/01/2003 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 10/01/2003 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 10/01/2003 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 10/01/2003 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 10/01/2003 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 10/01/2003 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 10/01/2003 Non-routine SupplyA6248 Hydrogel drsg gel filler 10/01/2003 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 10/01/2003 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 10/01/2003 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 10/01/2003 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 10/01/2003 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 10/01/2003 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 10/01/2003 Non-routine SupplyA6257 Transparent film <= 16 sq in 10/01/2003 Non-routine SupplyA6258 Transparent film >16<=48 in 10/01/2003 Non-routine SupplyA6259 Transparent film > 48 sq in 10/01/2003 Non-routine SupplyA6261 Wound filler gel/paste /oz 10/01/2003 Non-routine SupplyA6262 Wound filler dry form / gram 10/01/2003 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 10/01/2003 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 10/01/2003 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 10/01/2003 Non-routine SupplyA6404 Sterile gauze > 48 sq in 10/01/2003 Non-routine SupplyA6405 Sterile elastic gauze /yd 10/01/2003 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 10/01/2003 Non-routine SupplyA6410 Sterile eye pad 10/01/2003 Non-routine SupplyA6440 Zinc Paste >=3"<5" w/roll 10/01/2003 Non-routine SupplyA7043 Vacuum drainage bottle & tubing 10/01/2003 Non-routine SupplyA7501 Tracheostoma valve w diaphra 10/01/2003 Non-routine SupplyA7502 Replacement diaphragm/fplate 10/01/2003 Non-routine SupplyA7503 HMES filter holder or cap 10/01/2003 Non-routine SupplyA7504 Tracheostoma HMES filter 10/01/2003 Non-routine SupplyA7505 HMES or trach valve housing 10/01/2003 Non-routine Supply



A7506 HMES/trachvalve adhesivedisk 10/01/2003 Non-routine SupplyA7507 Integrated filter & holder 10/01/2003 Non-routine SupplyA7508 Housing & Integrated Adhesiv 10/01/2003 Non-routine SupplyA7509 Heat & moisture exchange sys 10/01/2003 Non-routine SupplyK0581 Ost pch clsd w barrier/filtr 10/01/2003 Non-routine SupplyK0582 Ost pch w bar/bltinconv/fltr 10/01/2003 Non-routine SupplyK0583 Ost pch clsd w/o bar w filtr 10/01/2003 Non-routine SupplyK0584 Ost pch for bar w flange/flt 10/01/2003 Non-routine SupplyK0585 Ost pch clsd for bar w lk fl 10/01/2003 Non-routine SupplyK0586 Ost pch for bar w lk fl/fltr 10/01/2003 Non-routine SupplyK0587 Ost pch drain w bar & filter 10/01/2003 Non-routine SupplyK0588 Ost pch drain for barrier fl 10/01/2003 Non-routine SupplyK0589 Ost pch drain 2 piece system 10/01/2003 Non-routine SupplyK0590 Ost pch drain/barr lk flng/f 10/01/2003 Non-routine SupplyK0591 Urine ost pouch w faucet/tap 10/01/2003 Non-routine SupplyK0592 Urine ost pouch w bltinconv 10/01/2003 Non-routine SupplyK0593 Ost urine pch w b/bltin conv 10/01/2003 Non-routine SupplyK0594 Ost pch urine w barrier/tapv 10/01/2003 Non-routine SupplyK0595 Os pch urine w bar/fange/tap 10/01/2003 Non-routine SupplyK0596 Urine ost pch bar w lock fln 10/01/2003 Non-routine SupplyK0597 Ost pch urine w lock flng/ft 10/01/2003 Non-routine SupplyK0614 chem/antiseptic solution, 8oz. 10/01/2003 Non-routine SupplyK0620 tubular elastic dressing 10/01/2003 Non-routine SupplyK0621 gauze, non-impreg pack strip 10/01/2003 Non-routine SupplyG0193 Endoscopic study swallow functn 10/01/2003 TherapyG0194 Sensory testing endoscopic study 10/01/2003 TherapyG0195 Clinical eval swallowing funct 10/01/2003 TherapyG0196 Eval of swallowing with radioopa 10/01/2003 TherapyG0197 Eval of pt for prescip speech devi 10/01/2003 TherapyG0198 Patient adapation & train for spe 10/01/2003 TherapyG0199 Reevaluation of patient use spec 10/01/2003 TherapyG0200 Eval of patient prescip of voice p 10/01/2003 TherapyG0201 Modi for training in use voice pro 10/01/2003 TherapyG0279 Excorp shock tx, elbow epi 10/01/2003 TherapyG0280 Excorp shock tx other than 10/01/2003 TherapyG0281 Elec stim unattend for press 10/01/2003 TherapyG0282 Elect stim wound care not pd 10/01/2003 TherapyG0283 Elec stim other than wound 10/01/2003 Therapy0019T Extracorp shock wave tx, ms 10/01/2003 Therapy0020T Extracorp shock wave tx, ft 10/01/2003 Therapy64550 Apply neurostimulator 10/01/2003 Therapy90901 Biofeedback train, any meth 10/01/2003 Therapy90911 Biofeedback peri/uro/rectal 10/01/2003 Therapy92506 Speech/hearing evaluation 10/01/2003 Therapy92507 Speech/hearing therapy 10/01/2003 Therapy92508 Speech/hearing therapy 10/01/2003 Therapy92510 Rehab for ear implant 10/01/2003 Therapy92526 Oral function therapy 10/01/2003 Therapy92601 Cochlear implt f/up exam < 7 10/01/2003 Therapy92602 Reprogram cochlear implt < 7 10/01/2003 Therapy92603 Cochlear implt f/up exam 7 > 10/01/2003 Therapy92604 Reprogram cochlear implt 7 > 10/01/2003 Therapy



92605 Eval for nonspeech device rx 10/01/2003 Therapy92606 Non-speech device service 10/01/2003 Therapy92607 Ex for speech device rx, 1hr 10/01/2003 Therapy92608 Ex for speech device rx addl 10/01/2003 Therapy92609 Use of speech device service 10/01/2003 Therapy92610 Evaluate swallowing function 10/01/2003 Therapy92611 Motion fluoroscopy/swallow 10/01/2003 Therapy92612 Endoscopy swallow tst (fees) 10/01/2003 Therapy92614 Laryngoscopic sensory test 10/01/2003 Therapy92616 Fees w/laryngeal sense test 10/01/2003 Therapy95831 Limb muscle testing, manual 10/01/2003 Therapy95832 Hand muscle testing, manual 10/01/2003 Therapy95833 Body muscle testing, manual 10/01/2003 Therapy95834 Body muscle testing, manual 10/01/2003 Therapy95851 Range of motion measurements 10/01/2003 Therapy95852 Range of motion measurements 10/01/2003 Therapy96000 Motion analysis, video/3d 10/01/2003 Therapy96001 Motion test w/ft press meas 10/01/2003 Therapy96002 Dynamic surface emg 10/01/2003 Therapy96003 Dynamic fine wire emg 10/01/2003 Therapy96105 Assessment of aphasia 10/01/2003 Therapy97001 Pt evaluation 10/01/2003 Therapy97002 Pt re-evaluation 10/01/2003 Therapy97003 Ot evaluation 10/01/2003 Therapy97004 Ot re-evaluation 10/01/2003 Therapy97012 Mechanical traction therapy 10/01/2003 Therapy97016 Vasopneumatic device therapy 10/01/2003 Therapy97018 Paraffin bath therapy 10/01/2003 Therapy97020 Microwave therapy 10/01/2003 Therapy97022 Whirlpool therapy 10/01/2003 Therapy97024 Diathermy treatment 10/01/2003 Therapy97026 Infrared therapy 10/01/2003 Therapy97028 Ultraviolet therapy 10/01/2003 Therapy97032 Electrical stimulation 10/01/2003 Therapy97033 Electric current therapy 10/01/2003 Therapy97034 Contrast bath therapy 10/01/2003 Therapy97035 Ultrasound therapy 10/01/2003 Therapy97036 Hydrotherapy 10/01/2003 Therapy97039 Physical therapy treatment 10/01/2003 Therapy97110 Therapeutic exercises 10/01/2003 Therapy97112 Neuromuscular reeducation 10/01/2003 Therapy97113 Aquatic therapy/exercises 10/01/2003 Therapy97116 Gait training therapy 10/01/2003 Therapy97124 Massage therapy 10/01/2003 Therapy97139 Physical medicine procedure 10/01/2003 Therapy97140 Manual therapy 10/01/2003 Therapy97150 Group therapeutic procedures 10/01/2003 Therapy97504 Orthotic training 10/01/2003 Therapy97520 Prosthetic training 10/01/2003 Therapy97530 Therapeutic activities 10/01/2003 Therapy97532 Cognitive skills development 10/01/2003 Therapy97533 Sensory integration 10/01/2003 Therapy



97535 Self care mngment training 10/01/2003 Therapy97537 Community/work reintegration 10/01/2003 Therapy97542 Wheelchair mngment training 10/01/2003 Therapy 97545 Work hardening 10/01/2003 Therapy97546 Work hardening add-on 10/01/2003 Therapy97601 Wound care selective 10/01/2003 Therapy97602 Wound care non-selective 10/01/2003 Therapy97703 Prosthetic checkout 10/01/2003 Therapy97750 Physical performance test 10/01/2003 Therapy97799 Physical medicine procedure 10/01/2003 Therapy

HH Consolidated Billing Code List -- As of Transmittal 8




A4212 Non coring needle or stylet 01/01/2004 Non-routine SupplyA4216 Sterile water/saline up to 10ml 01/01/2004 Non-routine SupplyA4217 Sterile water/saline 500ml 01/01/2004 Non-routine Supply

A4248 Chlorhexidine, containing anticeptic, 1ml 01/01/2004 Non-routine SupplyA4310 Insert tray w/o bag/cath 01/01/2004 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 01/01/2004 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 01/01/2004 Non-routine SupplyA4313 Catheter w/bag 3-way 01/01/2004 Non-routine SupplyA4314 Cath w/drainage 2-way latex 01/01/2004 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 01/01/2004 Non-routine SupplyA4316 Cath w/drainage 3-way 01/01/2004 Non-routine SupplyA4320 Irrigation tray 01/01/2004 Non-routine SupplyA4321 Cath therapeutic irrig agent 01/01/2004 Non-routine SupplyA4322 Irrigation syringe 01/01/2004 Non-routine SupplyA4324 Male ext cath w/adh coating 01/01/2004 Non-routine SupplyA4325 Male ext cath w/adh strip 01/01/2004 Non-routine SupplyA4326 Male external catheter 01/01/2004 Non-routine SupplyA4327 Fem urinary collect dev cup 01/01/2004 Non-routine SupplyA4328 Fem urinary collect pouch 01/01/2004 Non-routine SupplyA4330 Stool collection pouch 01/01/2004 Non-routine SupplyA4331 Extension drainage tubing 01/01/2004 Non-routine SupplyA4332 Lubricant for cath insertion 01/01/2004 Non-routine SupplyA4333 Urinary cath anchor device 01/01/2004 Non-routine SupplyA4334 Urinary cath leg strap 01/01/2004 Non-routine SupplyA4335 Incontinence supply 01/01/2004 Non-routine SupplyA4338 Indwelling catheter latex 01/01/2004 Non-routine SupplyA4340 Indwelling catheter special 01/01/2004 Non-routine SupplyA4344 Cath indw foley 2 way silicn 01/01/2004 Non-routine SupplyA4346 Cath indw foley 3 way 01/01/2004 Non-routine SupplyA4347 Male external catheter 01/01/2004 Non-routine SupplyA4348 Male ext cath extended wear 01/01/2004 Non-routine SupplyA4351 Straight tip urine catheter 01/01/2004 Non-routine SupplyA4352 Coude tip urinary catheter 01/01/2004 Non-routine SupplyA4353 Intermittent urinary cath 01/01/2004 Non-routine SupplyA4354 Cath insertion tray w/bag 01/01/2004 Non-routine SupplyA4355 Bladder irrigation tubing 01/01/2004 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 01/01/2004 Non-routine SupplyA4357 Bedside drainage bag 01/01/2004 Non-routine SupplyA4358 Urinary leg bag 01/01/2004 Non-routine SupplyA4359 Urinary suspensory w/o leg b 01/01/2004 Non-routine SupplyA4361 Ostomy face plate 01/01/2004 Non-routine SupplyA4362 Solid skin barrier 01/01/2004 Non-routine SupplyA4364 Liq adhes for facial prosth 01/01/2004 Non-routine SupplyA4365 Adhesive remover wipes 01/01/2004 Non-routine SupplyA4366 Ostomy vent, any type, each 01/01/2004 Non-routine SupplyA4367 Ostomy belt 01/01/2004 Non-routine SupplyA4368 Ostomy filter 01/01/2004 Non-routine SupplyA4368 Ostomy pouch filter 01/01/2004 Non-routine SupplyA4369 Skin barrier liquid per oz 01/01/2004 Non-routine Supply



A4371 Skin barrier powder per oz 01/01/2004 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 01/01/2004 Non-routine SupplyA4373 Skin barrier with flange 01/01/2004 Non-routine SupplyA4375 Drainable plastic pch w fcpl 01/01/2004 Non-routine SupplyA4376 Drainable rubber pch w fcplt 01/01/2004 Non-routine SupplyA4377 Drainable plstic pch w/o fp 01/01/2004 Non-routine SupplyA4378 Drainable rubber pch w/o fp 01/01/2004 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 01/01/2004 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 01/01/2004 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 01/01/2004 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 01/01/2004 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 01/01/2004 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 01/01/2004 Non-routine SupplyA4385 Ost skn barrier sld ext wear 01/01/2004 Non-routine SupplyA4387 Ost clsd pouch w att st barr 01/01/2004 Non-routine SupplyA4388 Drainable pch w ex wear barr 01/01/2004 Non-routine SupplyA4389 Drainable pch w st wear barr 01/01/2004 Non-routine SupplyA4390 Drainable pch ex wear convex 01/01/2004 Non-routine SupplyA4391 Urinary pouch w ex wear barr 01/01/2004 Non-routine SupplyA4392 Urinary pouch w st wear barr 01/01/2004 Non-routine SupplyA4393 Urine pch w ex wear bar conv 01/01/2004 Non-routine SupplyA4394 Ostomy pouch liq deodorant 01/01/2004 Non-routine SupplyA4395 Ostomy pouch solid deodorant 01/01/2004 Non-routine SupplyA4396 Peristomal hernia supprt blt 01/01/2004 Non-routine SupplyA4397 Irrigation supply sleeve 01/01/2004 Non-routine SupplyA4398 Ostomy irrigation bag 01/01/2004 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 01/01/2004 Non-routine SupplyA4400 Ostomy irrigation set 01/01/2004 Non-routine SupplyA4402 Lubricant per ounce 01/01/2004 Non-routine SupplyA4404 Ostomy ring each 01/01/2004 Non-routine SupplyA4405 Nonpectin based ostomy paste 01/01/2004 Non-routine SupplyA4406 Pectin based ostomy paste 01/01/2004 Non-routine SupplyA4407 Ext wear ost skn barr <=4sq” 01/01/2004 Non-routine SupplyA4408 Ext wear ost skn barr >4sq” 01/01/2004 Non-routine SupplyA4409 Ost skn barr w flng <=4 sq” 01/01/2004 Non-routine SupplyA4410 Ost skn barr w flng >4sq” 01/01/2004 Non-routine SupplyA4413 2 pc drainable ost pouch w/ filter 01/01/2004 Non-routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 01/01/2004 Non-routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 01/01/2004 Non-routine SupplyA4416 Ost pch clsd w barrier/filtr 01/01/2004 Non-routine SupplyA4417 Ost pch w bar/bltinconv/fltr 01/01/2004 Non-routine SupplyA4418 Ost pch clsd w/o bar w filtr 01/01/2004 Non-routine SupplyA4419 Ost pch for bar w flange/flt 01/01/2004 Non-routine SupplyA4420 Ost pch clsd for bar w lk fl 01/01/2004 Non-routine SupplyA4421 (6) Ostomy supply misc 01/01/2004 Non-routine SupplyA4422 Ost pouch absorbent material 01/01/2004 Non-routine SupplyA4423 Ost pch for bar w lk fl/fltr 01/01/2004 Non-routine SupplyA4424 Ost pch drain w bar & filter 01/01/2004 Non-routine SupplyA4425 Ost pch drain for barrier fl 01/01/2004 Non-routine SupplyA4426 Ost pch drain 2 piece system 01/01/2004 Non-routine SupplyA4427 Ost pch drain/barr lk flng/f 01/01/2004 Non-routine SupplyA4428 Urine ost pouch w faucet/tap 01/01/2004 Non-routine Supply



A4429 Urine ost pouch w bltinconv 01/01/2004 Non-routine SupplyA4430 Ost urine pch w b/bltin conv 01/01/2004 Non-routine SupplyA4431 Ost pch urine w barrier/tapv 01/01/2004 Non-routine SupplyA4432 Os pch urine w bar/fange/tap 01/01/2004 Non-routine SupplyA4433 Urine ost pch bar w lock fln 01/01/2004 Non-routine SupplyA4434 Ost pch urine w lock flng/ft 01/01/2004 Non-routine SupplyA4455 Adhesive remover per ounce 01/01/2004 Non-routine SupplyA4458 Reusable enema bag 01/01/2004 Non-routine SupplyA4460 Elastic compression bandage 01/01/2004 Non-routine SupplyA4462 Abdmnl drssng holder/binder 01/01/2004 Non-routine SupplyA4481 Tracheostoma filter 01/01/2004 Non-routine SupplyA4623 Tracheostomy inner cannula 01/01/2004 Non-routine SupplyA4625 Trach care kit for new trach 01/01/2004 Non-routine SupplyA4626 Tracheostomy cleaning brush 01/01/2004 Non-routine SupplyA4649 Surgical supplies 01/01/2004 Non-routine SupplyA4656 Needle, any size, each 01/01/2004 Non-routine SupplyA4657 Syringe, with or without needle, each 01/01/2004 Non-routine SupplyA4930 Sterile, gloves per pair 01/01/2004 Non-routine SupplyA5051 Pouch clsd w barr attached 01/01/2004 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 01/01/2004 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 01/01/2004 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 01/01/2004 Non-routine SupplyA5055 Stoma cap 01/01/2004 Non-routine SupplyA5061 Pouch drainable w barrier at 01/01/2004 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 01/01/2004 Non-routine SupplyA5063 Drain ostomy pouch w/flange 01/01/2004 Non-routine SupplyA5071 Urinary pouch w/barrier 01/01/2004 Non-routine SupplyA5072 Urinary pouch w/o barrier 01/01/2004 Non-routine SupplyA5073 Urinary pouch on barr w/flng 01/01/2004 Non-routine SupplyA5081 Continent stoma plug 01/01/2004 Non-routine SupplyA5082 Continent stoma catheter 01/01/2004 Non-routine SupplyA5093 Ostomy accessory convex inse 01/01/2004 Non-routine SupplyA5102 Bedside drain btl w/wo tube 01/01/2004 Non-routine SupplyA5105 Urinary suspensory 01/01/2004 Non-routine SupplyA5112 Urinary leg bag 01/01/2004 Non-routine SupplyA5113 Latex leg strap 01/01/2004 Non-routine SupplyA5114 Foam/fabric leg strap 01/01/2004 Non-routine SupplyA5119 Skin barrier wipes box pr 50 01/01/2004 Non-routine SupplyA5121 Solid skin barrier 6x6 01/01/2004 Non-routine SupplyA5122 Solid skin barrier 8x8 01/01/2004 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 01/01/2004 Non-routine SupplyA5131 Appliance cleaner 01/01/2004 Non-routine SupplyA6010 Collagen based wound filler, dry foam 01/01/2004 Non-routine SupplyA6011 Collagen gel/paste wound fil 01/01/2004 Non-routine SupplyA6020 Collage wound dressing 01/01/2004 Non-routine SupplyA6021 Collagen dressing <=16 sq in 01/01/2004 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 01/01/2004 Non-routine SupplyA6023 Collagen dressing >48 sq in 01/01/2004 Non-routine SupplyA6024 Collagen dsg wound filler 01/01/2004 Non-routine Supply

A6025Gel sheet for dermal or epidermal application (e.g. silicone, hydrogel, other) 01/01/2004 Non-routine Supply



A6154 Wound pouch each 01/01/2004 Non-routine SupplyA6196 Alginate dressing <=16 sq in 01/01/2004 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 01/01/2004 Non-routine SupplyA6198 alginate dressing > 48 sq in 01/01/2004 Non-routine SupplyA6199 Alginate drsg wound filler 01/01/2004 Non-routine SupplyA6200 Compos drsg <=16 no border 01/01/2004 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 01/01/2004 Non-routine SupplyA6202 Compos drsg >48 no border 01/01/2004 Non-routine SupplyA6203 Composite drsg <= 16 sq in 01/01/2004 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 01/01/2004 Non-routine SupplyA6205 Composite drsg > 48 sq in 01/01/2004 Non-routine SupplyA6206 Contact layer <= 16 sq in 01/01/2004 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 01/01/2004 Non-routine SupplyA6208 Contact layer > 48 sq in 01/01/2004 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 01/01/2004 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 01/01/2004 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 01/01/2004 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 01/01/2004 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 01/01/2004 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 01/01/2004 Non-routine SupplyA6215 Foam dressing wound filler 01/01/2004 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 01/01/2004 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 01/01/2004 Non-routine SupplyA6221 Gauze > 48 sq in w/border 01/01/2004 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 01/01/2004 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 01/01/2004 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 01/01/2004 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 01/01/2004 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 01/01/2004 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 01/01/2004 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 01/01/2004 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 01/01/2004 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 01/01/2004 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 01/01/2004 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 01/01/2004 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 01/01/2004 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 01/01/2004 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 01/01/2004 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 01/01/2004 Non-routine SupplyA6240 Hydrocolld drg filler paste 01/01/2004 Non-routine SupplyA6241 Hydrocolloid drg filler dry 01/01/2004 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 01/01/2004 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 01/01/2004 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 01/01/2004 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 01/01/2004 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 01/01/2004 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 01/01/2004 Non-routine SupplyA6248 Hydrogel drsg gel filler 01/01/2004 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 01/01/2004 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 01/01/2004 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 01/01/2004 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 01/01/2004 Non-routine Supply



A6255 Absorpt drg >16<=48 in w/bdr 01/01/2004 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 01/01/2004 Non-routine SupplyA6257 Transparent film <= 16 sq in 01/01/2004 Non-routine SupplyA6258 Transparent film >16<=48 in 01/01/2004 Non-routine SupplyA6259 Transparent film > 48 sq in 01/01/2004 Non-routine SupplyA6261 Wound filler gel/paste /oz 01/01/2004 Non-routine SupplyA6262 Wound filler dry form / gram 01/01/2004 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 01/01/2004 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 01/01/2004 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 01/01/2004 Non-routine SupplyA6404 Sterile gauze > 48 sq in 01/01/2004 Non-routine SupplyA6405 Sterile elastic gauze /yd 01/01/2004 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 01/01/2004 Non-routine Supply

A6407Packing strips, non-impregnated, up to 2 inches, per lin yd 01/01/2004 Non-routine Supply

A6410 Sterile eye pad 01/01/2004 Non-routine SupplyA6440 Zinc Paste >=3"<5" w/roll 01/01/2004 Non-routine Supply

A6441

Padding bandage, non-elastic, non-woven/non-knitted, width > or = 3" and < 5", per yard 01/01/2004 Non-routine Supply

A6442

Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard 01/01/2004 Non-routine Supply

A6443

Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Non-routine Supply

A6444

Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard 01/01/2004 Non-routine Supply

A6445

Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard 01/01/2004 Non-routine Supply

A6446

Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Non-routine Supply

A6447

Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard 01/01/2004 Non-routine Supply

A6448

Light compression bandage, elastic, knitted/woven, width less than three inches, per yard 01/01/2004 Non-routine Supply

A6449

Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Non-routine Supply

A6450

Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard 01/01/2004 Non-routine Supply



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 01/01/2004 Non-routine Supply

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 01/01/2004 Non-routine Supply

A6453

Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard 01/01/2004 Non-routine Supply

A6454

Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Non-routine Supply

A6455

Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard 01/01/2004 Non-routine Supply

A6456

Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard 01/01/2004 Non-routine Supply

A7043 Vacuum drainage bottle & tubing 01/01/2004 Non-routine SupplyA7501 Tracheostoma valve w diaphra 01/01/2004 Non-routine SupplyA7502 Replacement diaphragm/fplate 01/01/2004 Non-routine SupplyA7503 HMES filter holder or cap 01/01/2004 Non-routine SupplyA7504 Tracheostoma HMES filter 01/01/2004 Non-routine SupplyA7505 HMES or trach valve housing 01/01/2004 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 01/01/2004 Non-routine SupplyA7507 Integrated filter & holder 01/01/2004 Non-routine SupplyA7508 Housing & Integrated Adhesiv 01/01/2004 Non-routine SupplyA7509 Heat & moisture exchange sys 01/01/2004 Non-routine Supply

A7520Tracheostomy/larynectomy tube, non-cuffed 01/01/2004 Non-routine Supply

A7521 Tracheostomy/larynectomy tube, cuffed 01/01/2004 Non-routine Supply

A7522Tracheostomy/larynectomy tube, stainless steel 01/01/2004 Non-routine Supply

A7523 Tracheostomy shower protector, each 01/01/2004 Non-routine SupplyA7524 Tracheostomy stent/stud/button, each 01/01/2004 Non-routine SupplyK0614 chem/antiseptic solution, 8oz. 01/01/2004 Non-routine Supply K0620 tubular elastic dressing 01/01/2004 Non-routine SupplyG0193 Endoscopic study swallow functn 01/01/2004 TherapyG0194 Sensory testing endoscopic study 01/01/2004 TherapyG0195 Clinical eval swallowing funct 01/01/2004 TherapyG0196 Eval of swallowing with radioopa 01/01/2004 TherapyG0197 Eval of pt for prescip speech devi 01/01/2004 TherapyG0198 Patient adapation & train for spe 01/01/2004 Therapy



G0199 Reevaluation of patient use spec 01/01/2004 TherapyG0200 Eval of patient prescip of voice p 01/01/2004 TherapyG0201 Modi for training in use voice pro 01/01/2004 TherapyG0279 Excorp shock tx, elbow epi 01/01/2004 TherapyG0280 Excorp shock tx other than 01/01/2004 TherapyG0281 Elec stim unattend for press 01/01/2004 TherapyG0282 Elect stim wound care not pd 01/01/2004 TherapyG0283 Elec stim other than wound 01/01/2004 Therapy0019T Extracorp shock wave tx, ms 01/01/2004 Therapy0020T Extracorp shock wave tx, ft 01/01/2004 Therapy64550 Apply neurostimulator 01/01/2004 Therapy90901 Biofeedback train, any meth 01/01/2004 Therapy90911 Biofeedback peri/uro/rectal 01/01/2004 Therapy92506 Speech/hearing evaluation 01/01/2004 Therapy92507 Speech/hearing therapy 01/01/2004 Therapy92508 Speech/hearing therapy 01/01/2004 Therapy92510 Rehab for ear implant 01/01/2004 Therapy92526 Oral function therapy 01/01/2004 Therapy92601 Cochlear implt f/up exam < 7 01/01/2004 Therapy92602 Reprogram cochlear implt < 7 01/01/2004 Therapy92603 Cochlear implt f/up exam 7 > 01/01/2004 Therapy92604 Reprogram cochlear implt 7 > 01/01/2004 Therapy92605 Eval for nonspeech device rx 01/01/2004 Therapy92606 Non-speech device service 01/01/2004 Therapy92607 Ex for speech device rx, 1hr 01/01/2004 Therapy92608 Ex for speech device rx addl 01/01/2004 Therapy92609 Use of speech device service 01/01/2004 Therapy92610 Evaluate swallowing function 01/01/2004 Therapy92611 Motion fluoroscopy/swallow 01/01/2004 Therapy92612 Endoscopy swallow tst (fees) 01/01/2004 Therapy92614 Laryngoscopic sensory test 01/01/2004 Therapy92616 Fees w/laryngeal sense test 01/01/2004 Therapy95831 Limb muscle testing, manual 01/01/2004 Therapy95832 Hand muscle testing, manual 01/01/2004 Therapy95833 Body muscle testing, manual 01/01/2004 Therapy95834 Body muscle testing, manual 01/01/2004 Therapy95851 Range of motion measurements 01/01/2004 Therapy95852 Range of motion measurements 01/01/2004 Therapy96000 Motion analysis, video/3d 01/01/2004 Therapy96001 Motion test w/ft press meas 01/01/2004 Therapy96002 Dynamic surface emg 01/01/2004 Therapy96003 Dynamic fine wire emg 01/01/2004 Therapy96105 Assessment of aphasia 01/01/2004 Therapy97001 Pt evaluation 01/01/2004 Therapy97002 Pt re-evaluation 01/01/2004 Therapy97003 Ot evaluation 01/01/2004 Therapy97004 Ot re-evaluation 01/01/2004 Therapy97012 Mechanical traction therapy 01/01/2004 Therapy97016 Vasopneumatic device therapy 01/01/2004 Therapy97018 Paraffin bath therapy 01/01/2004 Therapy97020 Microwave therapy 01/01/2004 Therapy97022 Whirlpool therapy 01/01/2004 Therapy



97024 Diathermy treatment 01/01/2004 Therapy97026 Infrared therapy 01/01/2004 Therapy97028 Ultraviolet therapy 01/01/2004 Therapy97032 Electrical stimulation 01/01/2004 Therapy97033 Electric current therapy 01/01/2004 Therapy97034 Contrast bath therapy 01/01/2004 Therapy97035 Ultrasound therapy 01/01/2004 Therapy97036 Hydrotherapy 01/01/2004 Therapy97039 Physical therapy treatment 01/01/2004 Therapy97110 Therapeutic exercises 01/01/2004 Therapy97112 Neuromuscular reeducation 01/01/2004 Therapy97113 Aquatic therapy/exercises 01/01/2004 Therapy97116 Gait training therapy 01/01/2004 Therapy97124 Massage therapy 01/01/2004 Therapy97139 Physical medicine procedure 01/01/2004 Therapy97140 Manual therapy 01/01/2004 Therapy97150 Group therapeutic procedures 01/01/2004 Therapy97504 Orthotic training 01/01/2004 Therapy97520 Prosthetic training 01/01/2004 Therapy97530 Therapeutic activities 01/01/2004 Therapy97532 Cognitive skills development 01/01/2004 Therapy97533 Sensory integration 01/01/2004 Therapy97535 Self care mngment training 01/01/2004 Therapy97537 Community/work reintegration 01/01/2004 Therapy97542 Wheelchair mngment training 01/01/2004 Therapy97545 Work hardening 01/01/2004 Therapy 97546 Work hardening add-on 01/01/2004 Therapy97601 Wound care selective 01/01/2004 Therapy97602 Wound care non-selective 01/01/2004 Therapy97703 Prosthetic checkout 01/01/2004 Therapy97750 Physical performance test 01/01/2004 Therapy

97755

Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report, each 15 minutes 01/01/2004 Therapy

97799 Physical medicine procedure 01/01/2004 Therapy


CMS Division of Institutional Claims Processing 1 July 9, 2004




A4248 Chlorhexidine, containing anticeptic, 1ml 10/01/2004 Non-routine SupplyA4310 Insert tray w/o bag/cath 10/01/2004 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 10/01/2004 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 10/01/2004 Non-routine SupplyA4313 Catheter w/bag 3-way 10/01/2004 Non-routine SupplyA4314 Cath w/drainage 2-way latex 10/01/2004 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 10/01/2004 Non-routine SupplyA4316 Cath w/drainage 3-way 10/01/2004 Non-routine SupplyA4320 Irrigation tray 10/01/2004 Non-routine SupplyA4321 Cath therapeutic irrig agent 10/01/2004 Non-routine SupplyA4322 Irrigation syringe 10/01/2004 Non-routine SupplyA4324 Male ext cath w/adh coating 10/01/2004 Non-routine SupplyA4325 Male ext cath w/adh strip 10/01/2004 Non-routine SupplyA4326 Male external catheter 10/01/2004 Non-routine SupplyA4327 Fem urinary collect dev cup 10/01/2004 Non-routine SupplyA4328 Fem urinary collect pouch 10/01/2004 Non-routine SupplyA4330 Stool collection pouch 10/01/2004 Non-routine SupplyA4331 Extension drainage tubing 10/01/2004 Non-routine SupplyA4332 Lubricant for cath insertion 10/01/2004 Non-routine SupplyA4333 Urinary cath anchor device 10/01/2004 Non-routine SupplyA4334 Urinary cath leg strap 10/01/2004 Non-routine SupplyA4335 Incontinence supply 10/01/2004 Non-routine SupplyA4338 Indwelling catheter latex 10/01/2004 Non-routine SupplyA4340 Indwelling catheter special 10/01/2004 Non-routine SupplyA4344 Cath indw foley 2 way silicn 10/01/2004 Non-routine SupplyA4346 Cath indw foley 3 way 10/01/2004 Non-routine SupplyA4347 Male external catheter 10/01/2004 Non-routine SupplyA4348 Male ext cath extended wear 10/01/2004 Non-routine SupplyA4351 Straight tip urine catheter 10/01/2004 Non-routine SupplyA4352 Coude tip urinary catheter 10/01/2004 Non-routine SupplyA4353 Intermittent urinary cath 10/01/2004 Non-routine SupplyA4354 Cath insertion tray w/bag 10/01/2004 Non-routine SupplyA4355 Bladder irrigation tubing 10/01/2004 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 10/01/2004 Non-routine SupplyA4357 Bedside drainage bag 10/01/2004 Non-routine SupplyA4358 Urinary leg bag 10/01/2004 Non-routine SupplyA4359 Urinary suspensory w/o leg b 10/01/2004 Non-routine SupplyA4361 Ostomy face plate 10/01/2004 Non-routine SupplyA4362 Solid skin barrier 10/01/2004 Non-routine SupplyA4364 Liq adhes for facial prosth 10/01/2004 Non-routine SupplyA4365 Adhesive remover wipes 10/01/2004 Non-routine SupplyA4366 Ostomy vent, any type, each 10/01/2004 Non-routine SupplyA4367 Ostomy belt 10/01/2004 Non-routine SupplyA4368 Ostomy filter 10/01/2004 Non-routine SupplyA4368 Ostomy pouch filter 10/01/2004 Non-routine SupplyA4369 Skin barrier liquid per oz 10/01/2004 Non-routine Supply



A4371 Skin barrier powder per oz 10/01/2004 Non-routine SupplyA4372 Skin barrier solid 4x4 equiv 10/01/2004 Non-routine SupplyA4373 Skin barrier with flange 10/01/2004 Non-routine SupplyA4375 Drainable plastic pch w fcpl 10/01/2004 Non-routine SupplyA4376 Drainable rubber pch w fcplt 10/01/2004 Non-routine SupplyA4377 Drainable plstic pch w/o fp 10/01/2004 Non-routine SupplyA4378 Drainable rubber pch w/o fp 10/01/2004 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 10/01/2004 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 10/01/2004 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 10/01/2004 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 10/01/2004 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 10/01/2004 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 10/01/2004 Non-routine SupplyA4385 Ost skn barrier sld ext wear 10/01/2004 Non-routine SupplyA4387 Ost clsd pouch w att st barr 10/01/2004 Non-routine SupplyA4388 Drainable pch w ex wear barr 10/01/2004 Non-routine SupplyA4389 Drainable pch w st wear barr 10/01/2004 Non-routine SupplyA4390 Drainable pch ex wear convex 10/01/2004 Non-routine SupplyA4391 Urinary pouch w ex wear barr 10/01/2004 Non-routine SupplyA4392 Urinary pouch w st wear barr 10/01/2004 Non-routine SupplyA4393 Urine pch w ex wear bar conv 10/01/2004 Non-routine SupplyA4394 Ostomy pouch liq deodorant 10/01/2004 Non-routine SupplyA4395 Ostomy pouch solid deodorant 10/01/2004 Non-routine SupplyA4396 Peristomal hernia supprt blt 10/01/2004 Non-routine SupplyA4397 Irrigation supply sleeve 10/01/2004 Non-routine SupplyA4398 Ostomy irrigation bag 10/01/2004 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 10/01/2004 Non-routine SupplyA4400 Ostomy irrigation set 10/01/2004 Non-routine SupplyA4402 Lubricant per ounce 10/01/2004 Non-routine SupplyA4404 Ostomy ring each 10/01/2004 Non-routine SupplyA4405 Nonpectin based ostomy paste 10/01/2004 Non-routine SupplyA4406 Pectin based ostomy paste 10/01/2004 Non-routine SupplyA4407 Ext wear ost skn barr <=4sq” 10/01/2004 Non-routine SupplyA4408 Ext wear ost skn barr >4sq” 10/01/2004 Non-routine SupplyA4409 Ost skn barr w flng <=4 sq” 10/01/2004 Non-routine SupplyA4410 Ost skn barr w flng >4sq” 10/01/2004 Non-routine SupplyA4413 2 pc drainable ost pouch w/ filter 10/01/2004 Non-routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 10/01/2004 Non-routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 10/01/2004 Non-routine SupplyA4416 Ost pch clsd w barrier/filtr 10/01/2004 Non-routine SupplyA4417 Ost pch w bar/bltinconv/fltr 10/01/2004 Non-routine SupplyA4418 Ost pch clsd w/o bar w filtr 10/01/2004 Non-routine SupplyA4419 Ost pch for bar w flange/flt 10/01/2004 Non-routine SupplyA4420 Ost pch clsd for bar w lk fl 10/01/2004 Non-routine SupplyA4421 (6) Ostomy supply misc 10/01/2004 Non-routine SupplyA4422 Ost pouch absorbent material 10/01/2004 Non-routine SupplyA4423 Ost pch for bar w lk fl/fltr 10/01/2004 Non-routine SupplyA4424 Ost pch drain w bar & filter 10/01/2004 Non-routine SupplyA4425 Ost pch drain for barrier fl 10/01/2004 Non-routine SupplyA4426 Ost pch drain 2 piece system 10/01/2004 Non-routine SupplyA4427 Ost pch drain/barr lk flng/f 10/01/2004 Non-routine SupplyA4428 Urine ost pouch w faucet/tap 10/01/2004 Non-routine Supply



A4429 Urine ost pouch w bltinconv 10/01/2004 Non-routine SupplyA4430 Ost urine pch w b/bltin conv 10/01/2004 Non-routine SupplyA4431 Ost pch urine w barrier/tapv 10/01/2004 Non-routine SupplyA4432 Os pch urine w bar/fange/tap 10/01/2004 Non-routine SupplyA4433 Urine ost pch bar w lock fln 10/01/2004 Non-routine SupplyA4434 Ost pch urine w lock flng/ft 10/01/2004 Non-routine SupplyA4455 Adhesive remover per ounce 10/01/2004 Non-routine SupplyA4458 Reusable enema bag 10/01/2004 Non-routine SupplyA4460 Elastic compression bandage 10/01/2004 Non-routine SupplyA4462 Abdmnl drssng holder/binder 10/01/2004 Non-routine SupplyA4481 Tracheostoma filter 10/01/2004 Non-routine SupplyA4623 Tracheostomy inner cannula 10/01/2004 Non-routine SupplyA4625 Trach care kit for new trach 10/01/2004 Non-routine SupplyA4626 Tracheostomy cleaning brush 10/01/2004 Non-routine SupplyA4649 Surgical supplies 10/01/2004 Non-routine SupplyA4656 Needle, any size, each 10/01/2004 Non-routine SupplyA4657 Syringe, with or without needle, each 10/01/2004 Non-routine SupplyA4930 Sterile, gloves per pair 10/01/2004 Non-routine SupplyA5051 Pouch clsd w barr attached 10/01/2004 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 10/01/2004 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 10/01/2004 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 10/01/2004 Non-routine SupplyA5055 Stoma cap 10/01/2004 Non-routine SupplyA5061 Pouch drainable w barrier at 10/01/2004 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 10/01/2004 Non-routine SupplyA5063 Drain ostomy pouch w/flange 10/01/2004 Non-routine SupplyA5071 Urinary pouch w/barrier 10/01/2004 Non-routine SupplyA5072 Urinary pouch w/o barrier 10/01/2004 Non-routine SupplyA5073 Urinary pouch on barr w/flng 10/01/2004 Non-routine SupplyA5081 Continent stoma plug 10/01/2004 Non-routine SupplyA5082 Continent stoma catheter 10/01/2004 Non-routine SupplyA5093 Ostomy accessory convex inse 10/01/2004 Non-routine SupplyA5102 Bedside drain btl w/wo tube 10/01/2004 Non-routine SupplyA5105 Urinary suspensory 10/01/2004 Non-routine SupplyA5112 Urinary leg bag 10/01/2004 Non-routine SupplyA5113 Latex leg strap 10/01/2004 Non-routine SupplyA5114 Foam/fabric leg strap 10/01/2004 Non-routine SupplyA5119 Skin barrier wipes box pr 50 10/01/2004 Non-routine SupplyA5121 Solid skin barrier 6x6 10/01/2004 Non-routine SupplyA5122 Solid skin barrier 8x8 10/01/2004 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 10/01/2004 Non-routine SupplyA5131 Appliance cleaner 10/01/2004 Non-routine SupplyA6010 Collagen based wound filler, dry foam 10/01/2004 Non-routine SupplyA6011 Collagen gel/paste wound fil 10/01/2004 Non-routine SupplyA6020 Collage wound dressing 10/01/2004 Non-routine SupplyA6021 Collagen dressing <=16 sq in 10/01/2004 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 10/01/2004 Non-routine SupplyA6023 Collagen dressing >48 sq in 10/01/2004 Non-routine SupplyA6024 Collagen dsg wound filler 10/01/2004 Non-routine Supply




A6154 Wound pouch each 10/01/2004 Non-routine SupplyA6196 Alginate dressing <=16 sq in 10/01/2004 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 10/01/2004 Non-routine SupplyA6198 alginate dressing > 48 sq in 10/01/2004 Non-routine SupplyA6199 Alginate drsg wound filler 10/01/2004 Non-routine SupplyA6200 Compos drsg <=16 no border 10/01/2004 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 10/01/2004 Non-routine SupplyA6202 Compos drsg >48 no border 10/01/2004 Non-routine SupplyA6203 Composite drsg <= 16 sq in 10/01/2004 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 10/01/2004 Non-routine SupplyA6205 Composite drsg > 48 sq in 10/01/2004 Non-routine SupplyA6206 Contact layer <= 16 sq in 10/01/2004 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 10/01/2004 Non-routine SupplyA6208 Contact layer > 48 sq in 10/01/2004 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 10/01/2004 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 10/01/2004 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 10/01/2004 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 10/01/2004 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 10/01/2004 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 10/01/2004 Non-routine SupplyA6215 Foam dressing wound filler 10/01/2004 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 10/01/2004 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 10/01/2004 Non-routine SupplyA6221 Gauze > 48 sq in w/border 10/01/2004 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 10/01/2004 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 10/01/2004 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 10/01/2004 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 10/01/2004 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 10/01/2004 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 10/01/2004 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 10/01/2004 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 10/01/2004 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 10/01/2004 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 10/01/2004 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 10/01/2004 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 10/01/2004 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 10/01/2004 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 10/01/2004 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 10/01/2004 Non-routine SupplyA6240 Hydrocolld drg filler paste 10/01/2004 Non-routine SupplyA6241 Hydrocolloid drg filler dry 10/01/2004 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 10/01/2004 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 10/01/2004 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 10/01/2004 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 10/01/2004 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 10/01/2004 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 10/01/2004 Non-routine SupplyA6248 Hydrogel drsg gel filler 10/01/2004 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 10/01/2004 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 10/01/2004 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 10/01/2004 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 10/01/2004 Non-routine Supply



A6255 Absorpt drg >16<=48 in w/bdr 10/01/2004 Non-routine SupplyA6256 Absorpt drg > 48 sq in w/bdr 10/01/2004 Non-routine SupplyA6257 Transparent film <= 16 sq in 10/01/2004 Non-routine SupplyA6258 Transparent film >16<=48 in 10/01/2004 Non-routine SupplyA6259 Transparent film > 48 sq in 10/01/2004 Non-routine SupplyA6261 Wound filler gel/paste /oz 10/01/2004 Non-routine SupplyA6262 Wound filler dry form / gram 10/01/2004 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 10/01/2004 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 10/01/2004 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 10/01/2004 Non-routine SupplyA6404 Sterile gauze > 48 sq in 10/01/2004 Non-routine SupplyA6405 Sterile elastic gauze /yd 10/01/2004 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 10/01/2004 Non-routine Supply



A6441


A6442


A6443


A6444


A6445


A6446


A6447


A6448


A6449


A6450




A6451


A6452


A6453


A6454


A6455


A6456


A7043 Vacuum drainage bottle & tubing 10/01/2004 Non-routine SupplyA7501 Tracheostoma valve w diaphra 10/01/2004 Non-routine SupplyA7502 Replacement diaphragm/fplate 10/01/2004 Non-routine SupplyA7503 HMES filter holder or cap 10/01/2004 Non-routine SupplyA7504 Tracheostoma HMES filter 10/01/2004 Non-routine SupplyA7505 HMES or trach valve housing 10/01/2004 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 10/01/2004 Non-routine SupplyA7507 Integrated filter & holder 10/01/2004 Non-routine SupplyA7508 Housing & Integrated Adhesiv 10/01/2004 Non-routine SupplyA7509 Heat & moisture exchange sys 10/01/2004 Non-routine Supply




A7523 Tracheostomy shower protector, each 10/01/2004 Non-routine SupplyA7524 Tracheostomy stent/stud/button, each 10/01/2004 Non-routine SupplyK0614 chem/antiseptic solution, 8oz. 10/01/2004 Non-routine Supply K0620 tubular elastic dressing 10/01/2004 Non-routine SupplyG0193 Endoscopic study swallow functn 10/01/2004 TherapyG0194 Sensory testing endoscopic study 10/01/2004 TherapyG0195 Clinical eval swallowing funct 10/01/2004 TherapyG0196 Eval of swallowing with radioopa 10/01/2004 TherapyG0197 Eval of pt for prescip speech devi 10/01/2004 TherapyG0198 Patient adapation & train for spe 10/01/2004 Therapy



G0199 Reevaluation of patient use spec 10/01/2004 TherapyG0200 Eval of patient prescip of voice p 10/01/2004 TherapyG0201 Modi for training in use voice pro 10/01/2004 TherapyG0279 Excorp shock tx, elbow epi 10/01/2004 TherapyG0280 Excorp shock tx other than 10/01/2004 TherapyG0281 Elec stim unattend for press 10/01/2004 TherapyG0282 Elect stim wound care not pd 10/01/2004 TherapyG0283 Elec stim other than wound 10/01/2004 TherapyG0329 Electromagntic tx for ulcers 10/01/2004 Therapy0019T Extracorp shock wave tx, ms 10/01/2004 Therapy0020T Extracorp shock wave tx, ft 10/01/2004 Therapy64550 Apply neurostimulator 10/01/2004 Therapy90901 Biofeedback train, any meth 10/01/2004 Therapy90911 Biofeedback peri/uro/rectal 10/01/2004 Therapy92506 Speech/hearing evaluation 10/01/2004 Therapy92507 Speech/hearing therapy 10/01/2004 Therapy92508 Speech/hearing therapy 10/01/2004 Therapy92510 Rehab for ear implant 10/01/2004 Therapy92526 Oral function therapy 10/01/2004 Therapy92601 Cochlear implt f/up exam < 7 10/01/2004 Therapy92602 Reprogram cochlear implt < 7 10/01/2004 Therapy92603 Cochlear implt f/up exam 7 > 10/01/2004 Therapy92604 Reprogram cochlear implt 7 > 10/01/2004 Therapy92605 Eval for nonspeech device rx 10/01/2004 Therapy92606 Non-speech device service 10/01/2004 Therapy92607 Ex for speech device rx, 1hr 10/01/2004 Therapy92608 Ex for speech device rx addl 10/01/2004 Therapy92609 Use of speech device service 10/01/2004 Therapy92610 Evaluate swallowing function 10/01/2004 Therapy92611 Motion fluoroscopy/swallow 10/01/2004 Therapy92612 Endoscopy swallow tst (fees) 10/01/2004 Therapy92614 Laryngoscopic sensory test 10/01/2004 Therapy92616 Fees w/laryngeal sense test 10/01/2004 Therapy95831 Limb muscle testing, manual 10/01/2004 Therapy95832 Hand muscle testing, manual 10/01/2004 Therapy95833 Body muscle testing, manual 10/01/2004 Therapy95834 Body muscle testing, manual 10/01/2004 Therapy95851 Range of motion measurements 10/01/2004 Therapy95852 Range of motion measurements 10/01/2004 Therapy96000 Motion analysis, video/3d 10/01/2004 Therapy96001 Motion test w/ft press meas 10/01/2004 Therapy96002 Dynamic surface emg 10/01/2004 Therapy96003 Dynamic fine wire emg 10/01/2004 Therapy96105 Assessment of aphasia 10/01/2004 Therapy97001 Pt evaluation 10/01/2004 Therapy97002 Pt re-evaluation 10/01/2004 Therapy97003 Ot evaluation 10/01/2004 Therapy97004 Ot re-evaluation 10/01/2004 Therapy97012 Mechanical traction therapy 10/01/2004 Therapy97016 Vasopneumatic device therapy 10/01/2004 Therapy97018 Paraffin bath therapy 10/01/2004 Therapy97020 Microwave therapy 10/01/2004 Therapy



97022 Whirlpool therapy 10/01/2004 Therapy97024 Diathermy treatment 10/01/2004 Therapy97026 Infrared therapy 10/01/2004 Therapy97028 Ultraviolet therapy 10/01/2004 Therapy97032 Electrical stimulation 10/01/2004 Therapy97033 Electric current therapy 10/01/2004 Therapy97034 Contrast bath therapy 10/01/2004 Therapy97035 Ultrasound therapy 10/01/2004 Therapy97036 Hydrotherapy 10/01/2004 Therapy97039 Physical therapy treatment 10/01/2004 Therapy97110 Therapeutic exercises 10/01/2004 Therapy97112 Neuromuscular reeducation 10/01/2004 Therapy97113 Aquatic therapy/exercises 10/01/2004 Therapy97116 Gait training therapy 10/01/2004 Therapy97124 Massage therapy 10/01/2004 Therapy97139 Physical medicine procedure 10/01/2004 Therapy97140 Manual therapy 10/01/2004 Therapy97150 Group therapeutic procedures 10/01/2004 Therapy97504 Orthotic training 10/01/2004 Therapy97520 Prosthetic training 10/01/2004 Therapy97530 Therapeutic activities 10/01/2004 Therapy97532 Cognitive skills development 10/01/2004 Therapy97533 Sensory integration 10/01/2004 Therapy97535 Self care mngment training 10/01/2004 Therapy97537 Community/work reintegration 10/01/2004 Therapy97542 Wheelchair mngment training 10/01/2004 Therapy97545 Work hardening 10/01/2004 Therapy 97546 Work hardening add-on 10/01/2004 Therapy97601 Wound care selective 10/01/2004 Therapy97602 Wound care non-selective 10/01/2004 Therapy97703 Prosthetic checkout 10/01/2004 Therapy97750 Physical performance test 10/01/2004 Therapy

97755








A4248 Chlorhexidine, containing anticeptic, 1ml 01/01/2005 Non-routine SupplyA4310 Insert tray w/o bag/cath 01/01/2005 Non-routine SupplyA4311 Catheter w/o bag 2-way latex 01/01/2005 Non-routine SupplyA4312 Cath w/o bag 2-way silicone 01/01/2005 Non-routine SupplyA4313 Catheter w/bag 3-way 01/01/2005 Non-routine SupplyA4314 Cath w/drainage 2-way latex 01/01/2005 Non-routine SupplyA4315 Cath w/drainage 2-way silcne 01/01/2005 Non-routine SupplyA4316 Cath w/drainage 3-way 01/01/2005 Non-routine SupplyA4320 Irrigation tray 01/01/2005 Non-routine SupplyA4321 Cath therapeutic irrig agent 01/01/2005 Non-routine SupplyA4322 Irrigation syringe 01/01/2005 Non-routine SupplyA4326 Male external catheter 01/01/2005 Non-routine SupplyA4327 Fem urinary collect dev cup 01/01/2005 Non-routine SupplyA4328 Fem urinary collect pouch 01/01/2005 Non-routine SupplyA4330 Stool collection pouch 01/01/2005 Non-routine SupplyA4331 Extension drainage tubing 01/01/2005 Non-routine SupplyA4332 Lubricant for cath insertion 01/01/2005 Non-routine SupplyA4333 Urinary cath anchor device 01/01/2005 Non-routine SupplyA4334 Urinary cath leg strap 01/01/2005 Non-routine SupplyA4335 Incontinence supply 01/01/2005 Non-routine SupplyA4338 Indwelling catheter latex 01/01/2005 Non-routine SupplyA4340 Indwelling catheter special 01/01/2005 Non-routine SupplyA4344 Cath indw foley 2 way silicn 01/01/2005 Non-routine SupplyA4346 Cath indw foley 3 way 01/01/2005 Non-routine SupplyA4348 Male ext cath extended wear 01/01/2005 Non-routine Supply

A4349Male ext catheter, with or without adhesive, disposable, each 01/01/2005 Non-routine Supply

A4351 Straight tip urine catheter 01/01/2005 Non-routine SupplyA4352 Coude tip urinary catheter 01/01/2005 Non-routine SupplyA4353 Intermittent urinary cath 01/01/2005 Non-routine SupplyA4354 Cath insertion tray w/bag 01/01/2005 Non-routine SupplyA4355 Bladder irrigation tubing 01/01/2005 Non-routine SupplyA4356 Ext ureth clmp or compr dvc 01/01/2005 Non-routine SupplyA4357 Bedside drainage bag 01/01/2005 Non-routine SupplyA4358 Urinary leg bag 01/01/2005 Non-routine SupplyA4359 Urinary suspensory w/o leg b 01/01/2005 Non-routine SupplyA4361 Ostomy face plate 01/01/2005 Non-routine SupplyA4362 Solid skin barrier 01/01/2005 Non-routine SupplyA4364 Liq adhes for facial prosth 01/01/2005 Non-routine SupplyA4365 Adhesive remover wipes 01/01/2005 Non-routine SupplyA4366 Ostomy vent, any type, each 01/01/2005 Non-routine SupplyA4367 Ostomy belt 01/01/2005 Non-routine SupplyA4368 Ostomy filter 01/01/2005 Non-routine SupplyA4368 Ostomy pouch filter 01/01/2005 Non-routine SupplyA4369 Skin barrier liquid per oz 01/01/2005 Non-routine SupplyA4371 Skin barrier powder per oz 01/01/2005 Non-routine Supply



A4372 Skin barrier solid 4x4 equiv 01/01/2005 Non-routine SupplyA4373 Skin barrier with flange 01/01/2005 Non-routine SupplyA4375 Drainable plastic pch w fcpl 01/01/2005 Non-routine SupplyA4376 Drainable rubber pch w fcplt 01/01/2005 Non-routine SupplyA4377 Drainable plstic pch w/o fp 01/01/2005 Non-routine SupplyA4378 Drainable rubber pch w/o fp 01/01/2005 Non-routine SupplyA4379 Urinary plastic pouch w fcpl 01/01/2005 Non-routine SupplyA4380 Urinary rubber pouch w fcplt 01/01/2005 Non-routine SupplyA4381 Urinary plastic pouch w/o fp 01/01/2005 Non-routine SupplyA4382 Urinary hvy plstc pch w/o fp 01/01/2005 Non-routine SupplyA4383 Urinary rubber pouch w/o fp 01/01/2005 Non-routine SupplyA4384 Ostomy faceplt/silicone ring 01/01/2005 Non-routine SupplyA4385 Ost skn barrier sld ext wear 01/01/2005 Non-routine SupplyA4387 Ost clsd pouch w att st barr 01/01/2005 Non-routine SupplyA4388 Drainable pch w ex wear barr 01/01/2005 Non-routine SupplyA4389 Drainable pch w st wear barr 01/01/2005 Non-routine SupplyA4390 Drainable pch ex wear convex 01/01/2005 Non-routine SupplyA4391 Urinary pouch w ex wear barr 01/01/2005 Non-routine SupplyA4392 Urinary pouch w st wear barr 01/01/2005 Non-routine SupplyA4393 Urine pch w ex wear bar conv 01/01/2005 Non-routine SupplyA4394 Ostomy pouch liq deodorant 01/01/2005 Non-routine SupplyA4395 Ostomy pouch solid deodorant 01/01/2005 Non-routine SupplyA4396 Peristomal hernia supprt blt 01/01/2005 Non-routine SupplyA4397 Irrigation supply sleeve 01/01/2005 Non-routine SupplyA4398 Ostomy irrigation bag 01/01/2005 Non-routine SupplyA4399 Ostomy irrig cone/cath w brs 01/01/2005 Non-routine SupplyA4400 Ostomy irrigation set 01/01/2005 Non-routine SupplyA4402 Lubricant per ounce 01/01/2005 Non-routine SupplyA4404 Ostomy ring each 01/01/2005 Non-routine SupplyA4405 Nonpectin based ostomy paste 01/01/2005 Non-routine SupplyA4406 Pectin based ostomy paste 01/01/2005 Non-routine SupplyA4407 Ext wear ost skn barr <=4sq” 01/01/2005 Non-routine SupplyA4408 Ext wear ost skn barr >4sq” 01/01/2005 Non-routine SupplyA4409 Ost skn barr w flng <=4 sq” 01/01/2005 Non-routine SupplyA4410 Ost skn barr w flng >4sq” 01/01/2005 Non-routine SupplyA4413 2 pc drainable ost pouch w/ filter 01/01/2005 Non-routine SupplyA4414 Ostomy skn barr w/ flng < 4sq" 01/01/2005 Non-routine SupplyA4415 Ostomy skn barr w/ flng > 4sq" 01/01/2005 Non-routine SupplyA4416 Ost pch clsd w barrier/filtr 01/01/2005 Non-routine SupplyA4417 Ost pch w bar/bltinconv/fltr 01/01/2005 Non-routine SupplyA4418 Ost pch clsd w/o bar w filtr 01/01/2005 Non-routine SupplyA4419 Ost pch for bar w flange/flt 01/01/2005 Non-routine SupplyA4420 Ost pch clsd for bar w lk fl 01/01/2005 Non-routine SupplyA4421 (6) Ostomy supply misc 01/01/2005 Non-routine SupplyA4422 Ost pouch absorbent material 01/01/2005 Non-routine SupplyA4423 Ost pch for bar w lk fl/fltr 01/01/2005 Non-routine SupplyA4424 Ost pch drain w bar & filter 01/01/2005 Non-routine SupplyA4425 Ost pch drain for barrier fl 01/01/2005 Non-routine SupplyA4426 Ost pch drain 2 piece system 01/01/2005 Non-routine SupplyA4427 Ost pch drain/barr lk flng/f 01/01/2005 Non-routine SupplyA4428 Urine ost pouch w faucet/tap 01/01/2005 Non-routine SupplyA4429 Urine ost pouch w bltinconv 01/01/2005 Non-routine Supply



A4430 Ost urine pch w b/bltin conv 01/01/2005 Non-routine SupplyA4431 Ost pch urine w barrier/tapv 01/01/2005 Non-routine SupplyA4432 Os pch urine w bar/fange/tap 01/01/2005 Non-routine SupplyA4433 Urine ost pch bar w lock fln 01/01/2005 Non-routine SupplyA4434 Ost pch urine w lock flng/ft 01/01/2005 Non-routine SupplyA4455 Adhesive remover per ounce 01/01/2005 Non-routine SupplyA4458 Reusable enema bag 01/01/2005 Non-routine SupplyA4460 Elastic compression bandage 01/01/2005 Non-routine SupplyA4462 Abdmnl drssng holder/binder 01/01/2005 Non-routine SupplyA4481 Tracheostoma filter 01/01/2005 Non-routine SupplyA4623 Tracheostomy inner cannula 01/01/2005 Non-routine SupplyA4625 Trach care kit for new trach 01/01/2005 Non-routine SupplyA4626 Tracheostomy cleaning brush 01/01/2005 Non-routine SupplyA4649 Surgical supplies 01/01/2005 Non-routine SupplyA4656 Needle, any size, each 01/01/2005 Non-routine SupplyA4657 Syringe, with or without needle, each 01/01/2005 Non-routine SupplyA4930 Sterile, gloves per pair 01/01/2005 Non-routine SupplyA5051 Pouch clsd w barr attached 01/01/2005 Non-routine SupplyA5052 Clsd ostomy pouch w/o barr 01/01/2005 Non-routine SupplyA5053 Clsd ostomy pouch faceplate 01/01/2005 Non-routine SupplyA5054 Clsd ostomy pouch w/flange 01/01/2005 Non-routine SupplyA5055 Stoma cap 01/01/2005 Non-routine SupplyA5061 Pouch drainable w barrier at 01/01/2005 Non-routine SupplyA5062 Drnble ostomy pouch w/o barr 01/01/2005 Non-routine SupplyA5063 Drain ostomy pouch w/flange 01/01/2005 Non-routine SupplyA5071 Urinary pouch w/barrier 01/01/2005 Non-routine SupplyA5072 Urinary pouch w/o barrier 01/01/2005 Non-routine SupplyA5073 Urinary pouch on barr w/flng 01/01/2005 Non-routine SupplyA5081 Continent stoma plug 01/01/2005 Non-routine SupplyA5082 Continent stoma catheter 01/01/2005 Non-routine SupplyA5093 Ostomy accessory convex inse 01/01/2005 Non-routine SupplyA5102 Bedside drain btl w/wo tube 01/01/2005 Non-routine SupplyA5105 Urinary suspensory 01/01/2005 Non-routine SupplyA5112 Urinary leg bag 01/01/2005 Non-routine SupplyA5113 Latex leg strap 01/01/2005 Non-routine SupplyA5114 Foam/fabric leg strap 01/01/2005 Non-routine SupplyA5119 Skin barrier wipes box pr 50 01/01/2005 Non-routine SupplyA5121 Solid skin barrier 6x6 01/01/2005 Non-routine SupplyA5122 Solid skin barrier 8x8 01/01/2005 Non-routine SupplyA5126 Disk/foam pad +or- adhesive 01/01/2005 Non-routine SupplyA5131 Appliance cleaner 01/01/2005 Non-routine SupplyA6010 Collagen based wound filler, dry foam 01/01/2005 Non-routine SupplyA6011 Collagen gel/paste wound fil 01/01/2005 Non-routine SupplyA6020 Collage wound dressing 01/01/2005 Non-routine SupplyA6021 Collagen dressing <=16 sq in 01/01/2005 Non-routine SupplyA6022 Collagen drsg>6<=48 sq in 01/01/2005 Non-routine SupplyA6023 Collagen dressing >48 sq in 01/01/2005 Non-routine SupplyA6024 Collagen dsg wound filler 01/01/2005 Non-routine Supply


A6154 Wound pouch each 01/01/2005 Non-routine Supply



A6196 Alginate dressing <=16 sq in 01/01/2005 Non-routine SupplyA6197 Alginate drsg >16 <=48 sq in 01/01/2005 Non-routine SupplyA6198 alginate dressing > 48 sq in 01/01/2005 Non-routine SupplyA6199 Alginate drsg wound filler 01/01/2005 Non-routine SupplyA6200 Compos drsg <=16 no border 01/01/2005 Non-routine SupplyA6201 Compos drsg >16<=48 no bdr 01/01/2005 Non-routine SupplyA6202 Compos drsg >48 no border 01/01/2005 Non-routine SupplyA6203 Composite drsg <= 16 sq in 01/01/2005 Non-routine SupplyA6204 Composite drsg >16<=48 sq in 01/01/2005 Non-routine SupplyA6205 Composite drsg > 48 sq in 01/01/2005 Non-routine SupplyA6206 Contact layer <= 16 sq in 01/01/2005 Non-routine SupplyA6207 Contact layer >16<= 48 sq in 01/01/2005 Non-routine SupplyA6208 Contact layer > 48 sq in 01/01/2005 Non-routine SupplyA6209 Foam drsg <=16 sq in w/o bdr 01/01/2005 Non-routine SupplyA6210 Foam drg >16<=48 sq in w/o b 01/01/2005 Non-routine SupplyA6211 Foam drg > 48 sq in w/o brdr 01/01/2005 Non-routine SupplyA6212 Foam drg <=16 sq in w/border 01/01/2005 Non-routine SupplyA6213 Foam drg >16<=48 sq in w/bdr 01/01/2005 Non-routine SupplyA6214 Foam drg > 48 sq in w/border 01/01/2005 Non-routine SupplyA6215 Foam dressing wound filler 01/01/2005 Non-routine SupplyA6219 Gauze <= 16 sq in w/border 01/01/2005 Non-routine SupplyA6220 Gauze >16 <=48 sq in w/bordr 01/01/2005 Non-routine SupplyA6221 Gauze > 48 sq in w/border 01/01/2005 Non-routine SupplyA6222 Gauze <=16 in no w/sal w/o b 01/01/2005 Non-routine SupplyA6223 Gauze >16<=48 no w/sal w/o b 01/01/2005 Non-routine SupplyA6224 Gauze > 48 in no w/sal w/o b 01/01/2005 Non-routine SupplyA6228 Gauze <= 16 sq in water/sal 01/01/2005 Non-routine SupplyA6229 Gauze >16<=48 sq in watr/sal 01/01/2005 Non-routine SupplyA6230 Gauze > 48 sq in water/salne 01/01/2005 Non-routine SupplyA6231 Hydrogel dsg<=16 sq in 01/01/2005 Non-routine SupplyA6232 Hydrogel dsg>16<=48 sq in 01/01/2005 Non-routine SupplyA6233 Hydrogel dressing >48 sq in 01/01/2005 Non-routine SupplyA6234 Hydrocolld drg <=16 w/o bdr 01/01/2005 Non-routine SupplyA6235 Hydrocolld drg >16<=48 w/o b 01/01/2005 Non-routine SupplyA6236 Hydrocolld drg > 48 in w/o b 01/01/2005 Non-routine SupplyA6237 Hydrocolld drg <=16 in w/bdr 01/01/2005 Non-routine SupplyA6238 Hydrocolld drg >16<=48 w/bdr 01/01/2005 Non-routine SupplyA6239 Hydrocolld drg > 48 in w/bdr 01/01/2005 Non-routine SupplyA6240 Hydrocolld drg filler paste 01/01/2005 Non-routine SupplyA6241 Hydrocolloid drg filler dry 01/01/2005 Non-routine SupplyA6242 Hydrogel drg <=16 in w/o bdr 01/01/2005 Non-routine SupplyA6243 Hydrogel drg >16<=48 w/o bdr 01/01/2005 Non-routine SupplyA6244 Hydrogel drg >48 in w/o bdr 01/01/2005 Non-routine SupplyA6245 Hydrogel drg <= 16 in w/bdr 01/01/2005 Non-routine SupplyA6246 Hydrogel drg >16<=48 in w/b 01/01/2005 Non-routine SupplyA6247 Hydrogel drg > 48 sq in w/b 01/01/2005 Non-routine SupplyA6248 Hydrogel drsg gel filler 01/01/2005 Non-routine SupplyA6251 Absorpt drg <=16 sq in w/o b 01/01/2005 Non-routine SupplyA6252 Absorpt drg >16 <=48 w/o bdr 01/01/2005 Non-routine SupplyA6253 Absorpt drg > 48 sq in w/o b 01/01/2005 Non-routine SupplyA6254 Absorpt drg <=16 sq in w/bdr 01/01/2005 Non-routine SupplyA6255 Absorpt drg >16<=48 in w/bdr 01/01/2005 Non-routine Supply



A6256 Absorpt drg > 48 sq in w/bdr 01/01/2005 Non-routine SupplyA6257 Transparent film <= 16 sq in 01/01/2005 Non-routine SupplyA6258 Transparent film >16<=48 in 01/01/2005 Non-routine SupplyA6259 Transparent film > 48 sq in 01/01/2005 Non-routine SupplyA6261 Wound filler gel/paste /oz 01/01/2005 Non-routine SupplyA6262 Wound filler dry form / gram 01/01/2005 Non-routine SupplyA6266 Impreg gauze no h20/sal/yard 01/01/2005 Non-routine SupplyA6402 Sterile gauze <= 16 sq in 01/01/2005 Non-routine SupplyA6403 Sterile gauze>16 <= 48 sq in 01/01/2005 Non-routine SupplyA6404 Sterile gauze > 48 sq in 01/01/2005 Non-routine SupplyA6405 Sterile elastic gauze /yd 01/01/2005 Non-routine SupplyA6406 Sterile non-elastic gauze/yd 01/01/2005 Non-routine Supply



A6441


A6442


A6443


A6444


A6445


A6446


A6447


A6448


A6449


A6450




A6451


A6452


A6453


A6454


A6455


A6456


A7040 One way chest drain valve 01/01/2005 Non-routine Supply

A7041Water seal drainage container and tubing for use with implanted chest tube 01/01/2005 Non-routine Supply

A7043 Vacuum drainage bottle & tubing 01/01/2005 Non-routine Supply

A7045

Exhalation port with or without swivel used with accessories for postive airway devices, replacement only 01/01/2005 Non-routine Supply

A7501 Tracheostoma valve w diaphra 01/01/2005 Non-routine SupplyA7502 Replacement diaphragm/fplate 01/01/2005 Non-routine SupplyA7503 HMES filter holder or cap 01/01/2005 Non-routine SupplyA7504 Tracheostoma HMES filter 01/01/2005 Non-routine SupplyA7505 HMES or trach valve housing 01/01/2005 Non-routine SupplyA7506 HMES/trachvalve adhesivedisk 01/01/2005 Non-routine SupplyA7507 Integrated filter & holder 01/01/2005 Non-routine SupplyA7508 Housing & Integrated Adhesiv 01/01/2005 Non-routine SupplyA7509 Heat & moisture exchange sys 01/01/2005 Non-routine Supply




A7523 Tracheostomy shower protector, each 01/01/2005 Non-routine SupplyA7524 Tracheostomy stent/stud/button, each 01/01/2005 Non-routine Supply



A7527Tracheostomy/laryngectomy tube plug/stop, each 01/01/2005 Non-routine Supply

K0614 chem/antiseptic solution, 8oz. 01/01/2005 Non-routine Supply K0620 tubular elastic dressing 01/01/2005 Non-routine SupplyG0193 Endoscopic study swallow functn 01/01/2005 TherapyG0194 Sensory testing endoscopic study 01/01/2005 TherapyG0195 Clinical eval swallowing funct 01/01/2005 TherapyG0196 Eval of swallowing with radioopa 01/01/2005 TherapyG0197 Eval of pt for prescip speech devi 01/01/2005 TherapyG0198 Patient adapation & train for spe 01/01/2005 TherapyG0199 Reevaluation of patient use spec 01/01/2005 TherapyG0200 Eval of patient prescip of voice p 01/01/2005 TherapyG0201 Modi for training in use voice pro 01/01/2005 TherapyG0279 Excorp shock tx, elbow epi 01/01/2005 TherapyG0280 Excorp shock tx other than 01/01/2005 TherapyG0281 Elec stim unattend for press 01/01/2005 TherapyG0282 Elect stim wound care not pd 01/01/2005 TherapyG0283 Elec stim other than wound 01/01/2005 TherapyG0329 Electromagntic tx for ulcers 01/01/2005 Therapy0019T Extracorp shock wave tx, ms 01/01/2005 Therapy0020T Extracorp shock wave tx, ft 01/01/2005 Therapy64550 Apply neurostimulator 01/01/2005 Therapy90901 Biofeedback train, any meth 01/01/2005 Therapy90911 Biofeedback peri/uro/rectal 01/01/2005 Therapy92506 Speech/hearing evaluation 01/01/2005 Therapy92507 Speech/hearing therapy 01/01/2005 Therapy92508 Speech/hearing therapy 01/01/2005 Therapy92510 Rehab for ear implant 01/01/2005 Therapy92526 Oral function therapy 01/01/2005 Therapy92601 Cochlear implt f/up exam < 7 01/01/2005 Therapy92602 Reprogram cochlear implt < 7 01/01/2005 Therapy92603 Cochlear implt f/up exam 7 > 01/01/2005 Therapy92604 Reprogram cochlear implt 7 > 01/01/2005 Therapy92605 Eval for nonspeech device rx 01/01/2005 Therapy92606 Non-speech device service 01/01/2005 Therapy92607 Ex for speech device rx, 1hr 01/01/2005 Therapy92608 Ex for speech device rx addl 01/01/2005 Therapy92609 Use of speech device service 01/01/2005 Therapy92610 Evaluate swallowing function 01/01/2005 Therapy92611 Motion fluoroscopy/swallow 01/01/2005 Therapy92612 Endoscopy swallow tst (fees) 01/01/2005 Therapy92614 Laryngoscopic sensory test 01/01/2005 Therapy92616 Fees w/laryngeal sense test 01/01/2005 Therapy95831 Limb muscle testing, manual 01/01/2005 Therapy95832 Hand muscle testing, manual 01/01/2005 Therapy95833 Body muscle testing, manual 01/01/2005 Therapy95834 Body muscle testing, manual 01/01/2005 Therapy95851 Range of motion measurements 01/01/2005 Therapy95852 Range of motion measurements 01/01/2005 Therapy96000 Motion analysis, video/3d 01/01/2005 Therapy96001 Motion test w/ft press meas 01/01/2005 Therapy96002 Dynamic surface emg 01/01/2005 Therapy



96003 Dynamic fine wire emg 01/01/2005 Therapy96105 Assessment of aphasia 01/01/2005 Therapy97001 Pt evaluation 01/01/2005 Therapy97002 Pt re-evaluation 01/01/2005 Therapy97003 Ot evaluation 01/01/2005 Therapy97004 Ot re-evaluation 01/01/2005 Therapy97012 Mechanical traction therapy 01/01/2005 Therapy97016 Vasopneumatic device therapy 01/01/2005 Therapy97018 Paraffin bath therapy 01/01/2005 Therapy97020 Microwave therapy 01/01/2005 Therapy97022 Whirlpool therapy 01/01/2005 Therapy97024 Diathermy treatment 01/01/2005 Therapy97026 Infrared therapy 01/01/2005 Therapy97028 Ultraviolet therapy 01/01/2005 Therapy97032 Electrical stimulation 01/01/2005 Therapy97033 Electric current therapy 01/01/2005 Therapy97034 Contrast bath therapy 01/01/2005 Therapy97035 Ultrasound therapy 01/01/2005 Therapy97036 Hydrotherapy 01/01/2005 Therapy97039 Physical therapy treatment 01/01/2005 Therapy97110 Therapeutic exercises 01/01/2005 Therapy97112 Neuromuscular reeducation 01/01/2005 Therapy97113 Aquatic therapy/exercises 01/01/2005 Therapy97116 Gait training therapy 01/01/2005 Therapy97124 Massage therapy 01/01/2005 Therapy97139 Physical medicine procedure 01/01/2005 Therapy97140 Manual therapy 01/01/2005 Therapy97150 Group therapeutic procedures 01/01/2005 Therapy97504 Orthotic training 01/01/2005 Therapy97520 Prosthetic training 01/01/2005 Therapy97530 Therapeutic activities 01/01/2005 Therapy97532 Cognitive skills development 01/01/2005 Therapy97533 Sensory integration 01/01/2005 Therapy97535 Self care mngment training 01/01/2005 Therapy97537 Community/work reintegration 01/01/2005 Therapy97542 Wheelchair mngment training 01/01/2005 Therapy97545 Work hardening 01/01/2005 Therapy 97546 Work hardening add-on 01/01/2005 Therapy

97597debridement;surface area less than or equal to 20 square centimeters 01/01/2005 Therapy

97598debridement; total wound(s) surface greater than 20 square centimeters 01/01/2005 Therapy

97602 Wound care non-selective 01/01/2005 Therapy

97605

Negative pressure wound therapy (eg vacuum assisted drainage collection); total wound(s) surface area less than or equal to 50 square centimeters 01/01/2005 Therapy

97606

Negative pressure wound therapy (eg vacuum assisted drainage collection); total wound(s) surface area greater than 50 square centimeters 01/01/2005 Therapy

97703 Prosthetic checkout 01/01/2005 Therapy



97750 Physical performance test 01/01/2005 Therapy

97755



HH Consolidated Billing Code History

CMS Division of Institutional Claims Processing 1 January 16, 2004

NOTES

(1) Except as noted below, code inclusion and exclusion dates indicate for dates of service on or after the date shown

(2) Code updates from transmittal AB-01-65 were effective for dates of service on or after 1/1/2001 processed on or after 7/1/2001

(3) Two Federal Register (FR) publications preceded the first publication of a HH CB code list in Medicare instructions. See the HH PPS Final Rule (FR vol.65, no.128, July 3, 2000) and its correction notice (FR vol.66, no.117, June 18, 2001) for these codes.

(4) Transmittal AB-02-92 instituted a process for updating the HH CB code list on a quarterly basis if necessary.

(5) Repeated line entries for a single code indicate the code was included in HH consolidated billing by an earlier transmittal, then subsequently excluded and re-included by later transmittals

(6) Code A4421 was deleted in error by transmittal AB-03-096, published July 3, 2003. The error was corrected and the code was restored to the HH CB code list by transmittal AB-03-136, published August 29, 2003.

(7) With the January 2004 annual update, the HH CB code list began to published in One-Time Notifications in the CMS Manual System. Due to this change, transmittal numbers (e.g. Tr. 8) replaced Program Memorandum numbers (e.g. AB-03-136).

(8) Codes A7525 and A7526 were included in the HH consolidated billing in error by Transmittal 8, published October 17, 2003. The error was corrected in Transmittal 62, published January 16, 2004. These codes were never effective under HH CB (inclusion and exclusion dates are the same), but this line entry in the master code list is retained to document that the codes were published in HH CB issuances.

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