name: Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems


name: Non-emergency transportation: wheelchair van


name: Non-emergency transportation and air travel (private or commercial) intra or inter state


name: Non-emergency transportation: per mile - case worker or social worker


name: Transportation ancillary: parking fees, tolls, other


name: Non-emergency transportation: ancillary: lodging-recipient


name: Non-emergency transportation: ancillary: meals-recipient


name: Non-emergency transportation: ancillary: lodging escort


name: Non-emergency transportation: ancillary: meals-escort


name: Ambulance service, neonatal transport, base rate, emergency transport, one way


name: Bls specialized service disposable supplies; defibrillation (used by als ambulances and bls ambulances in jurisdictions where defibrillation is permitted in bls ambulances)


name: Als specialized service disposable supplies; defibrillation (to be used only in jurisdictions where defibrillation cannot be performed in bls ambulances)


name: Als specialized service disposable supplies; iv drug therapy


name: Als specialized service disposable supplies; esophageal intubation


name: Ambulance waiting time (als or bls), one half (1/2) hour increments


name: Ambulance (als or bls) oxygen and oxygen supplies, life sustaining situation


name: Extra ambulance attendant, ground (als or bls) or air (fixed or rotary winged); (requires medical review)


name: Noncovered ambulance mileage, per mile (e.g., for miles traveled beyond closest appropriate facility)


name: SYRINGE WITH NEEDLE, STERILE 1CC, EACH (A4206)


name: Syringe with needle, sterile 5 cc or greater, each


name: Supplies for self-administered injections


name: Non-coring needle or stylet with or without catheter


name: Syringe, sterile, 20 cc or greater, each


name: Refill kit for implantable infusion pump


name: Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately)


name: Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)


name: Infusion set for external insulin pump, non needle cannula type


name: Infusion set for external insulin pump, needle type


name: Syringe with needle for external insulin pump, sterile, 3 cc


name: Urine test or reagent strips or tablets (100 tablets or strips)


name: Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips


name: Platforms for home blood glucose monitor, 50 per box


name: Normal, low and high calibrator solution / chips


name: Temporary, absorbable lacrimal duct implant, each


name: Permanent, long term, non-dissolvable lacrimal duct implant, each


name: Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access


name: Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)


name: DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF 50 ML OR GREATER PER HOUR


name: DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF LESS THAN 50 ML PER HOUR


name: Insertion tray without drainage bag and without catheter (accessories only)


name: Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)


name: Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone


name: Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation


name: Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)


name: Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone


name: Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation


name: IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE


name: Therapeutic agent for urinary catheter irrigation


name: IRRIGATION SYRINGE, BULB OR PISTON, EACH


name: MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH


name: Female external urinary collection device; meatal cup, each


name: Female external urinary collection device; pouch, each


name: Perianal fecal collection pouch with adhesive, each


name: Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each


name: Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each


name: Indwelling catheter, foley type, two-way, all silicone, each


name: Indwelling catheter; foley type, three way for continuous irrigation, each


name: Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each


name: Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each


name: Intermittent urinary catheter, with insertion supplies


name: Insertion tray with drainage bag but without catheter


name: Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each


name: External urethral clamp or compression device (not to be used for catheter clamp), each


name: Bedside drainage bag, day or night, with or without anti-reflux device, with or without tube, each


name: Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each


name: Skin barrier; solid, 4 x 4 or equivalent; each


name: Ostomy irrigation supply; cone/catheter, with or without brush


name: Adhesive remover or solvent (for tape, cement or other adhesive), per ounce


name: Tracheostoma filter, any type, any size, each


name: Surgical stockings above knee length, each


name: Surgical stockings below knee length, each


name: Absorption Pads, Linen Protection, Disposable


name: Lead wires, (e.g., apnea monitor), per pair


name: Topical hyperbaric oxygen chamber, disposable


name: Special casting material (e.g., fiberglass)


name: Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes)


name: Battery, heavy duty; replacement for patient owned ventilator


name: Battery cables; replacement for patient-owned ventilator


name: BATTERY CHARGER; REPLACEMENT FOR PATIENT-OWNED VENTILATOR


name: Tracheal suction catheter, any type other than closed system, each


name: Tracheostomy care kit for new tracheostomy


name: Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler


name: Replacement batteries, medically necessary, transcutaneous electrical stimulator, owned by patient


name: Replacement, handgrip, cane, crutch, or walker, each


name: Replacement, tip, cane, crutch, walker, each.


name: Sphygmomanometer/blood pressure apparatus with cuff and stethoscope


name: Activated carbon filter for hemodialysis, each


name: Fistula cannulation set for hemodialysis, each


name: Shunt accessory, for hemodialysis, any type, each


name: Blood tubing, arterial or venous, for hemodialysis, each


name: Blood tubing, arterial and venous combined, for hemodialysis, each


name: OCCULT BLOOD TEST STRIPS, FOR DIALYSIS, PER 50


name: Ammonia test strips, for dialysis, per 50


name: Disposable catheter tips for peritoneal dialysis, per 10


name: Plumbing and/or electrical work for home hemodialysis equipment


name: Contracts, repair and maintenance, for hemodialysis equipment


name: Miscellaneous dialysis supplies, not otherwise specified


name: Venous pressure clamp, for hemodialysis, each


name: Ostomy pouch, closed; with barrier attached (1 piece), each


name: Ostomy pouch, closed; without barrier attached (1 piece), each


name: Ostomy pouch, closed; for use on faceplate, each


name: Ostomy pouch, closed; for use on barrier with flange (2 piece), each


name: Ostomy pouch, drainable; with barrier attached, (1 piece), each


name: Ostomy pouch, drainable; without barrier attached (1 piece), each


name: Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each


name: Ostomy pouch, urinary; with barrier attached (1 piece), each


name: Ostomy pouch, urinary; without barrier attached (1 piece), each


name: Ostomy pouch, urinary; for use on barrier with flange (2 piece), each


name: Continent device; catheter for continent stoma


name: Bedside drainage bottle with or without tubing, rigid or expandable, each


name: Urinary suspensory with leg bag, with or without tube, each


name: Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each


name: Skin barrier; solid, 6 x 6 or equivalent, each


name: Skin barrier; solid, 8 x 8 or equivalent, each


name: Adhesive or non-adhesive; disk or foam pad


name: Appliance cleaner, incontinence and ostomy appliances, per 16 oz.


name: Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing


name: Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing


name: Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing


name: Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing


name: Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries


name: Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape


name: Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape


name: Enteral feeding supply kit; gravity fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape


name: Parenteral nutrition solution: carbohydrates (dextrose), 50% or less (500 ml = 1 unit) - home mix


name: Parenteral nutrition solution; amino acid, 3.5%, (500 ml = 1 unit) - home mix


name: Parenteral nutrition solution; amino acid, 5.5% through 7%, (500 ml = 1 unit) - home mix


name: Parenteral nutrition solution; amino acid, 7% through 8.5%, (500 ml = 1 unit) - home mix


name: Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix


name: Parenteral nutrition solution; carbohydrates (dextrose), greater than 50% (500 ml = 1 unit) - home mix


name: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 grams of protein - premix


name: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 grams of protein - premix


name: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 grams of protein - premix


name: Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 grams of protein - premix


name: Parenteral nutrition; additives (vitamins, trace elements, heparin, electrolytes), home mix, per day


name: Parenteral nutrition supply kit; premix, per day


name: Parenteral nutrition supply kit; home mix, per day


name: Parenteral nutrition administration kit, per day


name: Parenteral nutrition solution compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal-aminosyn-rf, nephramine, renamine-premix


name: Enteral nutrition infusion pump, any type


name: Parenteral nutrition infusion pump, portable


name: Parenteral nutrition infusion pump, stationary


name: PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT


name: limited oral evaluation - problem focused


name: comprehensive oral evaluation - new or established patient


name: detailed and extensive oral evaluation - problem focused, by report


name: intraoral - comprehensive series of radiographic images


name: intraoral - periapical each additional radiographic image


name: extra-oral - 2D projection radiographic image created using a stationary radiation source, and detector


name: temporomandibular joint arthrogram, including injection


name: other temporomandibular joint radiographic images, by report


name: collection of microorganisms for culture and sensitivity


name: other oral pathology procedures, by report


name: unspecified diagnostic procedure, by report


name: tobacco counseling for the control and prevention of oral disease


name: amalgam - one surface, primary or permanent


name: amalgam - two surfaces, primary or permanent


name: amalgam - three surfaces, primary or permanent


name: amalgam - four or more surfaces, primary or permanent


name: Resin-four or more surfaces or involving incisal angle (anterior)


name: DENTAL INLAY-METALLIC-THREE OR MORE SURFACES


name: onlay - metallic - four or more surfaces


name: inlay - porcelain/ceramic - two surfaces


name: inlay - porcelain/ceramic - three or more surfaces


name: onlay - porcelain/ceramic - two surfaces


name: onlay - porcelain/ceramic - three surfaces


name: onlay - porcelain/ceramic - four or more surfaces


name: inlay - resin-based composite - one surface


name: inlay - resin-based composite - two surfaces


name: inlay - resin-based composite - three or more surfaces


name: onlay - resin-based composite - two surfaces


name: onlay - resin-based composite - three surfaces


name: onlay - resin-based composite - four or more surfaces


name: crown - resin-based composite (indirect)


name: Core build-up, including any pins when required


name: POST REMOVAL (NOT IN CONJUCTION WITH ENDODONTIC THERAPY)


name: unspecified restorative procedure, by report


name: pulpal therapy (resorbable filling) - anterior, primary tooth (excluding final restoration)


name: pulpal therapy (resorbable filling) - posterior, primary tooth (excluding final restoration)


name: endodontic therapy, premolar tooth (excluding final restoration)


name: endodontic therapy, molar tooth (excluding final restoration)


name: retreatment of previous root canal therapy - anterior


name: retreatment of previous root canal therapy - premolar


name: retreatment of previous root canal therapy - molar


name: apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, etc.)


name: apexification/recalcification - interim medication replacement


name: apexification/recalcification - final visit (includes completed root canal therapy - apical closure/calcific repair of perforations, root resorption, etc.)


name: Intentional replantation (including necessary splinting)


name: hemisection (including any root removal), not including root canal therapy


name: clinical crown lengthening - hard tissue


name: osseous surgery (including elevation of a full thickness flap and closure) - four or more contiguous teeth or tooth bounded spaces per quadrant


name: bone replacement graft - retained natural tooth - first site in quadrant


name: bone replacement graft - retained natural tooth - each additional site in quadrant


name: guided tissue regeneration, natural teeth - resorbable barrier, per site


name: guided tissue regeneration, natural teeth - non-resorbable barrier, per site


name: autogenous connective tissue graft procedure (including donor and recipient surgical sites) first tooth, implant, or edentulous tooth position in graft


name: full mouth debridement to enable a comprehensive periodontal evaluation and diagnosis on a subsequent visit


name: localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue, per tooth


name: unscheduled dressing change (by someone other than treating dentist or their staff)


name: unspecified periodontal procedure, by report


name: maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)


name: mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)


name: REMOVABLE UNILATERAL PARTIAL DENTURE-ONE PIECE CAST METAL (INCLUDING CLASPS AND TEETH)


name: repair or replace broken retentive clasping materials - per tooth


name: reline complete maxillary denture (direct)


name: reline maxillary partial denture (direct)


name: reline mandibular partial denture (direct)


name: reline complete maxillary denture (indirect)


name: reline complete mandibular denture (indirect)


name: reline maxillary partial denture (indirect)


name: reline mandibular partial denture (indirect)


name: interim partial denture (including retentive/clasping materials, rests, and teeth), maxillary


name: interim partial denture (including retentive/clasping materials, rests, and teeth), mandibular


name: PRECISION ATTACHMENT, BY REPORT (Other Removal Prosthodontics)


name: unspecified removable prosthodontic procedure, by report


name: mandibular resection prosthesis with guide flange


name: mandibular resection prosthesis without guide flange


name: Trismus appliance (not for tm treatment)


name: definitive palatal lift prosthesis (treatment)


name: UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY REPORT


name: surgical placement of implant body: endosteal implant


name: connecting bar - implant supported or abutment supported


name: implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments


name: UNSPECIFIED IMPLANT PROCEDURE, BY REPORT


name: retainer - cast metal for resin bonded fixed prosthesis


name: RETAINER CROWN-RESIN WITH HIGH NOBLE METAL


name: unspecified fixed prosthodontic procedure, by report


name: removal of residual tooth roots (cutting procedure)


name: incisional biopsy of oral tissue-hard (bone, tooth)


name: transseptal fiberotomy/supra crestal fiberotomy, by report


name: alveoloplasty in conjunction with extractions - four or more teeth or tooth spaces, per quadrant


name: alveoloplasty not in conjunction with extractions - four or more teeth or tooth spaces, per quadrant


name: Vestibuloplasty-ridge extension (second epithelialization)


name: Vestibuloplasty-ridge extension (including soft tissue grafts, muscle re-attachments, revision of soft tissue attachment, and management of hypertrophied and hyperplastic tissue)


name: excision of malignant tumor - lesion diameter up to 1.25 cm


name: excision of malignant tumor - lesion diameter greater than 1.25 cm


name: removal of benign odontogenic cyst or tumor - lesion diameter greater than 1.25 cm


name: removal of benign nonodontogenic cyst or tumor - lesion diameter up to 1.25 cm


name: removal of benign nonodontogenic cyst or tumor - lesion diameter greater than 1.25 cm


name: DESTRUCTION OF LESION(S) BY PHYSICAL OR CHEMICAL METHODS, BY REPORT


name: radical resection of maxilla or mandible


name: incision and drainage of abscess - intraoral soft tissue


name: incision and drainage of abscess - extraoral soft tissue


name: removal of foreign body from mucosa, skin, or subcutaneous alveolar tissue


name: removal of reaction producing foreign bodies, musculoskeletal system


name: partial ostectomy/sequestrectomy for removal of non-vital bone


name: MAXILLARY SINUSOTOMY FOR REMOVAL OF TOOTH FRAGMENT OR FOREIGN BODY


name: maxilla - open reduction (teeth immobilized, if present)


name: maxilla - closed reduction (teeth immobilized, if present)


name: mandible - open reduction (teeth immobilized, if present)


name: mandible - closed reduction (teeth immobilized, if present)


name: OPEN REDUCTION OF COMPOUND FRACTURE OF MALAR AND/OR ZYGOMATIC ARCH


name: CLOSED REDUCTION OF COMPOUND FRACTURE OF MALAR AND/OR ZYGOMATIC ARCH


name: facial bones - complicated reduction with fixation and multiple surgical approaches


name: Dental - closed reduction of dislocation


name: SURGICAL DISCECTOMY; WITH/WITHOUT IMPLANT


name: arthroscopy - diagnosis, with or without biopsy


name: arthroscopy: lavage and lysis of adhesions


name: arthroscopy: disc repositioning and stabilization


name: arthroscopic synovectomy of temporomandibular joint


name: arthroscopic discectomy of temporomandibular joint


name: arthroscopic debridement of temporomandibular joint


name: suture of recent small wounds up to 5 cm


name: skin graft (identify defect covered, location and type of graft)


name: osteoplasty - for orthognathic deformities


name: osteotomy - mandibular rami with bone graft; includes obtaining the graft


name: LeFort II or LeFort III (osteoplasty of facial bones for midface hypoplasia or retrusion) - without bone graft


name: LeFort II or LeFort III - with bone graft


name: osseous, osteoperiosteal, or cartilage graft of the mandible or maxilla - autogenous or nonautogenous, by report


name: repair of maxillofacial soft and/or hard tissue defect


name: excision of hyperplastic tissue - per arch


name: synthetic graft - mandible or facial bones, by report


name: implant-mandible for augmentation purposes (excluding alveolar ridge), by report


name: unspecified oral surgery procedure, by report


name: limited orthodontic treatment of the primary dentition


name: limited orthodontic treatment of the transitional dentition


name: limited orthodontic treatment of the adolescent dentition


name: limited orthodontic treatment of the adult dentition


name: interceptive orthodontic treatment of primary dentition


name: interceptive orthodontic treatment of transitional dentition


name: comprehensive orthodontic treatment of the transitional dentition


name: comprehensive orthodontic treatment of the adolescent dentition


name: comprehensive orthodontic treatment of the adult dentition


name: ORTHODONTIC RETENTION (REMOVAL OF APPLIANCES, CONSTRUCTION AND PLACEMENT OF RETAINER(S))


name: ORTHODONTIC TREATMENT (ALTERNATIVE BILLING TO A CONTRACT FEE)


name: UNSPECIFIED ORTHODONTIC PROCEDURE, BY REPORT


name: palliative treatment of dental pain - per visit


name: DEEP SEDATION/GENERAL ANESTHESIA-FIRST 30 MINUTES


name: CONSULTATION - DIAGNOSTIC SERVICE PROVIDED BY DENTIST OR PHYSICIAN OTHER THAN REQUESTING DENTIST OR PHYSICIAN


name: office visit for observation (during regularly scheduled hours) - no other services performed


name: office visit - after regularly scheduled hours


name: therapeutic parenteral drug, single administration


name: drugs or medicaments dispensed in the office for home use


name: TREATMENT OF COMPLICATIONS (POSTSURGICAL) - UNUSUAL CIRCUMSTANCES, BY REPORT


name: unspecified adjunctive procedure, by report


name: Cane, quad or three prong, includes canes of all materials, adjustable or fixed, with tips


name: Crutches, forearm, includes crutches of various materials, adjustable or fixed, pair, complete with tips and handgrips


name: Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips


name: Crutches underarm, wood, adjustable or fixed, pair, with pads, tips and handgrips


name: Crutch underarm, wood, adjustable or fixed, each, with pad, tip and handgrip


name: Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips


name: Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each


name: Walker, folding (pickup), adjustable or fixed height


name: Walker, rigid, wheeled, adjustable or fixed height


name: Walker, folding, wheeled, adjustable or fixed height


name: Walker, heavy duty, multiple braking system, variable wheel resistance


name: Platform attachment, forearm crutch, each


name: Wheel attachment, rigid pick-up walker, per pair


name: Leg extensions for walker, per set of four (4)


name: Sitz type bath or equipment, portable, used with or without commode


name: Sitz type bath or equipment, portable, used with or without commode, with faucet attachment/s


name: Commode chair, mobile or stationary, with fixed arms


name: Commode chair, mobile or stationary, with detachable arms


name: mobile commode chair with detachable arms


name: Pail or pan for use with commode chair, replacement only


name: Foot rest, for use with commode chair, each


name: Powered pressure reducing mattress overlay/pad, alternating, with pump, includes heavy duty


name: Powered air flotation bed (low air loss therapy)


name: Heat lamp, without stand (table model), includes bulb, or infrared element


name: Heat lamp, with stand, includes bulb, or infrared element


name: Paraffin bath unit, portable (see medical supply code a4265 for paraffin)


name: Hospital bed, fixed height, with any type side rails, with mattress


name: Hospital bed, fixed height, with any type side rails, without mattress


name: Hospital bed, variable height, hi-lo, with any type side rails, with mattress


name: Hospital bed, variable height, hi-lo, with any type side rails, without mattress


name: Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress


name: Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress


name: Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress


name: Hospital bed, total electric (head, foot and height adjustments), with any type side rails, without mattress


name: Hospital bed, institutional type includes: oscillating, circulating and stryker frame, with mattress


name: HOSPITAL BED, FIXED HEIGHT, WITHOUT SIDE RAILS, WITH MATTRESS


name: Hospital bed, fixed height, without side rails, without mattress


name: Hospital bed, variable height, hi-lo, without side rails, with mattress


name: Hospital bed, variable height, hi-lo, without side rails, without mattress


name: Hospital bed, semi-electric (head and foot adjustment), without side rails, with mattress


name: Hospital bed, semi-electric (head and foot adjustment), without side rails, without mattress


name: Hospital bed, total electric (head, foot and height adjustments), without side rails, with mattress


name: Hospital bed, total electric (head, foot and height adjustments), without side rails, without mattress


name: Bed accessory: board, table, or support device, any type


name: Control unit for electronic bowel irrigation/evacuation system


name: Disposable pack (water reservoir bag, speculum, valving mechanism and collection bag/box) for use with the electronic bowel irrigation/evacuation system


name: Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing


name: Stationary compressed gas system, purchase; includes regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing


name: PORTABLE GASEOUS OXYGEN SYSTEM, PURCHASE; INCLUDES REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK, AND TUBING


name: Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing


name: Portable liquid oxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter, refill adaptor, contents gauge, cannula or mask, and tubing


name: Portable liquid oxygen system, purchase; includes portable container, supply reservoir, flowmeter, humidifier, contents gauge, cannula or mask, tubing and refill adaptor


name: Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing


name: Stationary liquid oxygen system, purchase; includes use of reservoir, contents indicator, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing


name: Portable oxygen contents, gaseous, 1 month's supply = 1 unit


name: Portable oxygen contents, liquid, 1 month's supply = 1 unit


name: Oxygen tent, excluding croup or pediatric tents


name: Percussor, electric or pneumatic, home model


name: Ippb machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source


name: Humidifier, durable for extensive supplemental humidification during ippb treatments or oxygen delivery


name: Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter


name: Humidifier, durable for supplemental humidification during ippb treatment or oxygen delivery


name: Compressor, air power source for equipment which is not self-contained or cylinder driven


name: Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter


name: Respiratory suction pump, home model, portable or stationary, electric


name: Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems)


name: Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems


name: Sling or seat, patient lift, canvas or nylon


name: Patient lift, bathroom or toilet, not otherwise classified


name: Seat lift mechanism, non-electric, any type


name: Patient lift, hydraulic or mechanical, includes any seat, sling, strap(s) or pad(s)


name: Patient lift, electric with seat or sling


name: Pneumatic compressor, non-segmental home model


name: Pneumatic compressor, segmental home model without calibrated gradient pressure


name: Pneumatic compressor, segmental home model with calibrated gradient pressure


name: Non-segmental pneumatic appliance for use with pneumatic compressor, half arm


name: Non-segmental pneumatic appliance for use with pneumatic compressor, full leg


name: Non-segmental pneumatic appliance for use with pneumatic compressor, full arm


name: Non-segmental pneumatic appliance for use with pneumatic compressor, half leg


name: Segmental pneumatic appliance for use with pneumatic compressor, full leg


name: Segmental pneumatic appliance for use with pneumatic compressor, full arm


name: Segmental pneumatic appliance for use with pneumatic compressor, half leg


name: Segmental gradient pressure pneumatic appliance, full leg


name: Segmental gradient pressure pneumatic appliance, full arm


name: Segmental gradient pressure pneumatic appliance, half leg


name: Transcutaneous electrical nerve stimulation (tens) device, two lead, localized stimulation


name: Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation


name: Form fitting conductive garment for delivery of tens or nmes (with conductive fibers separated from the patient's skin by layers of fabric)


name: Non-implanted pelvic floor electrical stimulator, complete system


name: Neuromuscular stimulator, electronic shock unit


name: Electromyography (emg), biofeedback device


name: Osteogenesis stimulator, electrical, non-invasive, other than spinal applications


name: Osteogenesis stimulator, electrical, non-invasive, spinal applications


name: Osteogenesis stimulator, electrical, surgically implanted


name: Electronic salivary reflex stimulator (intra-oral/non-invasive)


name: Osteogenesis stimulator, low intensity ultrasound, non-invasive


name: Ambulatory infusion pump, single or multiple channels, electric or battery operated, with administrative equipment, worn by patient


name: Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.)


name: External ambulatory infusion pump, insulin


name: Parenteral infusion pump, stationary, single or multi-channel


name: Traction frame, attached to headboard, cervical traction


name: Traction stand, free standing, cervical traction


name: Traction frame, attached to footboard, extremity traction, (e.g., buck's)


name: Traction stand, free standing, extremity traction


name: Traction frame, attached to footboard, pelvic traction


name: Traction stand, free standing, pelvic traction, (e.g., buck's)


name: Trapeze bars, a/k/a patient helper, attached to bed, with grab bar


name: Fracture frame, attached to bed, includes weights


name: Fracture frame, free standing, includes weights


name: Continuous passive motion exercise device for use on knee only


name: Trapeze bar, free standing, complete with grab bar


name: Gravity assisted traction device, any type


name: Fracture, frame, dual with cross bars, attached to bed, (e.g., balken, 4 poster)


name: Fracture frame, attachments for complex pelvic traction


name: Fracture frame, attachments for complex cervical traction


name: Heel loop/holder, any type, with or without ankle strap, each


name: Manual wheelchair accessory, one-arm drive attachment, each


name: Manual wheelchair accessory, adapter for amputee, each


name: Manual wheelchair accessory, hand rim with projections, any type, replacement only, each


name: No. 2 footplates, except for elevating leg rest


name: Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each


name: Manual wheelchair accessory, anti-rollback device, each


name: Wheelchair accessory, positioning belt/safety belt/pelvic strap, each


name: Wheelchair accessory, elevating leg rest, complete assembly, each


name: Manual wheelchair accessory, solid seat insert


name: Wheelchair accessory, calf rest/pad, replacement only, each


name: Rollabout chair, any and all types with casters 5" or greater


name: Fully-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests


name: Fully-reclining wheelchair, detachable arms, desk or full length, swing away detachable elevating legrests


name: Fully-reclining wheelchair, detachable arms (desk or full length) swing away detachable footrest


name: HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG REST


name: HEMI-WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG RESTS


name: HEMI-WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOT RESTS


name: HEMI-WHEELCHAIR DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE FOOTRESTS


name: HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE ELEVATING LEG RESTS


name: HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE ELEVATING LEG RESTS


name: HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, FIXED LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST


name: HIGH STRENGTH LIGHTWEIGHT WHEELCHAIR, DETACHABLE ARMS DESK OR FULL LENGTH, SWING AWAY DETACHABLE FOOT RESTS


name: Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests


name: Wide heavy duty wheelchair, detachable arms desk or full length arms, swing away detachable footrests


name: Semi-reclining wheelchair, fixed full length arms, swing away detachable elevating leg rests


name: Semi-reclining wheelchair, detachable arms (desk or full length) elevating leg rest


name: Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests


name: Wheelchair, detachable arms, desk or full length, swing away detachable footrests


name: Wheelchair, detachable arms, desk or full length swing away detachable elevating legrests


name: Wheelchair, fixed full length arms, swing away detachable elevating legrests


name: Amputee wheelchair, fixed full length arms, swing away detachable elevating legrests


name: Amputee wheelchair, fixed full length arms, without footrests or legrest


name: Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest


name: Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests


name: Amputee wheelchair, detachable arms (desk or full length) swing away detachable elevating legrests


name: Heavy duty wheelchair, fixed full length arms, swing away detachable elevating legrests


name: Amputee wheelchair, fixed full length arms, swing away detachable footrest


name: Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification


name: WHEELCHAIR WITH FIXED ARM, ELEVATING LEGRESTS


name: WHEELCHAIR WITH DETACHABLE ARMS, FOOTRESTS


name: WHEELCHAIR WITH DETACHABLE ARMS, ELEVATING LEGRESTS


name: Wheelchair accessory, manual semi-reclining back, (recline greater than 15 degrees, but less than 80 degrees), each


name: Wheelchair accessory, manual fully reclining back, (recline greater than 80 degrees), each


name: Power operated vehicle (three or four wheel nonhighway) specify brand name and model number


name: Lightweight wheelchair, detachable arms, (desk or full length) swing away detachable, elevating legrest


name: LIGHTWEIGHT WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST


name: Lightweight wheelchair, detachable arms (desk or full length) swing away detachable footrest


name: Lightweight wheelchair, fixed full length arms, swing away detachable elevating legrests


name: Heavy duty wheelchair, detachable arms (desk or full length) elevating legrests


name: HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, SWING AWAY DETACHABLE FOOTREST


name: Heavy duty wheelchair, detachable arms (desk or full length) swing away detachable footrest


name: HEAVY DUTY WHEELCHAIR, FIXED FULL LENGTH ARMS, ELEVATING LEGREST


name: Special wheelchair seat height from floor


name: Special wheelchair seat depth, by upholstery


name: Special wheelchair seat depth and/or width, by construction


name: Durable medical equipment, miscellaneous


name: Oxygen and water vapor enriching system with heated delivery


name: Oxygen and water vapor enriching system without heated delivery


name: Kidney, dialysate delivery syst kidney machine, pump recirculating, air removal syst, flowrate meter, power off, heater and temperature control with alarm, i.v. poles, pressure gauge, concentrate container


name: Pressure alarm for hemodialysis, each, replacement


name: Bath conductivity meter for hemodialysis, each


name: Transducer protectors/fluid barriers, for hemodialysis, any size, per 10


name: Unipuncture control system for hemodialysis


name: Cycler dialysis machine for peritoneal dialysis


name: Delivery and/or installation charges for hemodialysis equipment


name: Reciprocating peritoneal dialysis system


name: Compact (portable) travel hemodialyzer system


name: Sorbent cartridges, for hemodialysis, per 10


name: Dialysis equipment, not otherwise specified


name: Replacement cushions for jaw motion rehabilitation system, pkg. of 6


name: Replacement measuring scales for jaw motion rehabilitation system, pkg. of 200


name: Dynamic adjustable elbow extension/flexion device, includes soft interface material


name: Dynamic adjustable wrist extension / flexion device, includes soft interface material


name: Dynamic adjustable knee extension / flexion device, includes soft interface material


name: Dynamic adjustable ankle extension/flexion device, includes soft interface material


name: Replacement soft interface material, dynamic adjustable extension/flexion device


name: Dynamic adjustable finger extension/flexion device, includes soft interface material


name: Dynamic adjustable toe extension/flexion device, includes soft interface material


name: Administration of influenza virus vaccine


name: SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER


name: Supervision of a nursing facility patient (patient not present) requiring complex and multidisciplinary care modalities involving regular development and/or revision of care plans by that individual, review of subsequent reports of patient status, review of related laboratory and other studies, communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian) and/or key caregiver(s) involved in patient's care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month; 30 minutes or more


name: Drug administered through a metered dose inhaler


name: Factor viii (antihemophilic factor (porcine)), per i.u.


name: Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified


name: Administration of Factor ix, complex, per i.u.


name: Immunosuppressive drug, not otherwise classified


name: Noc drugs, other than inhalation drugs, administered through dme


name: Prescription drug, oral, non chemotherapeutic, nos


name: Standard - weight frame motorized/power wheelchair


name: Standard - weight frame motorized/power wheelchair with programmable control parameters for speed adjustment, tremor dampening, acceleration control and braking


name: Lightweight portable motorized/power wheelchair


name: Detachable, non-adjustable height armrest, replacement only, each


name: Detachable, adjustable height armrest, base, replacement only, each


name: Detachable, adjustable height armrest, upper portion, replacement only, each


name: Standard size footplate, replacement only, each


name: Footrest, lower extension tube, replacement only, each


name: Footrest, upper hanger bracket, replacement only, each


name: Footrest, complete assembly, replacement only, each


name: Elevating legrest, lower extension tube, replacement only, each


name: Elevating legrest, upper hanger bracket, replacement only, each


name: Cam release assembly, footrest or legrest, replacement only, each


name: Swingaway, detachable footrests, replacement only, each


name: Elevating footrests, articulating (telescoping), each


name: Seat height less than 17" or equal to or greater than 21" for a high strength, lightweight, or ultralightweight wheelchair


name: Rear wheel assembly, complete, with solid tire, spokes or molded, replacement only, each


name: Rear wheel assembly, complete, with pneumatic tire, spokes or molded, replacement only, each


name: Front caster assembly, complete, with pneumatic tire, replacement only, each


name: Front caster assembly, complete, with semi-pneumatic tire, replacement only, each


name: Front caster assembly, complete, with solid tire, replacement only, each


name: Drive belt for power wheelchair, replacement only


name: Wheelchair component or accessory, not otherwise specified


name: Administration set, with small volume nonfiltered pneumatic nebulizer, disposable


name: Small volume nonfiltered pneumatic nebulizer, disposable


name: Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable


name: Administration set, with small volume filtered pneumatic nebulizer


name: Large volume nebulizer, disposable, unfilled, used with aerosol compressor


name: Large volume nebulizer, disposable, prefilled, used with aerosol compressor


name: Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer


name: Corrugated tubing, disposable, used with large volume nebulizer, 100 feet


name: Water collection device, used with large volume nebulizer


name: Filter, disposable, used with aerosol compressor or ultrasonic generator


name: Dome and mouthpiece, used with small volume ultrasonic nebulizer


name: Headgear used with positive airway pressure device


name: Tubing used with positive airway pressure device


name: Filter, disposable, used with positive airway pressure device


name: Filter, non disposable, used with positive airway pressure device


name: Elevating leg rests, pair (for use with capped rental wheelchair base)


name: Humidifier, non-heated, used with positive airway pressure device


name: Adhesive skin support attachment for use with external breast prosthesis, each


name: For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe


name: Ostomy faceplate equivalent, silicone ring, each


name: Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce


name: Cervical, flexible, thermoplastic collar, molded to patient


name: Cervical, semi-rigid, adjustable (plastic collar)


name: Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)


name: Cervical, collar, molded to patient model


name: Cervical, multiple post collar, occipital/mandibular supports, adjustable


name: Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (somi, guilford, taylor types)


name: Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension


name: Cervical-thoracic-lumbar-sacral-orthoses (ctlso), anterior-posterior-lateral control, molded to patient model, (minerva type)


name: Ctlso, anterior-posterior-lateral-control, molded to patient model, with interface material, (minerva type)


name: Halo procedure, cervical halo incorporated into jacket vest


name: Halo procedure, cervical halo incorporated into plaster body jacket


name: Halo procedure, cervical halo incorporated into milwaukee type orthosis


name: orthotic torso supports postsurgical pads


name: Cervical-thoracic-lumbar-sacral orthosis (ctlso) (milwaukee), inclusive of furnishing initial orthosis, including model


name: Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling


name: Addition to ctlso or scoliosis orthosis, kyphosis pad


name: Addition to ctlso or scoliosis orthosis, kyphosis pad, floating


name: Addition to ctlso or scoliosis orthosis, lumbar bolster pad


name: Addition to ctlso or scoliosis orthosis, lumbar or lumbar rib pad


name: Addition to ctlso or scoliosis orthosis, sternal pad


name: Addition to ctlso or scoliosis orthosis, thoracic pad


name: Addition to ctlso or scoliosis orthosis, trapezius sling


name: Addition to ctlso or scoliosis orthosis, outrigger


name: Addition to ctlso or scoliosis orthosis, outrigger, bilateral with vertical extensions


name: Addition to ctlso or scoliosis orthosis, lumbar sling


name: Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather


name: Addition to ctlso or scoliosis orthosis, ring flange, plastic or leather, molded to patient model


name: Addition to ctlso, scoliosis orthosis, cover for upright, each


name: Thoracic-lumbar-sacral-orthosis (tlso), inclusive of furnishing initial orthosis only


name: Addition to tlso, (low profile), lateral thoracic extension


name: Addition to tlso, (low profile), anterior thoracic extension


name: Addition to tlso, (low profile), milwaukee type superstructure


name: Addition to tlso, (low profile), lumbar derotation pad


name: Addition to tlso, (low profile), anterior asis pad


name: Addition to tlso, (low profile), anterior thoracic derotation pad


name: Addition to Thoracic-Lumbar-Sacral Orthosis (TLSO)(Low Profile), abdominal pad


name: Addition to tlso, (low profile), rib gusset (elastic), each


name: Addition to tlso, (low profile), lateral trochanteric pad


name: Other scoliosis procedure, body jacket molded to patient model


name: Other scoliosis procedure, post-operative body jacket


name: Hip orthosis, abduction control of hip joints, semi-flexible (von rosen type), custom fabricated


name: Hip orthosis, abduction control of hip joints, static, pelvic band or spreader bar, thigh cuffs, custom fabricated


name: Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment


name: Hip orthosis, abduction control of hip joints, static, plastic, prefabricated, includes fitting and adjustment


name: Hip orthosis, abduction control of hip joints, dynamic, pelvic control, adjustable hip motion control, thigh cuffs (rancho hip action type), custom fabricated


name: Hip orthosis, abduction control of hip joint, postoperative hip abduction type, custom fabricated


name: Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment


name: Legg perthes orthosis, (toronto type), custom fabricated


name: Legg perthes orthosis, (newington type), custom fabricated


name: Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated


name: Legg perthes orthosis, (scottish rite type), custom fabricated


name: Legg perthes orthosis, (patten bottom type), custom fabricated


name: Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise


name: Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment


name: Knee orthosis, without knee joint, rigid, custom fabricated


name: Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated


name: Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated


name: Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated


name: Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)


name: Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated


name: Ankle foot orthosis, posterior, single bar, clasp attachment to shoe counter, prefabricated, includes fitting and adjustment


name: Ankle foot orthosis, single upright with static or adjustable stop (phelps or perlstein type), custom fabricated


name: Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment


name: Ankle foot orthosis, plastic or other material, custom fabricated


name: Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated


name: Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic, custom fabricated


name: Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated


name: Ankle foot orthosis, plastic with ankle joint, custom fabricated


name: Ankle foot orthosis, single upright free plantar dorsiflexion, solid stirrup, calf band/cuff (single bar 'bk' orthosis), custom fabricated


name: Ankle foot orthosis, double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'bk' orthosis), custom fabricated


name: Knee ankle foot orthosis, single upright, free knee, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), custom fabricated


name: Knee ankle foot orthosis, single upright, free ankle, solid stirrup, thigh and calf bands/cuffs (single bar 'ak' orthosis), without knee joint, custom fabricated


name: Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs (double bar 'ak' orthosis), custom fabricated


name: Knee ankle foot orthosis, double upright, free ankle, solid stirrup, thigh and calf bands/cuffs, (double bar 'ak' orthosis), without knee joint, custom fabricated


name: Knee ankle foot orthosis, full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom fabricated


name: Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom fabricated


name: Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated


name: Hip knee ankle foot orthosis, torsion control, bilateral rotation straps, pelvic band/belt, custom fabricated


name: Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated


name: Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, ball bearing hip joint, pelvic band/ belt, custom fabricated


name: Hip knee ankle foot orthosis, torsion control, unilateral rotation straps, pelvic band/belt, custom fabricated


name: Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, hip joint, pelvic band/belt, custom fabricated


name: Hip knee ankle foot orthosis, torsion control, unilateral torsion cable, ball bearing hip joint, pelvic band/ belt, custom fabricated


name: Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, thermoplastic type casting material, custom fabricated


name: Ankle foot orthosis, fracture orthosis, tibial fracture cast orthosis, custom fabricated


name: Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, soft, prefabricated, includes fitting and adjustment


name: Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment


name: Ankle foot orthosis, fracture orthosis, tibial fracture orthosis, rigid, prefabricated, includes fitting and adjustment


name: Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, thermoplastic type casting material, custom fabricated


name: Knee ankle foot orthosis, fracture orthosis, femoral fracture cast orthosis, custom fabricated


name: Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment


name: Kafo, fracture orthosis, femoral fracture cast orthosis, semi-rigid, prefabricated, includes fitting and adjustment


name: Kafo, fracture orthosis, femoral fracture cast orthosis, rigid, prefabricated, includes fitting and adjustment


name: Addition to lower extremity fracture orthosis, plastic shoe insert with ankle joints


name: Addition to lower extremity fracture orthosis, limited motion knee joint


name: Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type


name: Addition to lower extremity fracture orthosis, quadrilateral brim


name: Addition to lower extremity fracture orthosis, waist belt


name: Addition to lower extremity fracture orthosis, hip joint, pelvic band, thigh flange, and pelvic belt


name: Addition to lower extremity, limited ankle motion, each joint


name: Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint


name: Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint


name: Addition to lower extremity, split flat caliper stirrups and plate attachment


name: Addition to lower extremity, round caliper and plate attachment


name: Addition to lower extremity, foot plate, molded to patient model, stirrup attachment


name: Addition to lower extremity, reinforced solid stirrup (scott-craig type)


name: Addition to lower extremity, long tongue stirrup


name: Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad


name: Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined


name: Addition to lower extremity, molded inner boot


name: Addition to lower extremity, abduction bar (bilateral hip involvement), jointed, adjustable


name: Addition to lower extremity, abduction bar-straight


name: Addition to lower extremity, non-molded lacer, for custom fabricated orthosis only


name: Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only


name: Addition to lower extremity, anterior swing band


name: Addition to lower extremity, pre-tibial shell, molded to patient model


name: Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)


name: Addition to lower extremity, extended steel shank


name: Addition to lower extremity, patten bottom


name: Addition to lower extremity, torsion control, ankle joint and half solid stirrup


name: Addition to lower extremity, torsion control, straight knee joint, each joint


name: Addition to lower extremity, straight knee joint, heavy duty, each joint


name: Addition to lower extremity, offset knee joint, each joint


name: Addition to lower extremity, offset knee joint, heavy duty, each joint


name: Addition to lower extremity orthosis, suspension sleeve


name: Addition to knee lock with integrated release mechanism (bail, cable, or equal), any material, each joint


name: Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint


name: Addition to knee joint, ratchet lock for active and progressive knee extension, each joint


name: Addition to knee joint, lift loop for drop lock ring


name: Addition to lower extremity, thigh/weight bearing, gluteal/ ischial weight bearing, ring


name: Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, molded to patient model


name: Addition to lower extremity, thigh/weight bearing, quadri- lateral brim, custom fitted


name: Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim molded to patient model


name: Addition to lower extremity, thigh/weight bearing, ischial containment/narrow m-l brim, custom fitted


name: Addition to lower extremity, thigh-weight bearing, lacer, non-molded


name: Addition to lower extremity, thigh/weight bearing, lacer, molded to patient model


name: Addition to lower extremity, thigh/weight bearing, high roll cuff


name: Addition to lower extremity, pelvic control, hip joint, clevis type two position joint, each


name: Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each


name: Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each


name: Addition to lower extremity, pelvic control, hip joint, heavy duty, each


name: Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each


name: Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each


name: Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables


name: Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables


name: Addition to lower extremity, pelvic control, band and belt, unilateral


name: Addition to lower extremity, pelvic control, band and belt, bilateral


name: Addition to lower extremity, pelvic and thoracic control, gluteal pad, each


name: Addition to lower extremity, thoracic control, thoracic band


name: Addition to lower extremity, thoracic control, paraspinal uprights


name: Addition to lower extremity, thoracic control, lateral support uprights


name: Addition to lower extremity orthosis, plating chrome or nickel, per bar


name: Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only


name: Addition to lower extremity orthosis, extension, per extension, per bar (for lineal adjustment for growth)


name: Addition to lower extremity orthosis, non-corrosive finish, per bar


name: Addition to lower extremity orthosis, drop lock retainer, each


name: Addition to lower extremity orthosis, knee control, full kneecap


name: Addition to lower extremity orthosis, knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only


name: Addition to lower extremity orthosis, knee control, condylar pad


name: Addition to lower extremity orthosis, soft interface for molded plastic, below knee section


name: Addition to lower extremity orthosis, soft interface for molded plastic, above knee section


name: Addition to lower extremity orthosis, tibial length sock, fracture or equal, each


name: Addition to lower extremity orthosis, femoral length sock, fracture or equal, each


name: Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each


name: Foot, insert, removable, molded to patient model, spenco, each


name: Foot, insert, removable, molded to patient model, plastazote or equal, each


name: Foot, insert, removable, molded to patient model, silicone gel, each


name: Foot, insert, removable, molded to patient model, longitudinal arch support, each


name: Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each


name: Foot, insert, removable, formed to patient foot, each


name: Foot, arch support, removable, premolded, longitudinal, each


name: Foot, arch support, removable, premolded, metatarsal, each


name: Foot, arch support, removable, premolded, longitudinal/ metatarsal, each


name: Foot, arch support, non-removable attached to shoe, longitudinal, each


name: Foot, arch support, non-removable attached to shoe, metatarsal, each


name: Foot, arch support, non-removable attached to shoe, longitudinal/metatarsal, each


name: Foot, abduction rotation bar, including shoes


name: Foot, abduction rotation bar, without shoes


name: Foot, adjustable shoe-styled positioning device


name: Orthopedic shoe, oxford with supinator or pronator, infant


name: Orthopedic shoe, oxford with supinator or pronator, child


name: Orthopedic shoe, oxford with supinator or pronator, junior


name: Orthopedic shoe, hightop with supinator or pronator, infant


name: Orthopedic shoe, hightop with supinator or pronator, child


name: Orthopedic shoe, hightop with supinator or pronator, junior


name: Orthopedic footwear, ladies shoe, oxford, each


name: Orthopedic footwear, ladies shoe, depth inlay, each


name: Orthopedic footwear, ladies shoe, hightop, depth inlay, each


name: Orthopedic footwear, mens shoe, oxford, each


name: Orthopedic footwear, mens shoe, depth inlay, each


name: Orthopedic footwear, mens shoe, hightop, depth inlay, each


name: Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)


name: Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)


name: Orthopedic footwear, custom shoe, depth inlay, each


name: Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each


name: Foot, shoe molded to patient model, silicone shoe, each


name: FOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, EACH


name: FOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH


name: Orthopedic footwear, additional charge for split size


name: Lift, elevation, heel, tapered to metatarsals, per inch


name: Lift, elevation, heel and sole, neoprene, per inch


name: Lift, elevation, heel and sole, cork, per inch


name: Lift, elevation, metal extension (skate)


name: Lift, elevation, inside shoe, tapered, up to one-half inch


name: Orthopedic shoe addition, insole, leather


name: Orthopedic shoe addition, insole, rubber


name: Orthopedic shoe addition, insole, felt covered with leather


name: Orthopedic shoe addition, toe tap standard


name: Orthopedic shoe addition, toe tap, horseshoe


name: Orthopedic shoe addition, special extension to instep (leather with eyelets)


name: Orthopedic shoe addition, convert instep to velcro closure


name: Orthopedic shoe addition, convert firm shoe counter to soft counter


name: Transfer of an orthosis from one shoe to another, caliper plate, existing


name: Transfer of an orthosis from one shoe to another, caliper plate, new


name: Transfer of an orthosis from one shoe to another, solid stirrup, existing


name: Transfer of an orthosis from one shoe to another, solid stirrup, new


name: Transfer of an orthosis from one shoe to another, dennis browne splint (riveton), both shoes


name: Orthopedic shoe, modification, addition or transfer, not otherwise specified


name: Elbow orthosis, double upright with forearm/arm cuffs, free motion, custom fabricated


name: Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated


name: Elbow orthosis, double upright with forearm/arm cuffs, adjustable position lock with active control, custom fabricated


name: Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, wrist or finger driven, custom fabricated


name: Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated


name: Wrist hand finger orthosis, external powered, electric, custom fabricated


name: Wrist hand orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment


name: Addition of joint to upper extremity orthosis, any material; per joint


name: Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment


name: Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment


name: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable rancho type


name: Wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, friction arm support (friction dampening to proximal and distal joints)


name: Wheelchair accessory, addition to mobile arm support, elevating proximal arm


name: Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment


name: Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment


name: Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment


name: Addition to upper extremity orthosis, sock, fracture or equal, each


name: Replace girdle for spinal orthosis (ctlso or so)


name: Replace quadrilateral socket brim, molded to patient model


name: Replace quadrilateral socket brim, custom fitted


name: Replace molded thigh lacer, for custom fabricated orthosis only


name: Replace non-molded thigh lacer, for custom fabricated orthosis only


name: Replace molded calf lacer, for custom fabricated orthosis only


name: Replace non-molded calf lacer, for custom fabricated orthosis only


name: Replace proximal and distal upright for kafo


name: Replace metal bands kafo, proximal thigh


name: Replace metal bands kafo-afo, calf or distal thigh


name: Replace leather cuff kafo, proximal thigh


name: Replace leather cuff kafo-afo, calf or distal thigh


name: Repair of orthotic device, labor component, per 15 minutes


name: Repair of orthotic device, repair or replace minor parts


name: Partial foot, shoe insert with longitudinal arch, toe filler


name: Partial foot, molded socket, ankle height, with toe filler


name: Partial foot, molded socket, tibial tubercle height, with toe filler


name: Ankle, symes, metal frame, molded leather socket, articulated ankle/foot


name: Below knee, molded socket, shin, sach foot


name: Below knee, plastic socket, joints and thigh lacer, sach foot


name: Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot


name: Knee disarticulation (or through knee), molded socket, bent knee configuration, external knee joints, shin, sach foot


name: Above knee, molded socket, single axis constant friction knee, shin, sach foot


name: Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each


name: Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each


name: Above knee, for proximal femoral focal deficiency, constant friction knee, shin, sach foot


name: Hip disarticulation, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot


name: Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, sach foot


name: Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot


name: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee


name: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension, below knee, each additional cast change and realignment


name: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'ak' or knee disarticulation


name: Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and supension, 'ak' or knee disarticulation, each additional cast change and realignment


name: IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING RIGID DRESSING, BELOW KNEE


name: IMMEDIATE POST SURGICAL OR EARLY FITTING, APPLICATION OF NON-WEIGHT BEARING RIGID DRESSING, ABOVE KNEE


name: Initial, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed


name: Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed


name: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model


name: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed


name: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model


name: Preparatory, below knee 'ptb' type socket, non-alignable system, no cover, sach foot, prefabricated, adjustable open end socket


name: Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, laminated socket, molded to model


name: Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model


name: Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed


name: Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model


name: Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket


name: Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model


name: Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, thermoplastic or equal, molded to patient model


name: Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, sach foot, laminated socket, molded to patient model


name: Addition to lower extremity, endoskeletal system, above knee, hydracadence system


name: Addition to lower extremity, endoskeletal system, above knee - knee disarticulation, 4 bar linkage, with friction swing phase control


name: Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control


name: Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control


name: Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control


name: Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each


name: Addition to lower extremity, test socket, symes


name: Addition to lower extremity, test socket, below knee


name: Addition to lower extremity, test socket, knee disarticulation


name: Addition to lower extremity, test socket, above knee


name: Addition to lower extremity, test socket, hip disarticulation


name: Addition to lower extremity, test socket, hemipelvectomy


name: Addition to lower extremity, below knee, acrylic socket


name: Addition to lower extremity, symes type, expandable wall socket


name: Addition to lower extremity, above knee or knee disarticulation, acrylic socket


name: Addition to lower extremity, symes type, 'ptb' brim design socket


name: Addition to lower extremity, symes type, posterior opening (canadian) socket


name: Addition to lower extremity, symes type, medial opening socket


name: Addition to lower extremity, below knee, total contact


name: Addition to lower extremity, below knee, leather socket


name: Addition to lower extremity, below knee, wood socket


name: Addition to lower extremity, knee disarticulation, leather socket


name: Addition to lower extremity, above knee, leather socket


name: Addition to lower extremity, hip disarticulation, flexible inner socket, external frame


name: Addition to lower extremity, above knee, wood socket


name: Addition to lower extremity, below knee, flexible inner socket, external frame


name: Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket


name: Addition to lower extremity, below knee suction socket


name: Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket


name: Addition to lower extremity, ischial containment/narrow m-l socket


name: Additions to lower extremity, total contact, above knee or knee disarticulation socket


name: Addition to lower extremity, above knee, flexible inner socket, external frame


name: Addition to lower extremity, suction suspension, above knee or knee disarticulation socket


name: Addition to lower extremity, knee disarticulation, expandable wall socket


name: Addition to lower extremity, socket insert, symes, (kemblo, pelite, aliplast, plastazote or equal)


name: Addition to lower extremity, socket insert, below knee (kemblo, pelite, aliplast, plastazote or equal)


name: Addition to lower extremity, socket insert, knee disarticulation (kemblo, pelite, aliplast, plastazote or equal)


name: Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)


name: Addition to lower extremity, socket insert, multi-durometer symes


name: Addition to lower extremity, socket insert, multi-durometer, below knee


name: Addition to lower extremity, below knee, cuff suspension


name: Addition to lower extremity, below knee, molded distal cushion


name: Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar)


name: Addition to lower extremity, below knee, removable medial brim suspension


name: Additions to lower extremity, below knee, knee joints, single axis, pair


name: Additions to lower extremity, below knee, knee joints, polycentric, pair


name: Additions to lower extremity, below knee, joint covers, pair


name: Addition to lower extremity, below knee, thigh lacer, nonmolded


name: Addition to lower extremity, below knee, thigh lacer, gluteal/ischial, molded


name: Addition to lower extremity, below knee, fork strap


name: Addition to lower extremity, below knee, back check (extension control)


name: Addition to lower extremity, below knee, waist belt, webbing


name: Addition to lower extremity, below knee, waist belt, padded and lined


name: Addition to lower extremity, above knee, pelvic control belt, light


name: Addition to lower extremity, above knee, pelvic control belt, padded and lined


name: Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each


name: Addition to lower extremity, above knee or knee disarticulation, pelvic joint


name: Addition to lower extremity, above knee or knee disarticulation, pelvic band


name: Addition to lower extremity, above knee or knee disarticulation, silesian bandage


name: All lower extremity prostheses, shoulder harness


name: Replacement, socket, below knee, molded to patient model


name: Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model


name: Replacement, socket, hip disarticulation, including hip joint, molded to patient model


name: Custom shaped protective cover, below knee


name: Custom shaped protective cover, above knee


name: Custom shaped protective cover, knee disarticulation


name: Custom shaped protective cover, hip disarticulation


name: Addition, exoskeletal knee-shin system, single axis, manual lock


name: Additions exoskeletal knee-shin system, single axis, manual lock, ultra-light material


name: Addition, exoskeletal knee-shin system, single axis, friction swing and stance phase control (safety knee)


name: Addition, exoskeletal knee-shin system, single axis, variable friction swing phase control


name: Addition, exoskeletal knee-shin system, polycentric, mechanical stance phase lock


name: Addition, exoskeletal knee-shin system, polycentric, friction swing and stance phase control


name: Addition, exoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control


name: Addition, exoskeletal knee-shin system, single axis, fluid swing phase control


name: Addition, exoskeletal knee-shin system, single axis, external joints fluid swing phase control


name: Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control


name: Addition, exoskeletal knee-shin system, single axis, pneumatic/hydra pneumatic swing phase control


name: Addition, exoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)


name: Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)


name: Addition, exoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)


name: Addition, endoskeletal knee-shin system, single axis, manual lock


name: Addition, endoskeletal knee-shin system, single axis, manual lock, ultra-light material


name: ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, SINGLE AXIS, FRICTION SWING AND STANCE PHASE CONTROL (SAFETY KNEE)


name: Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock


name: Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock


name: ADDITION, ENDOSKELETAL KNEE-SHIN SYSTEM, POLYCENTRIC, FRICTION SWING, AND STANCE PHASE CONTROL


name: Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction stance phase control


name: Addition, endoskeletal knee-shin system, single axis, fluid swing phase control


name: Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control


name: Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing phase control


name: Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control


name: Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable


name: Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist


name: Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist


name: Addition, endoskeletal system, below knee, alignable system


name: Addition, endoskeletal system, above knee or hip disarticulation, alignable system


name: Addition, endoskeletal system, above knee, knee disarticulation or hip disarticulation, manual lock


name: Addition, endoskeletal system, high activity knee control frame


name: Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal)


name: Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)


name: Addition, endoskeletal system, hip disarticulation, ultra-light material (titanium, carbon fiber or equal)


name: Addition, endoskeletal system, below knee, flexible protective outer surface covering system


name: Addition, endoskeletal system, above knee, flexible protective outer surface covering system


name: Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system


name: All lower extremity prostheses, foot, external keel, sach foot


name: All lower extremity prostheses, foot, flexible keel


name: All lower extremity prostheses, foot, single axis ankle/foot


name: All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal)


name: All lower extremity prostheses, foot, multiaxial ankle/foot


name: All lower extremity prosthesis, multi-axial ankle, dynamic response foot, one piece system


name: All lower extremity prostheses, flex foot system


name: All lower extremity prostheses, flex-walk system or equal


name: All exoskeletal lower extremity prostheses, axial rotation unit


name: All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability


name: All endoskeletal lower extremity prostheses, dynamic prosthetic pylon


name: All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal)


name: All lower extremity prosthesis, shank foot system with vertical loading pylon


name: Wrist disarticulation, molded socket, flexible elbow hinges, triceps pad


name: Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad


name: Below elbow, molded socket, flexible elbow hinge, triceps pad


name: Below elbow, molded socket, (muenster or northwestern suspension types)


name: Below elbow, molded double wall split socket, step-up hinges, half cuff


name: Below elbow, molded double wall split socket, stump activated locking hinge, half cuff


name: Elbow disarticulation, molded socket, outside locking hinge, forearm


name: Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm


name: Above elbow, molded double wall socket, internal locking elbow, forearm


name: Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm


name: Shoulder disarticulation, passive restoration (complete prosthesis)


name: Shoulder disarticulation, passive restoration (shoulder cap only)


name: Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm


name: Interscapular thoracic, passive restoration (complete prosthesis)


name: Interscapular thoracic, passive restoration (shoulder cap only)


name: Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow


name: Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow


name: Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic


name: Immediate post surgical or early fitting, each additional cast change and realignment


name: Immediate post surgical or early fitting, application of rigid dressing only


name: Below elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping


name: Elbow disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping


name: Above elbow, molded socket, endoskeletal system, including soft prosthetic tissue shaping


name: Shoulder disarticulation, molded socket, endoskeletal system, including soft prosthetic tissue shaping


name: Interscapular thoracic, molded socket, endoskeletal system, including soft prosthetic tissue shaping


name: Preparatory, wrist disarticulation or below elbow, single wall plastic socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, molded to patient model


name: Preparatory, wrist disarticulation or below elbow, single wall socket, friction wrist, flexible elbow hinges, figure of eight harness, humeral cuff, bowden cable control, usmc or equal pylon, no cover, direct formed


name: Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model


name: Preparatory, elbow disarticulation or above elbow, single wall socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, direct formed


name: Preparatory, shoulder disarticulation or interscapular thoracic, single wall plastic socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, molded to patient model


name: Preparatory, shoulder disarticulation or interscapular thoracic, single wall socket, shoulder joint, locking elbow, friction wrist, chest strap, fair lead cable control, usmc or equal pylon, no cover, direct formed


name: Upper extremity additions, polycentric hinge, pair


name: Upper extremity additions, single pivot hinge, pair


name: Upper extremity additions, flexible metal hinge, pair


name: Upper extremity addition, disconnect locking wrist unit


name: Upper extremity addition, additional disconnect insert for locking wrist unit, each


name: Upper extremity addition, flexion/extension wrist unit, with or without friction


name: Upper extremity addition, spring assisted rotational wrist unit with latch release


name: Upper extremity addition, rotation wrist unit with cable lock


name: Upper extremity addition, quick disconnect hook adapter, otto bock or equal


name: Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal


name: Upper extremity addition, stainless steel, any wrist


name: Upper extremity addition, latex suspension sleeve, each


name: Upper extremity addition, lift assist for elbow


name: Upper extremity addition, nudge control elbow lock


name: Upper extremity additions, shoulder abduction joint, pair


name: Upper extremity addition, excursion amplifier, pulley type


name: Upper extremity addition, excursion amplifier, lever type


name: Upper extremity addition, shoulder flexion-abduction joint, each


name: Upper extremity addition, shoulder universal joint, each


name: Upper extremity addition, standard control cable, extra


name: Upper extremity addition, heavy duty control cable


name: Upper extremity addition, teflon, or equal, cable lining


name: Upper extremity addition, hook to hand, cable adapter


name: Upper extremity addition, harness, chest or shoulder, saddle type


name: Upper extremity addition, harness, (e.g., figure of eight type), single cable design


name: Upper extremity addition, harness, (e.g., figure of eight type), dual cable design


name: Upper extremity addition, test socket, wrist disarticulation or below elbow


name: Upper extremity addition, test socket, elbow disarticulation or above elbow


name: Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic


name: Upper extremity addition, suction socket


name: Upper extremity addition, frame type socket, below elbow or wrist disarticulation


name: Upper extremity addition, frame type socket, above elbow or elbow disarticulation (procedure)


name: Upper extremity addition, frame type socket, shoulder disarticulation


name: Upper extremity addition, frame type socket, interscapular-thoracic


name: Upper extremity addition, removable insert, each


name: Upper extremity addition, silicone gel insert or equal, each


name: prosthetic upper limb terminal device hooks 2 load/equal


name: prosthetic upper limb terminal device hooks APRL VC or equal


name: Addition to terminal device, modifier wrist unit


name: Addition to terminal device, precision pinch device


name: Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment


name: Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated


name: Hand restoration (casts, shading and measurements included), partial hand, with glove, thumb or one finger remaining


name: Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining


name: Hand restoration (casts, shading and measurements included), partial hand, with glove, no fingers remaining


name: Hand restoration (shading, and measurements included), replacement glove for above


name: Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device


name: Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device


name: Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device


name: Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device


name: Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device


name: Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device


name: Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device


name: Above elbow, external power, molded inner socket, removable humeral shell, internal locking elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device


name: Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device


name: Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device


name: Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device


name: Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device


name: Electric hook, switch or myoelectric controlled, pediatric


name: Electronic elbow, hosmer or equal, switch controlled


name: Electronic elbow, microprocessor sequential control of elbow and terminal device


name: Electronic elbow, adolescent, variety village or equal, myoelectronically controlled


name: Electronic elbow, child, variety village or equal, myoelectronically controlled


name: Repair of prosthetic device, repair or replace minor parts


name: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type


name: GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, EACH


name: GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH


name: Gradient compression stocking, below knee, 40-50 mmhg, each


name: Gradient compression stocking, thigh length, 18-30 mmhg, each


name: Gradient compression stocking, thigh length, 30-40 mmhg, each


name: Gradient compression stocking, thigh length, 40-50 mmhg, each


name: Gradient compression stocking, full length/chap style, 18-30 mmhg, each


name: Gradient compression stocking, full length/chap style, 30-40 mmhg, each


name: Gradient compression stocking, full length/chap style, 40-50 mmhg, each


name: Gradient compression stocking, waist length, 18-30 mmhg, each


name: Gradient compression stocking, waist length, 40-50 mmhg, each


name: Gradient compression stocking, garter belt


name: Truss, addition to standard pad, water pad


name: Truss, addition to standard pad, scrotal pad


name: Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each


name: Prosthetic sock, multiple ply, below knee, each


name: Prosthetic sock, multiple ply, above knee, each


name: Prosthetic sock, multiple ply, upper limb, each


name: Prosthetic sock, single ply, fitting, below knee, each


name: Prosthetic sock, single ply, fitting, above knee, each


name: Prosthetic sock, single ply, fitting, upper limb, each


name: Unlisted procedure for miscellaneous prosthetic services


name: Implantable breast prosthesis, silicone or equal


name: Cochlear device, includes all internal and external components


name: Interphalangeal joint spacer, silicone or equal, each


name: Vascular graft material, synthetic, implant


name: Intragastric hypothermia using gastric freezing


name: Iv chelation therapy (chemical endarterectomy)


name: Mucoprotein, blood (seromucoid) (medical necessity procedure)


name: Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision


name: Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician


name: CULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY


name: Blood (whole), for transfusion, per unit


name: Red blood cells, leukocytes reduced, each unit


name: Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit


name: Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled


name: Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge


name: Catheterization for collection of specimen(s) (multiple patients)


name: Infusion therapy, using other than chemotherapeutic drugs, per visit


name: Chemotherapy administration by other than infusion technique only (e.g., subcutaneous, intramuscular, push), per visit


name: Chemotherapy administration by infusion technique only, per visit


name: Chemotherapy administration by both infusion technique and other technique(s) (e.g., subcutaneous, intramuscular, push), per visit


name: Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory


name: Wet mounts, including preparations of vaginal, cervical or skin specimens


name: Post-coital direct, qualitative examinations of vaginal or cervical mucous


name: Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen


name: Transportation of portable x-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen


name: Transportation of portable ekg to facility or location, per patient


name: Sphere, single vision, plano to plus or minus 4.00, per lens


name: Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens


name: Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens


name: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens


name: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens


name: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens


name: Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 4.25 to 7.00d sphere, over 6.00d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens


name: Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens


name: Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens


name: LENTICULAR, (MYODISC), PER LENS, SINGLE VISION


name: Not otherwise classified, single vision lens


name: Sphere, bifocal, plano to plus or minus 4.00d, per lens


name: Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens


name: Sphere, bifocal, plus or minus 7.12 to plus or minus 20.00d, per lens


name: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens


name: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens


name: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens


name: Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere,.12 to 2.00d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 4.25 to plus or minus 7.00d sphere, over 6.00d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, .25 to 2.25d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25 to 4.00d cylinder, per lens


name: Spherocylinder, bifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens