Sitemap
Use this sitemap to find QuickIntell product pages, healthcare RCM guides, EHR integrations, resources, company pages, and operational reference directories.
Products
- AI RCM
- Risk Adjustment
- EHR and Payer Portal Automation
- Payer Portal Bots
- Workflow Agent Builder
- Pipeline Orchestration
- Appeals Management
- QuickScribe - AI Medical Scribe
- QuickCode - AI Medical Coding
- QuickAuth - Prior Authorization
- Payer Intelligence API
- QuickRCM - End-to-End RCM
- Cognitive Automator - Desktop RCM Automation
- Products — Managed RCM
- QuickEHR
- Products — QuickEHR — Pricing
- Products — QuickEHR — Bundles
- Products — QuickEHR — Group Practices
- Products — QuickEHR — Virtual Practice
- Products — QuickEHR — Telemedicine
- Products — QuickEHR — Multi Location
- Products — QuickEHR — Cloud EHR
- Products — QuickEHR — Dashboard
- Products — QuickEHR — Business Intelligence
- Products — QuickEHR — Reporting
- Products — QuickEHR — Report Center
- Products — QuickEHR — Physician Dashboard
- Products — QuickEHR — Scheduling
- Products — QuickEHR — Self Scheduling
- Products — QuickEHR — Appointment Reminders
- Products — QuickEHR — Patient Communications
- Products — QuickEHR — Patient Messaging
- Products — QuickEHR — Patient Engagement
- Products — QuickEHR — Reputation Management
- Products — QuickEHR — Patient Flow
- Products — QuickEHR — Patient Rooming
- Products — QuickEHR — Patient Kiosk
- Products — QuickEHR — Patient Education
- Products — QuickEHR — Billing
- Products — QuickEHR — Practic__emanagement
- Products — QuickEHR — Practic__emanagement Software
- Products — QuickEHR — Period Close
- Products — QuickEHR — Invoicing
- Products — QuickEHR — Patient Statements
- Products — QuickEHR — Credit Card Processing
- Products — QuickEHR — Payments
- Products — QuickEHR — Central Billing Office
- Products — QuickEHR — Managed RCM
- Products — QuickEHR — RCM Pricing
- Products — QuickEHR — Eligibility Verification
- Products — QuickEHR — Medical Coding
- Products — QuickEHR — Claims Management
- Products — QuickEHR — Accounts Receivable
- Products — QuickEHR — Soft Collections
- Products — QuickEHR — Era Posting
- Products — QuickEHR — Electronic Claims
- Products — QuickEHR — Electronic Faxing
- Products — QuickEHR — Clearinghouse
- Products — QuickEHR — Claims Scrubbing
- Products — QuickEHR — Claims Review
- Products — QuickEHR — Patient Portal Software
- Products — QuickEHR — Consent Forms
- Products — QuickEHR — Patient Cards
- Products — QuickEHR — Patient Charts
- Products — QuickEHR — Patient Health Management
- Products — QuickEHR — Population Health
- Products — QuickEHR — Remote Patient Monitoring
- Products — QuickEHR — Clinical Documentation
- Products — QuickEHR — Specialty Templates
- Products — QuickEHR — Template Library
- Products — QuickEHR — Clinical Mobile App
- Products — QuickEHR — Mobile
- Products — QuickEHR — Record Locator Exchange
- Products — QuickEHR — Interoperability
- Products — QuickEHR — Interoperability Support
- Products — QuickEHR — Open Api
- Products — QuickEHR — Testing Sandbox
- Products — QuickEHR — Developer Solutions
- Products — QuickEHR — Api Connection Request
- Products — QuickEHR — Professional Services
- Products — QuickEHR — Consulting
- Products — QuickEHR — Custom Work
- Products — QuickEHR — Implementation
- Products — QuickEHR — Training
- Products — QuickEHR — Data Export
- Products — QuickEHR — Data Conversion
- Products — QuickEHR — Odbc
- Products — QuickEHR — Security
- Products — QuickEHR — Mfa
- Products — QuickEHR — Certification
- Products — QuickEHR — Certification Services
- Products — QuickEHR — Meaningful Use
- Products — QuickEHR — Mips
- Products — QuickEHR — Mips Services
- Products — QuickEHR — Clinical Quality Measures
- Products — QuickEHR — Immunization Reporting
- Products — QuickEHR — E Prescribing
- Products — QuickEHR — Epcs
- QuickERA - EOB to ERA
- Risk Adjustment Coding
- Claims Filing
- Cost Estimator
- Provider Credentialing
- Denial Management
- AI RCM Eligibility Verification
- Inpatient Billing
- Payment Posting
- AI RCM Claims Processing
- AI RCM Denial Prevention
- AI RCM Coding Notes Review
- AI RCM Document Classification
- AI RCM EOB to ERA
- AI RCM Insurance Discovery
- AI RCM Accounts Receivable
- Risk Adjustment Technology
- Retrospective Chart Reviews
- Clinical Decision Support
- Prospective Risk Adjustment
- Risk Adjustment Healthcare API
- QuickVoice Voice Agents
- Voice Agents for Providers
- Voice Agents for Payors
- Voice Agents for Pharma
- End-to-End AI RCM
- Products — Contract Management
- Products — Managed RCM — Credentialing
- Products — Managed RCM — Eligibility Verification
- Products — Managed RCM — Prior Authorization
- Products — Managed RCM — Medical Coding
- Products — Managed RCM — Denial Management
- Products — Managed RCM — Payment Posting
- Products — Managed RCM — Accounts Receivable
- Products — Managed RCM — Payer Contracting
- Revenue Cycle Integration Map
- Denial Code Lookup
- AI RCM Vendor Scorecard
- Healthcare RCM ROI Calculator
- Products
Solutions
- Solutions — Specialties
- Practic__emanagement
- Billing Coding
- Providers
- Hospitals & Health Systems
- Hospital Reimbursement Benchmarking
- Hospital Contract Variance Analysis
- Behavioral Health & SUD
- Ambulatory Surgery Centers
- Home Health & Hospice
- Imaging & Radiology
- Labs & Pathology
- ABN Automation for Labs
- MSOs & ACOs
- Payers & Health Plans
- Solutions — AI Voice Assistants
- Solutions — Cdi Optimization
- Solutions — Care Coordination
- Solutions — ACO Compliance
- Solutions — Performance Coding
- Solutions — Population Risk
- Solutions — Provider Analytics
- Solutions — View All
- Solutions — RCM Automation — Coordination Of Benefits
- Solutions
Reimbursement Intelligence
Integrations
- Integrations
- Integrations — Marketplace
- Epic EHR Integration
- Oracle Health (Cerner) Integration
- athenahealth Integration
- eClinicalWorks Integration
- NextGen Healthcare Integration
- MEDITECH Integration
- Allscripts/Veradigm Integration
- Integrations — Practice Fusion
- Integrations — Drchrono
- Integrations — Kareo
- Integrations — Advancedmd
- Integrations — Carecloud
- Integrations — Greenway Health
- Integrations — Modmed
- Integrations — Elation
- Integrations — Amazing Charts
- Integrations — Nexttech
- Integrations — Valant
- Integrations — Simplepractice
- Integrations — Therapynotes
- Integrations — Prognocis
- Integrations — Raintree
- Integrations — Charm Health
- Integrations — Aprima
- Integrations — Centricity
- Integrations — Openemr
- Integrations — Availity
- Integrations — Practice Fusion — Migration Plan
Content Library
Comparisons
- Quickintell vs. Athelas
- Quickintell vs. Adonis
- Quickintell vs. Thoughtful AI
- Quickintell vs. Athenahealth
- Best AI RCM Software
- QuickIntell vs. Waystar
- Quickintell vs. R1 RCM
- Quickintell vs. Epic RCM
- QuickIntell vs. Optum
- Best AI Medical Scribe
- Best AI Medical Coding Software
- RCM Outsourcing vs. AI Automation
- Best RCM Software
- Healthcare RCM Software Guide
- Quickintell vs. Eclinicalworks
- Quickintell vs. Nextgen
- Quickintell vs. Notable
- Quickintell vs. Akasa
- Quickintell vs. Infinx
- Best AI Prior Auth Software
- Quickintell vs. Fathom Health
- Quickintell vs. Abridge
- Quickintell vs. Codametrix
- Quickintell vs. Olive AI
- Best AI Denial Management Software
- Best AI Eligibility Verification Software
- Best AI Medical Billing Software
- Quickintell vs. Kareo
Insights & Thought Leadership
- Payer Provider AI Arms Race
- 400 Billion Healthcare Waste
- Spotting AI Washing Healthcare
- Healthcare Cfo Guide To AI
- Payer Provider AI Claims Adjudication
- Medical Coder Shortage Evolution
- Healthcare AI Landscape 2026
- Building AI For Healthcare Founder Story
- AI Agents In Healthcare
- Future Of Medical Coding
- Cms Interoperability Rules 2026
- AI Transforming Healthcare 2026
- Predictive Analytics Revenue Cycle
- Agentic AI In Healthcare
- Generative AI In Healthcare
- Llms In Healthcare
- State Of Healthcare Denials 2026
- AI Healthcare Claims Processing
- AI Patient Scheduling
- AI Insurance Verification
- Administrative Burden Crisis
- AI First Revenue Cycle
- Voice AI Healthcare
- Proof And ROI
- Trust Compliance Governance
- Human Plus AI Workforce
Medical Coding & RCM Reference Guides | QuickIntell
- Primary Care Provider Payer Readiness
- Primary Care Referral Order Handoff
- Behavioral Health Benefit Administrator Checklist
- Behavioral Health Authorization Renewal Handoff
- Dermatology Specialty Therapy Access Readiness
- Dermatology Documentation Billing Handoff
- Urgent Care Registration Coverage Exceptions
- Urgent Care Daily Payment Reconciliation
- Physical Therapy Benefits Visit Tracking
- Physical Therapy Authorization Change Handoff
- Eligibility Benefits Verification Checklist
- Credentialing Versus Payer Enrollment
- Claim Submission Acknowledgment Status
- Payer Contract Underpayment Review
- AR Aging Prioritization Worksheet
- Pdf Eob To 835
- Eob Ocr vs. Era Conversion
- Hospital Eob To Era Workflow
- Epic Eob To Era Workflow
- Healthcare Lockbox Eob Conversion
- Medical Coding
- CPT Codes Explained
- Diagnosis Codes ICD-10
- How Medical Billing Works
- Revenue Cycle Analytics
- Medical Billing Automation
- HCC Coding
- What Is Revenue Cycl__emanagement
- Revenue Cycl__emanagement Companies
- Workers Compensation Billing
- Coordination Of Benefits
- What Is Prior Authorization
- What Is Clinical Documentation Improvement
- What Is A Superbill
- What Is Explanation Of Benefits
- What Is A Medical Clearinghouse
- What Is Charge Capture
- What Is Hcpcs Coding
- What Is A Medical Claim
- What Is AI Medical Coding
- What Is Accounts Receivable Healthcare
- What Is An AI Revenue Agent
- AI Voice Agents In RCM
- How To Write A Medical Necessity Appeal
- Oig And Sam Monthly Screening Explained
- Good Faith Estimate 101 No Surprises Act
- Payer Credentialing And Enrollment 101
- Medical Billing Clearinghouse
- Best Clearinghouse For Medical Billing
- Top Clearinghouses Medical Billing
- List Of Clearinghouses In Medical Billing
- Healthcare Clearinghouse Companies
- Medical Billing Clearinghouse Cost
- Fre__emedical Billing Clearinghouse
- Medical Billing Software With Clearinghouse
- 837 Claims Clearinghouse
- 835 Era Clearinghouse
- Clearinghouse Eligibility Verification
- Openemr Clearinghouse
AI RCM Resources for Healthcare Revenue Cycle Leaders
- AI RCM Rfp Template
- AI RCM Pilot Acceptance Testing
- AI RCM Software Pricing Models
- AI RCM Billing Company Onboarding
- Prior Authorization Claim Handoff
- Payment Posting Exception Workflows
- Denial Prevention vs. Denial Management
- RCM Dashboard Data Dictionary
- Eob To Era Evaluation Checklist
- RCM Migration Playbook
- AI RCM Implementation Timeline
- Build Business Case AI RCM
- Questions To Ask AI RCM Demo
- Soc2 HIPAA Certifications
- Radiology Denial Reduction Case Study
- Prior Auth Automation Case Study
- Emergency Medicine Coding Case Study
- Home Health AR Case Study
- Asc Clean Claim Case Study
- Cardiology Denial Reduction Case Study
- Multi Specialty Prior Auth Case Study
- Primary Care AI Scribe Case Study
- RCM Company Scaling Case Study
- Community Hospital AR Case Study
- Risk Adjustment Faq
- Family Medicine Faq
- Fqhc Uds Readiness
- No Surprises Act
Payer Guides
- Unitedhealthcare Prior Authorization
- Aetna Prior Authorization
- Cigna Prior Authorization
- Humana Prior Authorization
- BCBS Prior Authorization
- Anthem Prior Authorization
- Aetna Eligibility Verification
- Cigna Eligibility Verification
- Unitedhealthcare Eligibility Verification
- Medicare Eligibility Verification
- Urgent Care CPT Codes
- Podiatry CPT Codes
- Dermatology CPT Codes
- Emergency Medicine CPT Codes
- Cardiology CPT Codes
- Orthopedic CPT Codes
- Obgyn CPT Codes
- Gastroenterology CPT Codes
- Neurology CPT Codes
- Ophthalmology CPT Codes
- Medicare Advantage Billing
- Medicaid Prior Authorization
- Tricare Prior Authorization Billing
- Medicaid Eligibility Verification
- Humana Eligibility Verification
- BCBS Eligibility Verification
Who We Serve
Specialties
- Urgent Care
- Specialties — Urgent Care — EHR Software
- Primary Care
- Specialties — Primary Care — EHR Software
- Family Medicine
- Specialties — Family Medicine — EHR Software
- Internal Medicine
- Specialties — Internal Medicine — EHR Software
- Pediatrics
- Specialties — Pediatrics — EHR Software
- Cardiology
- Specialties — Cardiology — EHR Software
- Orthopedics
- Specialties — Orthopedics — EHR Software
- Neurology
- Specialties — Neurology — EHR Software
- Dermatology
- Specialties — Dermatology — EHR Software
- Gastroenterology
- Specialties — Gastroenterology — EHR Software
- Oncology
- Urology
- Specialties — Urology — EHR Software
- Pulmonology
- Specialties — Pulmonology — EHR Software
- Nephrology
- Specialties — Nephrology — EHR Software
- Endocrinology
- Specialties — Endocrinology — EHR Software
- Rheumatology
- Psychiatry
- Specialties — Psychiatry — EHR Software
- Psychology
- Behavioral Health
- Specialties — Behavioral Health — EHR Software
- Specialties — Addiction Medicine
- Specialties — Addiction Medicine — EHR Software
- Specialties — Addiction Medicine — Billing Coding
- Specialties — Addiction Medicine — Practic__emanagement
- Ambulatory Surgery Centers
- General Surgery
- Plastic Surgery
- Specialties — Plastic Surgery — EHR Software
- Radiology
- Pathology
- Specialties — Pathology — EHR Software
- Anesthesiology
- Specialties — Anesthesiology — EHR Software
- Geriatrics
- OB-GYN
- Specialties — OB-GYN — EHR Software
- Ophthalmology
- Specialties — Ophthalmology — EHR Software
- ENT
- Specialties — Ent — EHR Software
- Allergy & Immunology
- Specialties — Allergy & Immunology — EHR Software
- Infectious Disease
- Hematology
- Pain Management
- Specialties — Pain Management — EHR Software
- Physical Therapy
- Specialties — Physical Therapy — EHR Software
- Speech Therapy
- Other Specialties
- Specialties
- Routine clinical laboratories: Medical necessity, frequency, and ABN before collection
- Anatomic pathology: Missing clinical information and add-on test authorization
- Molecular diagnostics and genetic testing: Test-specific coverage and documentation readiness
- Toxicology and urine drug testing laboratories: Frequency and test-panel appropriateness with provider query
- Radiology and advanced imaging: Order-to-authorization readiness and expiration management
- Interventional radiology: Procedure packet assembly and authorization-change management
- Sleep medicine and sleep laboratories: Sleep-test-to-PAP qualification and compliance tracking
- DME and HME suppliers: Pre-delivery documentation readiness
- Orthotics and prosthetics: Order, note, and product-code reconciliation
- Home infusion suppliers: Referral and documentation orchestration
- Ambulance and repetitive nonemergency transport: Repetitive transport authorization and PCS completeness
- Dental practices and DSOs: Predetermination and attachment completeness
- Medical oncology and hematology: Regimen benefits, authorization, and renewal management
- Radiation oncology: Treatment-course authorization and change management
- Infusion centers: Financial clearance and drug acquisition
- Rheumatology: Biologic authorization, renewal, and payer-switch management
- Dermatology: Biologic access with structured severity evidence
- Ophthalmology and retina: Retina drug access, inventory, and claim reconciliation
- Gastroenterology and inflammatory bowel disease: Endoscopy financial clearance with IBD biologic access
- Neurology: Botulinum toxin and neurologic biologic authorization
- Allergy and Immunology: Biologic and immunoglobulin access
- Urology: Drug and procedure authorization
- Endocrinology and diabetes: CGM and pump qualification and resupply
- Cardiology: Cardiac diagnostic and procedure authorization packet
- Orthopedics: Joint-replacement and orthopedic surgery readiness
- Spine Surgery: Conservative-treatment evidence for spine authorization
- Pain Management: Procedure medical-necessity and frequency control
- Vascular Surgery and Vein Practices: Conservative-treatment and imaging evidence for vein procedures
- Wound Care and Hyperbaric Medicine: Longitudinal wound evidence and skin-substitute compliance
- Podiatry: Routine foot care and diabetic footwear coverage
- Ambulatory surgery centers: Surgical case financial clearance
- Anesthesia practices: Facility-to-anesthesia record reconciliation
- Plastic, Reconstructive and Bariatric Surgery: Reconstructive medical-necessity evidence
- ENT and audiology: Sinus surgery documentation readiness with cochlear implant support
- OB/GYN and Maternal Care: Maternity benefit and authorization tracking
- Fertility and Reproductive Medicine: Cycle benefits and financial clearance
- Pediatrics: Newborn eligibility and pediatric referral closure
- Autism and ABA providers: Authorization units and treatment-plan renewal
- Outpatient behavioral health and psychiatry: Benefit carve-out and authorization
- Inpatient psychiatry, residential treatment, PHP and IOP: Continued-stay authorization and authorized-day control
- Substance-use-disorder providers: ASAM level-of-care authorization and continued-stay control
- Opioid treatment programs: Part 2-aware consent and records-disclosure control
- Physical therapy, occupational therapy, and speech therapy: Benefits, visits, authorization, and KX/ABN control tower
- Chiropractic: Active-treatment, maintenance-care, and ABN control tower
- Home health: Referral-to-start-of-care documentation readiness
- Hospice: Benefit-period certification and election documents
- Skilled nursing facilities: Admission and continued-stay coverage control
- Assisted living, HCBS and personal-care agencies: EVV exceptions and authorization units
- Nephrology and Dialysis: Additional-treatment and monthly-visit documentation
- Hospital utilization management: Patient-status, authorization, and notice orchestration
- Emergency departments and trauma centers: Post-service coverage discovery and accident-liability routing
- Transplant Programs: Evaluation and financial clearance
- Clinical Trials and Research Billing: Protocol billing coverage analysis
- FQHCs and Rural Health Clinics: Encounter, eligibility, and wrap-payment reconciliation
- Primary care and multispecialty groups: Referral and order readiness
- RPM, RTM, CCM, and PCM programs: Monthly evidence and billing readiness
- Telehealth organizations: Provider-location-payer compliance router
- Workers’ compensation, auto and liability care: State-specific authorization and document-status management
- Occupational medicine: Employer-authorized service and form completion
Locations
- Locations
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Puerto Rico
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming
Payers
- Payers Directory
- AARP Medicare
- Absolute Total Care
- Accident Fund
- Aetna
- Aetna Better Health
- Aetna Dental
- Aetna Medicare
- Aetna Signature Administrators
- Affinity Health Plan
- AgeWell New York
- AIG Workers Comp
- AIM Specialty Health
- Alameda Alliance for Health
- Alignment Healthcare
- Allied Benefit Systems
- Allstate
- Ambetter
- Ambetter Texas
- American Family Insurance
- Amerigroup
- AmeriHealth Caritas
- AmeriHealth NJ
- Ameritas
- AmTrust
- Anthem (Elevance Health)
- Anthem BCBS Georgia
- Anthem Blue Cross (California)
- ArchWell Health
- Asuris Northwest Health
- Auto-Owners Insurance
- Avesis
- AvMed
- Banner Health Plans
- BCBS Alabama
- BCBS Arizona
- BCBS Federal Employee Program
- BCBS Illinois
- BCBS Kansas
- BCBS Louisiana
- BCBS Michigan
- BCBS Minnesota
- BCBS Mississippi
- BCBS Montana
- BCBS Nebraska
- BCBS New Mexico
- BCBS North Carolina
- BCBS North Dakota
- BCBS Oklahoma
- BCBS Rhode Island
- BCBS South Carolina
- BCBS Tennessee
- BCBS Texas
- BCBS Vermont
- BCBS Western NY
- BCBS Wyoming
- Beacon Health Options
- BHHC
- Blue Cross of Idaho
- Blue KC
- Blue Shield of California
- Blue Shield Promise
- Boon Group
- BridgeSpan Health
- Bright Healthcare
- Brighton Health Plan Solutions
- Broadspire
- Buckeye Health Plan
- California State Fund (SCIF)
- CalOptima Health
- CalViva Health
- Cano Health
- Capital Blue Cross
- Capital Rx
- CareCredit
- CareFirst BCBS
- Careington
- Carelon
- CareOregon
- CareSource
- CDPHP
- CenCal Health
- Centene
- CenterWell
- Central California Alliance
- CGS Administrators
- CHAMPVA
- ChenMed
- CHRISTUS Health Plan
- Chubb
- Cigna
- Cigna Dental
- Cigna Medicare
- Cityblock Health
- Clover Health
- CNA Insurance
- Cofinity
- Cohere Health
- Community First Health Plans
- Community Health Choice
- Community Health Plan of Washington
- CommunityCare Oklahoma
- Contra Costa Health Plan
- CorVel
- Crawford & Company
- CVS Caremark
- Cypress Benefit Administrators
- Davis Vision
- Delta Dental
- Dental Select
- DentaQuest
- DenteMax
- Devoted Health
- Dominion Dental
- Elixir Rx
- EmblemHealth
- EmpiRx Health
- EMPLOYERS
- eQHealth
- Erie Insurance
- ESIS
- Essence Healthcare
- Everest Insurance
- eviCore
- Excellus BCBS
- Express Scripts
- EyeMed
- Fallon Community Health Plan
- Farmers Insurance
- Fidelis Care
- First Coast Medicare
- First Health Network
- Florida Blue
- Freedom Health
- Friday Health Plans
- Gallagher Bassett
- GEHA
- GEICO
- Geisinger Health Plan
- Gold Coast Health Plan
- Guardian
- HAP
- Harvard Pilgrim
- Health First Health Plans
- Health Net
- Health Plan of Nevada
- Health Plan of San Joaquin
- Healthfirst
- HealthHelp
- HealthPartners
- HealthSmart
- Helmsman Management
- Highmark BCBS
- Highmark BCBS Delaware
- Highmark Wholecare
- HM Insurance Group
- HMSA
- Horizon BCBS NJ
- Humana
- Humana Dental
- Humana Gold Plus
- Humana Military
- ICW Group
- IEHP
- Independence Blue Cross
- Independent Health
- Indian Health Service
- InnovAge
- InterLink Health Services
- Johns Hopkins HealthCare
- Kaiser Permanente
- KEPRO
- Kern Health Systems
- Key Benefit Administrators
- Keystone First
- L.A. Care
- LIBERTY Dental Plan
- Liberty Mutual
- Lincoln Financial
- Luminare Health
- Lyra Health
- Magellan Health
- Managed Dental Care
- MARCH Vision
- Markel
- Martin's Point Health Care
- Maryland Physicians Care
- Mass General Brigham Health Plan
- MCG Health
- McLaren Health Plan
- Medica
- Medicaid (Generic Reference)
- Medical Mutual
- Medicare (Traditional)
- MedImpact
- MedRisk
- MedStar Family Choice
- Meridian Health Plan
- Meritain Health
- MES Solutions
- MetLife Dental
- MetroPlus Health
- Mitchell
- Molina Healthcare
- Molina Washington
- MultiPlan
- Mutual of Omaha
- MVP Health Care
- Nationwide
- Navitus
- New Century Health
- NGS Medicare
- Noridian
- Novitas Solutions
- NVA
- NYSIF
- Oak Street Health
- Ohio BWC
- One Call
- OptiCare
- Optimum HealthCare
- Optum
- OptumRx
- Oscar Health
- Oxford Health Plans
- Palmetto GBA
- Parkland Community Health Plan
- Partnership HealthPlan of California
- Passport Health Plan
- Peach State Health Plan
- Pinnacol Assurance
- PMA Companies
- Premera Blue Cross
- Presbyterian Health Plan
- Prime Therapeutics
- Principal Financial
- Priority Health
- Priority Partners
- Progressive Insurance
- Providence Health Plan
- Quartet Health
- Quartz Health Plan
- Railroad Medicare
- Regence
- Renaissance Dental
- Rocky Mountain Health Plans
- Safety National
- San Francisco Health Plan
- Sanford Health Plan
- Santa Clara Family Health Plan
- SCAN Health Plan
- Security Health Plan
- Sedgwick
- SelectHealth
- Sentara Health Plans
- Sharp Health Plan
- SilverScript
- Simply Healthcare
- Solstice Benefits
- Sound Health & Wellness
- Spectera
- Spring Health
- State Farm
- SummaCare
- Sun Life Dental
- Sunshine Health
- Superior HealthPlan
- Superior Vision
- Texas Mutual
- The Hartford
- Travelers Insurance
- TRICARE East
- TRICARE West
- TRISTAR
- Trustmark
- Tufts Health Plan
- UCare
- UHC Community Plan
- UMR
- United Concordia
- UnitedHealthcare
- UnitedHealthcare Dental
- UPMC for You
- UPMC Health Plan
- USAA
- VA CCN
- Vantage Health Plan
- VSP
- W. R. Berkley
- Washington L&I
- WebTPA
- WellCare
- Wellmark Blue Cross Blue Shield
- Wellpoint
- WellSense
- Westfield Insurance
- WPS Medicare
- Zenith American Solutions
- Zenith Insurance
- Zing Health
- Zurich Insurance
Denials
Reference Hubs
CARC Codes
- CARC 1 - Deductible Amount
- CARC 4 - The procedure code is inconsistent with the modifier used or a requir...
- CARC 11 - The diagnosis is inconsistent with the procedure.
- CARC 16 - Claim/service lacks information or has submission/billing error(s).
- CARC 18 - Exact duplicate claim/service
- CARC 22 - This care may be covered by another payer per coordination of benefits.
- CARC 23 - The impact of prior payer(s) adjudication including payments and/or a...
- CARC 24 - Charges are covered under a capitation agreement/managed care plan.
- CARC 27 - Expenses incurred after coverage terminated.
- CARC 29 - The time limit for filing has expired.
- CARC 31 - Patient cannot be identified as our insured.
- CARC 45 - Charge exceeds fee schedule/maximum allowable or contracted/legislate...
- CARC 50 - These are non-covered services because this is not deemed a 'medical...
- CARC 54 - Multiple physicians/assistants are not covered in this case.
- CARC 96 - Non-covered charge(s).
- CARC 97 - The benefit for this service is included in the payment/allowance for...
- CARC 109 - Claim/service not covered by this payer/contractor. You must send the...
- CARC 119 - Benefit maximum for this time period or occurrence has been reached.
- CARC 125 - Submission/billing error(s). Usage: Refer to the 835 Healthcare Polic...
- CARC 150 - Payer deems the information submitted does not support this level of...
- CARC 167 - This (these) diagnosis(es) is (are) not covered.
- CARC 181 - Procedure code was invalid on the date of service.
- CARC 197 - Precertification/authorization/notification/pre-treatment absent.
- CARC 204 - This service/equipment/drug is not covered under the patient's curren...
- CARC 226 - Information requested from the Billing/Rendering Provider was not pro...
- CARC 231 - Mutually exclusive procedures cannot be done in the same day/setting.
- CARC B7 - This provider was not certified/eligible to be paid for this procedur...
- CARC B9 - Patient is enrolled in a Hospice.
- CARC B15 - This service/procedure requires that a qualifying service/procedure b...
- CARC 252 - An attachment/other documentation is required to adjudicate this clai...
- CARC B13 - Previously paid. Payment for this claim/service may have been provide...
- CARC A1 - Claim/Service denied. At least one Remark Code must be provided (may...
- CARC 227 - Information requested from the Billing/Rendering Provider was not pro...
- CARC 151 - Payment adjusted because the payer deems the information submitted do...
- CARC 243 - Services not authorized by network/primary care providers.
- CARC 59 - Processed based on multiple or concurrent procedure rules.
- CARC 242 - Services not provided by network/primary care providers.
- CARC 234 - This procedure is not paid separately.
- CARC 55 - Procedure/treatment/drug is deemed experimental/investigational by th...
- CARC 236 - This procedure or procedure/modifier combination is not compatible wi...
- CARC 26 - Expenses incurred prior to coverage.
- CARC 107 - The related or qualifying claim/service was not identified on this cl...
- CARC 129 - Prior processing information appears incorrect.
- CARC 39 - Services denied at the time authorization/pre-certification was reque...
- CARC 253 - Sequestration - reduction in federal payment.
- CARC 256 - Service not payable per managed care contract.
- CARC 272 - Coverage/program guidelines were not met.
- CARC 288 - Referral absent.
- CARC B11 - The claim/service has been transferred to the proper payer/processor...
- CARC 5 - The procedure code/type of bill is inconsistent with the place of ser...
- CARC 49 - This is a non-covered service because it is a routine/preventive exam...
- CARC 170 - Payment is denied when performed/billed by this type of provider.
- CARC 177 - Patient has not met the required eligibility requirements.
- CARC 216 - Based on the findings of a review organization.
- CARC 222 - Exceeds the contracted maximum number of hours/days/units by this pro...
- CARC 2 - Coinsurance Amount.
- CARC 8 - The procedure code is inconsistent with the provider type/specialty (...
- CARC 95 - Plan procedures not followed.
- CARC 131 - Claim specific negotiated discount.
- CARC 133 - The disposition of this service line is pending further review.
- CARC 185 - The rendering provider is not eligible to perform the service billed.
- CARC 193 - Original payment decision is being maintained. Upon review, it was de...
- CARC 198 - Precertification/notification/authorization/pre-treatment exceeded.
- CARC 200 - Expenses incurred during lapse in coverage.
- CARC 273 - Coverage/program guidelines were exceeded.
- CARC 284 - Precertification/authorization/notification/pre-treatment number may...
- CARC 286 - Appeal procedures not followed.
- CARC B16 - 'New Patient' qualifications were not met.
- CARC 32 - Our records indicate that this dependent is not an eligible dependent...
- CARC 21 - This injury/illness is the liability of the no-fault carrier.
- CARC 3 - Co-payment Amount.
- CARC 146 - Diagnosis was invalid for the date(s) of service reported.
- CARC 147 - Provider contracted/negotiated rate expired or not on file.
- CARC 163 - Attachment/other documentation referenced on the claim was not received.
- CARC 208 - National Provider Identifier - Not matched.
- CARC 251 - The attachment/other documentation that was received was incomplete o...
- CARC 58 - Treatment was deemed by the payer to have been rendered in an inappro...
- CARC B10 - Allowed amount has been reduced because a component of the basic proc...
- CARC B20 - Procedure/service was partially or fully furnished by another provider.
- CARC 40 - Charges do not meet qualifications for emergent/urgent care.
- CARC 9 - The diagnosis is inconsistent with the patient's age.
- CARC 15 - The authorization number is missing, invalid, or does not apply to th...
- CARC 20 - This injury/illness is covered by the liability carrier.
- CARC 6 - The procedure/revenue code is inconsistent with the patient's age.
- CARC 136 - Failure to follow prior payer's coverage rules.
- CARC 182 - Procedure modifier was invalid on the date of service.
- CARC 206 - National Provider Identifier - missing.
- CARC 246 - This non-payable code is for required reporting only.
- CARC 276 - Services denied by the prior payer(s) are not covered by this payer.
- CARC 7 - The procedure/revenue code is inconsistent with the patient's gender.
- CARC 30 - Payment adjusted because the patient has not met the required eligibi...
- CARC 183 - The referring provider is not eligible to refer the service billed.
- CARC 187 - Consumer Spending Account payments (includes but is not limited to Fl...
- CARC 201 - Workers' Compensation case settled. Patient is responsible for amount...
- CARC 261 - The procedure or service is inconsistent with the patient's history.
- CARC 10 - The diagnosis is inconsistent with the patient's gender.
- CARC 12 - The diagnosis is inconsistent with the provider type.
- CARC 13 - The date of death precedes the date of service.
- CARC 14 - The date of birth follows the date of service.
- CARC 35 - Lifetime benefit maximum has been reached.
- CARC 41 - Discount agreed to in Preferred Provider contract.
- CARC 42 - Charges exceed our fee schedule or maximum allowable amount.
- CARC 44 - Prompt-pay discount.
- CARC 47 - This (these) diagnosis(es) is (are) not covered, missing, or are inva...
- CARC 52 - The referring/prescribing/rendering provider is not eligible to refer...
- CARC 62 - Payment denied/reduced for absence of, or exceeded, pre-certification...
- CARC 65 - Procedure code was incorrect. This payment reflects the correct code.
- CARC 66 - Blood Deductible.
- CARC 70 - Cost outlier - Adjustment to compensate for additional costs.
- CARC 74 - Indirect Medical Education Adjustment.
- CARC 75 - Direct Medical Education Adjustment.
- CARC 77 - Covered days.
- CARC 78 - Non-Covered days/Room charge adjustment.
- CARC 87 - Transfer amount.
- CARC 88 - Adjustment amount represents collection against receivable created in...
- CARC 89 - Professional fees removed from charges.
- CARC 90 - Ingredient cost adjustment.
- CARC 91 - Dispensing fee adjustment.
- CARC 100 - Payment made to patient/insured/responsible party.
- CARC 101 - Predetermination: anticipated payment upon completion of services or...
- CARC 102 - Major Medical Adjustment.
- CARC 103 - Provider promotional discount (e.g., Senior citizen discount).
- CARC 104 - Managed care withholding.
- CARC 105 - Tax withholding.
- CARC 108 - Rent/purchase guidelines were not met.
- CARC 111 - Not covered unless the provider accepts assignment.
- CARC 114 - Procedure/product not approved by the Food and Drug Administration.
- CARC 115 - Procedure postponed, canceled, or delayed.
- CARC 116 - The advance indemnification notice signed by the patient did not comp...
- CARC 122 - Psychiatric reduction.
- CARC 128 - Newborn's services are covered in the mother's Allowance.
- CARC 140 - Patient/Insured health identification number and name do not match.
- CARC 149 - Lifetime benefit maximum has been reached for this service/benefit ca...
- CARC 152 - Payer deems the information submitted does not support this length of...
- CARC 166 - These services were submitted after this payer's responsibility for p...
- CARC 168 - Service(s) have been considered under the patient's medical plan. Ben...
- CARC 178 - Payment adjusted because the patient has not met the required spend d...
- CARC 180 - Patient has not met the required residency requirements.
- CARC 186 - Level of care change adjustment.
- CARC 188 - This product/procedure is only covered when used according to FDA rec...
- CARC 190 - Payment is included in the allowance for a Skilled Nursing Facility (...
- CARC 192 - Non standard adjustment code from paper remittance.
- CARC 205 - Pharmacy discount card processing fee.
- CARC 210 - Payment adjusted because pre-certification/authorization not received...
- CARC 219 - Based on extent of injury.
- CARC 221 - Workers' Compensation claim adjudicated as non-compensable.
- CARC 229 - Partial charge amount not considered by Medicare due to the initial c...
- CARC 249 - This claim has been identified as a readmission.
- CARC 275 - Prior payer's (or payers') patient responsibility (deductible, coinsu...
- CARC A5 - Medicare Claim PPS Capital Cost Outlier Amount.
- CARC 19 - This is a work-related injury/illness and thus the liability of the W...
- CARC 33 - Insured has no dependent coverage.
- CARC 34 - Insured has no coverage for newborns.
- CARC 51 - These are non-covered services because this is a pre-existing condition.
- CARC 53 - Services by an immediate relative or a member of the same household a...
- CARC 56 - Procedure/treatment has not been deemed 'proven to be effective' by t...
- CARC 60 - Charges for outpatient services are not covered when performed within...
- CARC 61 - Adjustment for failure to obtain second surgical opinion.
- CARC 69 - Day outlier amount.
- CARC 76 - Disproportionate Share Adjustment.
- CARC 85 - Patient Interest Adjustment (Use Only Group code PR).
- CARC 94 - Processed in Excess of charges.
- CARC 106 - Patient payment option/election not in effect.
- CARC 110 - Billing date predates service date.
- CARC 112 - Service not furnished directly to the patient and/or not documented.
- CARC 117 - Transportation is only covered to the closest facility that can provi...
- CARC 118 - ESRD network support adjustment.
- CARC 121 - Indemnification adjustment - compensation for outstanding member resp...
- CARC 130 - Claim submission fee.
- CARC 132 - Prearranged demonstration project adjustment.
- CARC 134 - Technical fees removed from charges.
- CARC 135 - Interim bills cannot be processed.
- CARC 137 - Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
- CARC 139 - Contracted funding agreement - Subscriber is employed by the provider...
- CARC 142 - Monthly Medicaid patient liability amount.
- CARC 143 - Portion of payment deferred.
- CARC 144 - Incentive adjustment, e.g. preferred product/service.
- CARC 148 - Information from another provider was not provided or was insufficien...
- CARC 153 - Service/procedure was provided as a result of an act of war.
- CARC 154 - Payer deems the information submitted does not support this dosage.
- CARC 155 - Patient refused the service/procedure.
- CARC 157 - Service/procedure was provided as a result of an act of war.
- CARC 158 - Service/procedure was provided outside of the United States.
- CARC 159 - Service/procedure was provided as a result of terrorism.
- CARC 160 - Injury/illness was the result of an activity that is a benefit exclus...
- CARC 161 - Provider performance bonus.
- CARC 164 - Attachment/other documentation referenced on the claim was not receiv...
- CARC 169 - Alternate benefit has been provided.
- CARC 171 - Payment is denied when performed/billed by this type of provider in t...
- CARC 172 - Payment is adjusted when performed/billed by a provider of this speci...
- CARC 173 - Service/equipment was not prescribed by a physician.
- CARC 174 - Service was not prescribed prior to delivery.
- CARC 175 - Prescription is incomplete.
- CARC 176 - Prescription is not current.
- CARC 179 - Patient has not met the required waiting requirements.
- CARC 184 - The prescribing/ordering provider is not eligible to prescribe/order...
- CARC 189 - 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) w...
- CARC 199 - Revenue code and Procedure code do not match.
- CARC 202 - Non-covered personal comfort or convenience services.
- CARC 203 - Discontinued or reduced service.
- CARC 207 - National Provider Identifier - Invalid format.
- CARC 209 - Per regulatory or other agreement, the provider cannot collect this a...
- CARC 211 - National Drug Code (NDC) is not eligible for rebate.
- CARC 212 - Administrative surcharges are not covered.
- CARC 213 - Non-compliance with the physician self referral prohibition legislati...
- CARC 215 - Based on subrogation of a third party settlement.
- CARC 223 - Adjustment code for mandated federal, state or local law/regulation t...
- CARC 224 - Patient identification compromised by identity theft. Identity verifi...
- CARC 225 - Penalty or Interest Payment by Payer (Only used for plan to plan enco...
- CARC 228 - Denied for failure of this provider, payer or subscriber to supply re...
- CARC 232 - Institutional Transfer Amount.
- CARC 233 - Services/charges related to the treatment of a hospital-acquired cond...
- CARC 235 - Sales Tax.
- CARC 237 - Legislated/Regulatory Penalty.
- CARC 238 - Claim spans eligible and ineligible periods of coverage.
- CARC 239 - Claim spans eligible and ineligible periods of coverage. Rebill separ...
- CARC 240 - The diagnosis is inconsistent with the patient's birth weight.
- CARC 241 - Low Income Subsidy (LIS) Co-payment Amount.
- CARC 245 - Provider performance program withhold.
- CARC 247 - Deductible for Professional service rendered in an Institutional sett...
- CARC 248 - Coinsurance for Professional service rendered in an Institutional set...
- CARC 250 - The attachment/other documentation that was received was the incorrec...
- CARC 254 - Claim received by the dental plan, but benefits not available under t...
- CARC 257 - The disposition of the related Property & Casualty claim (injury or i...
- CARC 258 - Claim/service not covered when patient is in custody/incarcerated.
- CARC 259 - Additional payment for Dental/Vision service utilization.
- CARC 260 - Processed under Medicaid ACA Enhanced Fee Schedule.
- CARC 262 - Adjustment for delivery cost.
- CARC 263 - Adjustment for shipping cost.
- CARC 264 - Adjustment for postage cost.
- CARC 265 - Adjustment for administrative cost.
- CARC 266 - Adjustment for compound preparation cost.
- CARC 267 - Claim/service spans multiple months.
- CARC 268 - The Claim spans two calendar years. Please resubmit one claim per cal...
- CARC 269 - Anesthesia not covered for this service/procedure.
- CARC 270 - Claim received by the medical plan, but benefits not available under...
- CARC 271 - Prior contractual reductions related to a current periodic payment as...
- CARC 274 - Fee/Service not payable per patient Care Coordination arrangement.
- CARC 278 - Performance program proficiency requirements not met.
- CARC 279 - Services not provided by Preferred network providers.
- CARC 280 - Claim received by the medical plan, but benefits not available under...
- CARC 281 - Deductible waived per contractual agreement.
- CARC 282 - The procedure/revenue code is inconsistent with the type of bill.
- CARC 283 - Attending provider is not eligible to provide direction of care.
- CARC 285 - Appeal procedures not followed.
- CARC 287 - Referral exceeded.
- CARC 289 - Services considered under the dental and medical plans, benefits not...
- CARC 290 - Claim received by the medical plan, but benefits not available under...
- CARC 291 - Claim received by the dental plan, but benefits not available under t...
- CARC 292 - Claim received by the medical plan, but benefits not available under...
- CARC 293 - Payment made to employer.
- CARC 294 - Payment made to attorney.
- CARC 295 - Pharmacy Direct/Indirect Remuneration (DIR).
- CARC 296 - Precertification/notification number does not apply to the specified...
- CARC 297 - Claim received by the medical plan, but benefits not available under...
- CARC 298 - Claim received by the medical plan, but benefits not available under...
- CARC 299 - The billing provider is not eligible to receive payment for the servi...
- CARC 300 - Claim received by the medical plan, but benefits not available under...
- CARC 301 - Claim received by the medical plan, but benefits not available under...
- CARC 302 - Precertification/notification number provided is no longer valid.
- CARC 303 - Prior payer's (or payers') patient responsibility (deductible, coinsu...
- CARC 304 - Claim received by the medical plan, but benefits not available under...
- CARC 305 - Claim received by the medical plan, but benefits not available under...
- CARC 306 - Type of bill is inconsistent with patient status.
- CARC 307 - Payment adjusted based on the Medicare Maximum Fair Price Standard.
- CARC 308 - Adjustment based on contracted funding agreement rate vs the amount b...
- CARC A0 - Patient refund amount.
- CARC A6 - Prior hospitalization or 30 day transfer requirement not met.
- CARC A8 - Ungroupable DRG.
- CARC B1 - Non-covered visits.
- CARC B4 - Late filing penalty.
- CARC B12 - Services not documented in patient's medical records.
- CARC B14 - Only one visit or consultation per physician per day is covered.
- CARC B23 - Procedure billed is not authorized per the Clinical Laboratory Improv...
- CARC P1 - State-mandated Requirement for Property and Casualty, see Claim Payme...
- CARC P2 - Not a work related injury/illness and thus not the liability of the w...
- CARC P3 - Workers' Compensation case settled, patient is responsible for furthe...
- CARC P4 - Workers' Compensation claim adjudicated as non-compensable.
- CARC P5 - Based on payer reasonable and customary fees. No maximum allowable de...
- CARC P6 - Based on entitlement to benefits.
- CARC P7 - The applicable fee schedule/fee database does not contain the billed...
- CARC P8 - Claim is under investigation.
- CARC P9 - No available or correlating CPT/HCPCS code to describe this service.
- CARC P10 - Payment reduced to zero due to litigation. Additional information wil...
- CARC P11 - The disposition of the claim/service is undetermined during the premi...
- CARC P12 - Workers' compensation jurisdictional fee schedule adjustment.
- CARC P13 - Payment reduced or denied based on workers' compensation jurisdiction...
- CARC P14 - The Benefit for this Service is included in the payment/allowance for...
- CARC P15 - Workers' Compensation Medical Treatment Guideline Adjustment.
- CARC P16 - Medical provider not authorized/certified to provide treatment to inj...
- CARC P17 - Referral not authorized by attending physician per regulatory require...
- CARC P18 - Procedure is not listed in the jurisdiction fee schedule. An allowanc...
- CARC P19 - Procedure has a relative value of zero in the jurisdiction fee schedu...
- CARC P20 - Service not paid under jurisdictional regulations or payment policies...
- CARC P21 - Payment denied based on Medical Payments Coverage (MPC) or Personal I...
- CARC P22 - Payment adjusted based on MPC or PIP Benefits jurisdictional regulati...
- CARC P23 - Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) B...
- CARC P24 - Payment adjusted based on Preferred Provider Organization (PPO).
- CARC P25 - Payment adjusted based on Medical Provider Network (MPN).
- CARC P26 - Payment adjusted based on Voluntary Provider network (VPN).
- CARC P27 - Payment denied based on the Liability Coverage Benefits jurisdictiona...
- CARC P28 - Payment adjusted based on Liability Coverage Benefits jurisdictional...
- CARC P29 - Liability Benefits jurisdictional fee schedule adjustment.
- CARC P30 - Exacerbation of previous condition denied due to incomplete medical d...
- CARC P31 - Exacerbation of previous condition denied due to treatment exceeding...
- CARC P32 - Payment adjusted due to Apportionment as determined by the Workers' C...
RARC Codes
- RARC M15 - Separately billed services/tests have been bundled as they are consid...
- RARC M25 - The information furnished does not substantiate the need for this lev...
- RARC M62 - Missing/incomplete/invalid treatment authorization code.
- RARC M80 - Not covered when performed during the same session/date as a previous...
- RARC N4 - Missing/Incomplete/Invalid prior insurance carrier EOB.
- RARC N20 - Service not payable with other service rendered on the same date.
- RARC N115 - This decision was based on a Local Coverage Determination (LCD). An L...
- RARC N130 - Consult plan benefit documents/guidelines for information about restr...
- RARC N362 - The number of Days or Units of Service exceeds our acceptable maximum.
- RARC N386 - This decision was based on a National Coverage Determination (NCD).
- RARC N381 - Alert: Consult our contractual agreement for restrictions/billing/pay...
- RARC M51 - Missing/incomplete/invalid procedure code(s).
- RARC N706 - Missing documentation.
- RARC M76 - Missing/incomplete/invalid diagnosis or condition.
- RARC M127 - Missing patient medical record for this service.
- RARC N30 - Patient ineligible for this service.
- RARC N19 - Procedure code incidental to primary procedure.
- RARC N418 - Misrouted claim. See the payer's claim submission instructions.
- RARC N56 - Procedure code billed is not correct/valid for the services billed or...
- RARC N382 - Missing/incomplete/invalid patient identifier.
- RARC M86 - Service denied because payment already made for same/similar procedur...
- RARC N290 - Missing/incomplete/invalid rendering provider primary identifier.
- RARC N245 - Incomplete/invalid plan information for other insurance.
- RARC N211 - Alert: You may not appeal this decision.
- RARC N569 - Not covered when performed for the reported diagnosis.
- RARC N598 - Health care policy coverage is primary.
- RARC N522 - Duplicate of a claim processed, or to be processed, as a crossover cl...
- RARC M77 - Missing/incomplete/invalid/inappropriate place of service.
- RARC N525 - These services are not covered when performed within the global perio...
- RARC N179 - Additional information has been requested from the member. The charge...
- RARC N257 - Missing/incomplete/invalid billing provider/supplier primary identifier.
- RARC M119 - Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (...
- RARC N255 - Missing/incomplete/invalid billing provider taxonomy.
- RARC N216 - We do not offer coverage for this type of service or the patient is n...
- RARC N220 - Alert: See the payer's web site or contact the payer's Customer Servi...
- RARC N286 - Missing/incomplete/invalid referring provider primary identifier.
- RARC M81 - You are required to code to the highest level of specificity.
- RARC N95 - This provider type/provider specialty may not bill this service.
- RARC N16 - Family/member Out-of-Pocket maximum has been met. Payment based on a...
- RARC N10 - Adjustment based on a medical/dental provider's initial determination.
- RARC N34 - Incorrect claim form/format for this service.
- RARC M115 - This item is denied when provided to this patient by a non-contract o...
- RARC M47 - Missing/incomplete/invalid internal or document control number.
- RARC M144 - Pre-/post-operative care payment is included in the allowance for the...
- RARC N59 - Please refer to your provider manual for additional program and provi...
- RARC N265 - Missing/incomplete/invalid ordering provider primary identifier.
- RARC M53 - Missing/incomplete/invalid days or units of service.
- RARC M60 - Missing Certificate of Medical Necessity.
- RARC N122 - Add-on code cannot be billed by itself.
- RARC N52 - Patient not enrolled in the billing provider's managed care plan on t...
- RARC N54 - Claim information is inconsistent with pre-certified/authorized servi...
- RARC N264 - Missing/incomplete/invalid ordering provider name.
- RARC N431 - Service is not covered with this procedure.
- RARC N650 - This policy was not in effect for this date of loss. No coverage is a...
- RARC M20 - Missing/incomplete/invalid HCPCS code.
- RARC N45 - Payment based on authorized amount.
- RARC M16 - Alert: Please see our Web site, mailing, bulletin, or other publicati...
- RARC N123 - This is a split service and represents a portion of the units from th...
- RARC N104 - This claim/service is not payable under our claims jurisdiction area....
- RARC N65 - Procedure code or procedure rate count cannot be determined, or was n...
- RARC N356 - Not covered when performed with, or subsequent to, a non-covered serv...
- RARC N1 - Alert: You may appeal this decision in writing within the required ti...
- RARC N22 - This procedure code was added/changed because it more accurately desc...
- RARC M50 - Missing/incomplete/invalid revenue code(s).
- RARC M67 - Missing/incomplete/invalid other procedure code(s).
- RARC N294 - Missing/incomplete/invalid service facility primary identifier.
- RARC N435 - Exceeds number/frequency approved/allowed within time period without...
- RARC M56 - Missing/incomplete/invalid payer identifier.
- RARC M49 - Missing/incomplete/invalid value code(s) or amount(s).
- RARC M54 - Missing/incomplete/invalid total charges.
- RARC M2 - Not paid separately when the patient is an inpatient.
- RARC N289 - Missing/incomplete/invalid rendering provider name.
- RARC N345 - Date range not valid with units submitted.
- RARC N35 - Program integrity/utilization review decision.
- RARC N480 - Incomplete/invalid Explanation of Benefits (EOB).
- RARC M13 - Only one initial visit is covered per specialty per medical group.
- RARC N26 - Missing itemized bill/statement.
- RARC M79 - Missing/incomplete/invalid charge.
- RARC M52 - Missing/incomplete/invalid 'from' date(s) of service.
- RARC M41 - We do not pay for this as the patient has no legal obligation to pay...
- RARC N29 - Missing documentation/orders/notes/summary/report/chart.
- RARC N58 - Missing/incomplete/invalid patient liability amount.
- RARC N280 - Missing/incomplete/invalid pay-to provider primary identifier.
- RARC N329 - Missing/incomplete/invalid patient birth date.
- RARC N450 - Covered only when performed by the primary treating physician or the...
- RARC N206 - The supporting documentation does not match the claim/service.
- RARC M4 - Alert: This may involve a question of fact that may be addressed by t...
- RARC M17 - Alert: Payment approved as you did not know, and could not reasonably...
- RARC M18 - Certain services may be approved for home use. Neither a hospital nor...
- RARC M28 - This does not qualify for payment under Part B when Part A coverage i...
- RARC M30 - Missing pathology report.
- RARC M31 - Missing radiology report.
- RARC M126 - Missing/incomplete/invalid individual lab codes included in the test.
- RARC M130 - Missing invoice or statement certifying the actual cost of the lens,...
- RARC M143 - The provider must update license information with the payer.
- RARC N5 - EOB/EOMB reflects prior payer's payment or patient responsibility. Th...
- RARC N11 - Denial reversed because of medical review.
- RARC N13 - Payment based on professional/technical component modifier(s).
- RARC N14 - Payment based on a contractual amount or agreement, fee schedule, or...
- RARC N31 - Missing/incomplete/invalid prescribing provider identifier.
- RARC M1 - X-ray not taken within the past 12 months or near enough to the start...
- RARC M3 - Equipment is the same or similar to equipment already being used.
- RARC M7 - No rental payments after the item is purchased, or after the total of...
- RARC M9 - This is the tenth rental month. You must offer the option of changing...
- RARC M23 - Missing invoice.
- RARC M27 - The patient has been relieved of liability of payment of these items...
- RARC M36 - This is the 11th rental month. You must offer the patient the option...
- RARC M39 - The patient is not liable for payment for this service as the advance...
- RARC M44 - Missing/incomplete/invalid condition code.
- RARC M55 - We do not pay for self-administered anti-emetic drugs.
- RARC M59 - Missing/incomplete/invalid 'from' date of service.
- RARC M64 - Missing/incomplete/invalid other diagnosis.
- RARC M66 - Our records indicate that we should be the third payer for this claim...
- RARC M69 - Paid at the regular rate as you did not submit documentation to justi...
- RARC M70 - NDC code submitted for this service was translated to a HCPCS code fo...
- RARC M90 - Not covered more than once in a 12-month period.
- RARC M97 - Not paid to practitioner when provided to patient in this place of se...
- RARC M102 - Service not performed on equipment approved by the FDA for this purpose.
- RARC M117 - Not covered unless submitted via electronic claim.
- RARC M124 - Missing indication of whether the patient owns the equipment that req...
- RARC N7 - Processing of this claim/service has included consideration under Maj...
- RARC N12 - Policy provides coverage supplemental to Medicare. As the member does...
- RARC N21 - Alert: Your line item has been separated into multiple lines to exped...
- RARC N25 - This company has been contracted by your benefit plan to provide admi...
- RARC N27 - Missing/incomplete/invalid treatment number.
- RARC N32 - Claim must be submitted by the provider who rendered the service.
- RARC N36 - Claim must meet primary payer's processing requirements before we can...
- RARC N40 - Missing radiology film(s)/image(s).
- RARC N44 - Payer's Reasonable & Customary fees lower than provider's submitted c...
- RARC N46 - Missing/incomplete/invalid admission hour.
- RARC N50 - Missing/incomplete/invalid discharge information.
- RARC N55 - Procedures for billing with group/referring/performing providers were...
- RARC N64 - The 'from' and 'to' dates must be different.
- RARC N67 - Professional provider services not paid separately. Included in facil...
- RARC N70 - Consolidated billing and payment applies.
- RARC N77 - Missing/incomplete/invalid designated provider number.
- RARC N82 - Providers who administer vaccines are encouraged to bill separately.
- RARC N85 - Requested additional information was not received.
- RARC N88 - Alert: This payment is being made conditionally. An HHA episode of ca...
- RARC N97 - Patients with stress incontinence, urinary obstruction, and specific...
- RARC N102 - This claim has been denied without reviewing the medical record becau...
- RARC N106 - Payment for services furnished to Skilled Nursing Facility (SNF) inpa...
- RARC N109 - This claim/service was chosen for complex review and was denied after...
- RARC N112 - This claim is excluded from your electronic remittance advice.
- RARC N118 - This service is not paid if billed more than once every 28 days.
- RARC N127 - This is a misdirected claim/service for an RRB beneficiary. Submit pa...
- RARC N131 - Total payments under multiple contracts cannot exceed the allowance f...
- RARC N146 - Missing screening document.
- RARC N160 - The patient must choose an option before a payment can be made for th...
- RARC N173 - No qualifying hospital stay dates were provided for this episode of c...
- RARC N176 - Services provided aboard a ship are covered only when the ship is of...
- RARC N180 - This item or service does not meet the criteria for the category unde...
- RARC N185 - Alert: Do not resubmit this claim/service.
- RARC N192 - Patient is a Medicaid/Qualified Medicare Beneficiary.
- RARC N200 - The professional component must be billed separately.
- RARC N225 - Incomplete/invalid documentation/orders/notes/summary/report/chart.
- RARC N234 - Incomplete/invalid oxygen certification/re-certification.
- RARC N260 - Missing/incomplete/invalid billing provider/supplier contact informat...
- RARC N272 - Missing/incomplete/invalid other payer attending provider identifier.
- RARC N291 - Missing/incomplete/invalid rendering provider primary identifier.
- RARC N300 - Missing/incomplete/invalid occurrence date(s).
- RARC N318 - Missing/incomplete/invalid discharge or end of care date.
- RARC N336 - Missing/incomplete/invalid referral date.
- RARC N350 - Missing/incomplete/invalid description of service for a Not Otherwise...
- RARC N370 - Billing exceeds the rental months covered/approved by the payer.
- RARC N380 - The original claim has been processed, submit a corrected claim.
- RARC N390 - This service/report cannot be billed separately.
- RARC N400 - Alert: Electronically enabled providers should submit claims electron...
- RARC N410 - Not covered unless the prescription changes.
- RARC N428 - Not covered when performed in this place of service.
- RARC N455 - Missing Physician Order.
- RARC N466 - Missing Physical Therapy Notes/Report.
- RARC N479 - Missing Explanation of Benefits (Coordination of Benefits or Medicare...
- RARC N505 - This facility is not authorized for this procedure.
- RARC N517 - Resubmit a new claim with the requested information.
- RARC N540 - Payment adjusted based on the interrupted stay policy.
- RARC N565 - Alert: This non-payable code is for required reporting only.
- RARC N575 - Mismatch between the submitted provider information and the provider...
- RARC N600 - Adjusted because services may be related to a hospital admission.
- RARC N620 - This payer does not cover items and services furnished to an individu...
- RARC N630 - Referral not authorized by attending physician.
- RARC N640 - Exceeds number/frequency approved/allowed within time period.
- RARC N657 - This should be billed with the appropriate code for these services.
- RARC N674 - Not covered unless a pre-requisite procedure/service has been provided.
- RARC N700 - Payment adjusted based on the Electronic Health Records (EHR) Incenti...
- RARC N750 - Missing/incomplete/invalid Social Security Number or Health Insurance...
- RARC N788 - Alert: Patient was transferred. Medicare Advantage plan (Part C) or P...
- RARC N800 - Only one evaluation and management code at this service level is cove...
- RARC N9 - Adjustment represents the estimated amount a previous payer may pay.
- RARC N15 - Services for a newborn must be billed separately.
- RARC N37 - Missing/incomplete/invalid tooth number/letter.
- RARC N61 - Rebill services on separate claims.
- RARC N90 - Covered only when performed by the attending physician.
- RARC N117 - This service is paid only once in a patient's lifetime.
- RARC N128 - This amount represents the prior to coverage portion of the allowance.
- RARC N170 - A new/revised/renewed certificate of medical necessity is needed.
- RARC N210 - Alert: You may appeal this decision.
- RARC N287 - Missing/incomplete/invalid referring provider primary identifier.
- RARC N309 - Missing/incomplete/invalid assessment date.
- RARC N420 - Not covered when considered routine.
Coding Reference
Reference Hubs
- MS-DRG reference (FY2027 weights and length of stay)
- HCPCS Part B drug codes (ASP, MUE, NDC units)
- Medicare telehealth services list (CY2026)
- CMS-HCC V28 categories (what is an HCC code)
- MDC 01 - Assignment of Diagnosis Codes
- MDC 02 - Assignment of Diagnosis Codes
- MDC 03 - Assignment of Diagnosis Codes
- MDC 04 - Assignment of Diagnosis Codes
- MDC 05 - Assignment of Diagnosis Codes
- MDC 06 - Assignment of Diagnosis Codes
- MDC 07 - Diseases and Disorders of the Hepatobiliary System and Pa...
- MDC 08 - Diseases and Disorders of the Musculoskeletal System and...
- MDC 09 - Diseases and Disorders of the Skin, Subcutaneous Tissue a...
- MDC 10 - Assignment of Diagnosis Codes
- MDC 11 - Assignment of Diagnosis Codes
- MDC 12 - Assignment of Diagnosis Codes
- MDC 13 - Assignment of Diagnosis Codes
- MDC 14 - Assignment of Diagnosis Codes
- MDC 15 - Newborns and Other Neonates with Conditions Originating i...
- MDC 16 - Diseases and Disorders of Blood, Blood Forming Organs and...
- MDC 17 - Myeloproliferative Diseases and Disorders, Poorly Differe...
- MDC 18 - Infectious and Parasitic Diseases, Systemic or Unspecifie...
- MDC 19 - Assignment of Diagnosis Codes
- MDC 20 - Assignment of Diagnosis Codes
- MDC 21 - Assignment of Diagnosis Codes
- MDC 22 - Assignment of Diagnosis Codes
- MDC 23 - Factors Influencing Health Status and Other Contacts with...
- MDC 24 - Not assigned to an MDC
- MDC 25 - Assignment of Diagnosis Codes
- MDC PRE - Pre-MDC (transplants, tracheostomy, ECMO)
- MS-DRGs not assigned to an MDC
- Drugs administered other than oral method, chemotherapy drugs (J codes)
- Temporary codes (Q codes)
- Medical and surgical supplies, administrative (A codes)
- Other ASP-priced HCPCS codes
- Medicare coverage reference (NCDs, lab NCD code lists, MACs)
- What is a National Coverage Determination (NCD)
- Medicare LCD lookup guide
- Medicare Coverage Database guide
- Medicare LCD list (every active Local Coverage Determination)
- NCCI edit checker (PTP bundling pairs)
- CGS Administrators, LLC (204 LCDs)
- First Coast Service Options, Inc. (79 LCDs)
- Noridian Healthcare Solutions, LLC (174 LCDs)
- Novitas Solutions, Inc. (71 LCDs)
- Palmetto GBA (190 LCDs)
- Wellpoint Federal (89 LCDs)
- Wisconsin Physicians Service Insurance Corporation (113 LCDs)
- Reference methodology
- Research reports
- FY2027 MS-DRG weight changes
- MUE lookup tool
MS-DRGs (FY2027)
- DRG 001 - Heart Transplant or Implant of Heart Assist System with MCC
- DRG 002 - Heart Transplant or Implant of Heart Assist System without MCC
- DRG 003 - ECMO or Tracheostomy with MV >96 Hours or Principal Diagnosis Except...
- DRG 004 - Tracheostomy with MV >96 Hours or Principal Diagnosis Except Face, Mo...
- DRG 005 - Liver Transplant with MCC or Intestinal Transplant
- DRG 006 - Liver Transplant without MCC
- DRG 007 - Lung Transplant
- DRG 010 - Pancreas or Islet Cell Transplant
- DRG 011 - Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
- DRG 012 - Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
- DRG 013 - Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy witho...
- DRG 014 - Allogeneic Bone Marrow Transplant
- DRG 016 - Autologous Bone Marrow Transplant with CC/MCC
- DRG 017 - Autologous Bone Marrow Transplant without CC/MCC
- DRG 018 - Chimeric Antigen Receptor (CAR) T-Cell and Other Immunotherapies
- DRG 020 - Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage...
- DRG 021 - Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage...
- DRG 022 - Intracranial Vascular Procedures with Principal Diagnosis Hemorrhage...
- DRG 023 - Craniotomy with Major Device Implant or Acute Complex CNS Principal D...
- DRG 024 - Craniotomy with Major Device Implant or Acute Complex CNS Principal D...
- DRG 025 - Craniotomy and Endovascular Intracranial Procedures with MCC
- DRG 026 - Craniotomy and Endovascular Intracranial Procedures with CC
- DRG 027 - Craniotomy and Endovascular Intracranial Procedures without CC/MCC
- DRG 028 - Spinal Procedures with MCC
- DRG 029 - Spinal Procedures with CC or Spinal Neurostimulators
- DRG 030 - Spinal Procedures without CC/MCC
- DRG 031 - Ventricular Shunt Procedures with MCC
- DRG 032 - Ventricular Shunt Procedures with CC
- DRG 033 - Ventricular Shunt Procedures without CC/MCC
- DRG 034 - Carotid Artery Stent Procedures with MCC
- DRG 035 - Carotid Artery Stent Procedures with CC
- DRG 036 - Carotid Artery Stent Procedures without CC/MCC
- DRG 037 - Extracranial Procedures with MCC
- DRG 038 - Extracranial Procedures with CC
- DRG 039 - Extracranial Procedures without CC/MCC
- DRG 040 - Peripheral, Cranial Nerve and Other Nervous System Procedures with MCC
- DRG 041 - Peripheral, Cranial Nerve and Other Nervous System Procedures with CC...
- DRG 042 - Peripheral, Cranial Nerve and Other Nervous System Procedures without...
- DRG 052 - Spinal Disorders and Injuries with CC/MCC
- DRG 053 - Spinal Disorders and Injuries without CC/MCC
- DRG 054 - Nervous System Neoplasms with MCC
- DRG 055 - Nervous System Neoplasms without MCC
- DRG 056 - Degenerative Nervous System Disorders with MCC
- DRG 057 - Degenerative Nervous System Disorders without MCC
- DRG 058 - Multiple Sclerosis and Cerebellar Ataxia with MCC
- DRG 059 - Multiple Sclerosis and Cerebellar Ataxia with CC
- DRG 060 - Multiple Sclerosis and Cerebellar Ataxia without CC/MCC
- DRG 061 - Ischemic Stroke, Precerebral Occlusion or Transient Ischemia with Thr...
- DRG 062 - Ischemic Stroke, Precerebral Occlusion or Transient Ischemia with Thr...
- DRG 063 - Ischemic Stroke, Precerebral Occlusion or Transient Ischemia with Thr...
- DRG 064 - Intracranial Hemorrhage or Cerebral Infarction with MCC
- DRG 065 - Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 H...
- DRG 066 - Intracranial Hemorrhage or Cerebral Infarction without CC/MCC
- DRG 067 - Precerebral Occlusion without Infarction with MCC
- DRG 068 - Precerebral Occlusion without Infarction without MCC
- DRG 069 - Transient Ischemia without Thrombolytic
- DRG 070 - Other Cerebrovascular Disorders with MCC
- DRG 071 - Other Cerebrovascular Disorders with CC
- DRG 072 - Other Cerebrovascular Disorders without CC/MCC
- DRG 073 - Cranial and Peripheral Nerve Disorders with MCC
- DRG 074 - Cranial and Peripheral Nerve Disorders without MCC
- DRG 075 - Viral Meningitis with CC/MCC
- DRG 076 - Viral Meningitis without CC/MCC
- DRG 080 - Nontraumatic Stupor and Coma with MCC
- DRG 081 - Nontraumatic Stupor and Coma without MCC
- DRG 082 - Traumatic Stupor and Coma >1 Hour with MCC
- DRG 083 - Traumatic Stupor and Coma >1 Hour with CC
- DRG 084 - Traumatic Stupor and Coma >1 Hour without CC/MCC
- DRG 085 - Traumatic Stupor and Coma <1 Hour with MCC
- DRG 086 - Traumatic Stupor and Coma <1 Hour with CC
- DRG 087 - Traumatic Stupor and Coma <1 Hour without CC/MCC
- DRG 088 - Concussion with MCC
- DRG 089 - Concussion with CC
- DRG 090 - Concussion without CC/MCC
- DRG 091 - Other Disorders of Nervous System with MCC
- DRG 092 - Other Disorders of Nervous System with CC
- DRG 093 - Other Disorders of Nervous System without CC/MCC
- DRG 094 - Bacterial and Tuberculous Infections of Nervous System with MCC
- DRG 095 - Bacterial and Tuberculous Infections of Nervous System with CC
- DRG 096 - Bacterial and Tuberculous Infections of Nervous System without CC/MCC
- DRG 097 - Non-Bacterial Infection of Nervous System Except Viral Meningitis wit...
- DRG 098 - Non-Bacterial Infection of Nervous System Except Viral Meningitis wit...
- DRG 099 - Non-Bacterial Infection of Nervous System Except Viral Meningitis wit...
- DRG 100 - Seizures with MCC
- DRG 101 - Seizures without MCC
- DRG 102 - Headaches with MCC
- DRG 103 - Headaches without MCC
- DRG 113 - Orbital Procedures with CC/MCC
- DRG 114 - Orbital Procedures without CC/MCC
- DRG 115 - Extraocular Procedures Except Orbit
- DRG 116 - Intraocular Procedures with CC/MCC
- DRG 117 - Intraocular Procedures without CC/MCC
- DRG 121 - Acute Major Eye Infections with CC/MCC
- DRG 122 - Acute Major Eye Infections without CC/MCC
- DRG 123 - Neurological Eye Disorders
- DRG 124 - Other Disorders of the Eye with MCC or Thrombolytic Agent
- DRG 125 - Other Disorders of the Eye without MCC
- DRG 135 - Sinus and Mastoid Procedures with CC/MCC
- DRG 136 - Sinus and Mastoid Procedures without CC/MCC
- DRG 137 - Mouth Procedures with CC/MCC
- DRG 138 - Mouth Procedures without CC/MCC
- DRG 139 - Salivary Gland Procedures
- DRG 140 - Major Head and Neck Procedures with MCC
- DRG 141 - Major Head and Neck Procedures with CC
- DRG 142 - Major Head and Neck Procedures without CC/MCC
- DRG 143 - Other Ear, Nose, Mouth and Throat O.R. Procedures with MCC
- DRG 144 - Other Ear, Nose, Mouth and Throat O.R. Procedures with CC
- DRG 145 - Other Ear, Nose, Mouth and Throat O.R. Procedures without CC/MCC
- DRG 146 - Ear, Nose, Mouth and Throat Malignancy with MCC
- DRG 147 - Ear, Nose, Mouth and Throat Malignancy with CC
- DRG 148 - Ear, Nose, Mouth and Throat Malignancy without CC/MCC
- DRG 149 - Dysequilibrium
- DRG 150 - Epistaxis with MCC
- DRG 151 - Epistaxis without MCC
- DRG 152 - Otitis Media and URI with MCC
- DRG 153 - Otitis Media and URI without MCC
- DRG 154 - Other Ear, Nose, Mouth and Throat Diagnoses with MCC
- DRG 155 - Other Ear, Nose, Mouth and Throat Diagnoses with CC
- DRG 156 - Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC
- DRG 157 - Dental and Oral Diseases with MCC
- DRG 158 - Dental and Oral Diseases with CC
- DRG 159 - Dental and Oral Diseases without CC/MCC
- DRG 163 - Major Chest Procedures with MCC
- DRG 164 - Major Chest Procedures with CC
- DRG 165 - Major Chest Procedures without CC/MCC
- DRG 166 - Other Respiratory System O.R. Procedures with MCC
- DRG 167 - Other Respiratory System O.R. Procedures with CC
- DRG 168 - Other Respiratory System O.R. Procedures without CC/MCC
- DRG 173 - Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosi...
- DRG 175 - Pulmonary Embolism with MCC or Acute Cor Pulmonale
- DRG 176 - Pulmonary Embolism without MCC
- DRG 177 - Respiratory Infections and Inflammations with MCC
- DRG 178 - Respiratory Infections and Inflammations with CC
- DRG 179 - Respiratory Infections and Inflammations without CC/MCC
- DRG 180 - Respiratory Neoplasms with MCC
- DRG 181 - Respiratory Neoplasms with CC
- DRG 182 - Respiratory Neoplasms without CC/MCC
- DRG 183 - Major Chest Trauma with MCC
- DRG 184 - Major Chest Trauma with CC
- DRG 185 - Major Chest Trauma without CC/MCC
- DRG 186 - Pleural Effusion with MCC
- DRG 187 - Pleural Effusion with CC
- DRG 188 - Pleural Effusion without CC/MCC
- DRG 189 - Pulmonary Edema and Respiratory Failure
- DRG 190 - Chronic Obstructive Pulmonary Disease with MCC
- DRG 191 - Chronic Obstructive Pulmonary Disease with CC
- DRG 192 - Chronic Obstructive Pulmonary Disease without CC/MCC
- DRG 193 - Simple Pneumonia and Pleurisy with MCC
- DRG 194 - Simple Pneumonia and Pleurisy with CC
- DRG 195 - Simple Pneumonia and Pleurisy without CC/MCC
- DRG 196 - Interstitial Lung Disease with MCC
- DRG 197 - Interstitial Lung Disease with CC
- DRG 198 - Interstitial Lung Disease without CC/MCC
- DRG 199 - Pneumothorax with MCC
- DRG 200 - Pneumothorax with CC
- DRG 201 - Pneumothorax without CC/MCC
- DRG 202 - Bronchitis and Asthma with CC/MCC
- DRG 203 - Bronchitis and Asthma without CC/MCC
- DRG 204 - Respiratory Signs and Symptoms
- DRG 205 - Other Respiratory System Diagnoses with MCC
- DRG 206 - Other Respiratory System Diagnoses without MCC
- DRG 207 - Respiratory System Diagnosis with Ventilator Support >96 Hours
- DRG 208 - Respiratory System Diagnosis with Ventilator Support <=96 Hours
- DRG 209 - Complex Aortic Arch Procedures
- DRG 210 - Cardiac Pacemaker Revision or Device Replacement with MCC
- DRG 211 - Cardiac Pacemaker Revision or Device Replacement without MCC
- DRG 212 - Concomitant Aortic and Mitral Valve Procedures
- DRG 213 - Endovascular Abdominal Aorta with Iliac Branch Procedures
- DRG 215 - Other Heart Assist System Implant
- DRG 216 - Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac...
- DRG 217 - Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac...
- DRG 218 - Cardiac Valve and Other Major Cardiothoracic Procedures with Cardiac...
- DRG 219 - Cardiac Valve and Other Major Cardiothoracic Procedures without Cardi...
- DRG 220 - Cardiac Valve and Other Major Cardiothoracic Procedures without Cardi...
- DRG 221 - Cardiac Valve and Other Major Cardiothoracic Procedures without Cardi...
- DRG 228 - Other Cardiothoracic Procedures with MCC
- DRG 229 - Other Cardiothoracic Procedures without MCC
- DRG 231 - Coronary Bypass with PTCA with MCC
- DRG 232 - Coronary Bypass with PTCA without MCC
- DRG 233 - Coronary Bypass with Cardiac Catheterization or Open Ablation with MCC
- DRG 234 - Coronary Bypass with Cardiac Catheterization or Open Ablation without...
- DRG 235 - Coronary Bypass without Cardiac Catheterization with MCC
- DRG 236 - Coronary Bypass without Cardiac Catheterization without MCC
- DRG 239 - Amputation for Circulatory System Disorders Except Upper Limb and Toe...
- DRG 240 - Amputation for Circulatory System Disorders Except Upper Limb and Toe...
- DRG 241 - Amputation for Circulatory System Disorders Except Upper Limb and Toe...
- DRG 242 - Permanent Cardiac Pacemaker Implant with MCC
- DRG 243 - Permanent Cardiac Pacemaker Implant with CC
- DRG 244 - Permanent Cardiac Pacemaker Implant without CC/MCC
- DRG 245 - AICD Generator Procedures
- DRG 250 - Percutaneous Cardiovascular Procedures without Intraluminal Device wi...
- DRG 251 - Percutaneous Cardiovascular Procedures without Intraluminal Device wi...
- DRG 252 - Other Vascular Procedures with MCC
- DRG 253 - Other Vascular Procedures with CC
- DRG 254 - Other Vascular Procedures without CC/MCC
- DRG 255 - Upper Limb and Toe Amputation for Circulatory System Disorders with MCC
- DRG 256 - Upper Limb and Toe Amputation for Circulatory System Disorders with CC
- DRG 257 - Upper Limb and Toe Amputation for Circulatory System Disorders withou...
- DRG 263 - Vein Ligation and Stripping
- DRG 265 - AICD Lead Procedures
- DRG 266 - Endovascular Cardiac Valve Replacement and Supplement Procedures with...
- DRG 267 - Endovascular Cardiac Valve Replacement and Supplement Procedures with...
- DRG 268 - Aortic and Heart Assist Procedures Except Pulsation Balloon with MCC
- DRG 269 - Aortic and Heart Assist Procedures Except Pulsation Balloon without MCC
- DRG 270 - Other Major Cardiovascular Procedures with MCC
- DRG 271 - Other Major Cardiovascular Procedures with CC
- DRG 272 - Other Major Cardiovascular Procedures without CC/MCC
- DRG 273 - Percutaneous and Other Intracardiac Procedures with MCC
- DRG 274 - Percutaneous and Other Intracardiac Procedures without MCC
- DRG 275 - Cardiac Defibrillator Implant with Cardiac Catheterization and MCC
- DRG 276 - Cardiac Defibrillator Implant with MCC or Carotid Sinus Neurostimulator
- DRG 277 - Cardiac Defibrillator Implant without MCC
- DRG 278 - Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular...
- DRG 279 - Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular...
- DRG 280 - Acute Myocardial Infarction, Discharged Alive with MCC
- DRG 281 - Acute Myocardial Infarction, Discharged Alive with CC
- DRG 282 - Acute Myocardial Infarction, Discharged Alive without CC/MCC
- DRG 283 - Acute Myocardial Infarction, Expired with MCC
- DRG 284 - Acute Myocardial Infarction, Expired with CC
- DRG 285 - Acute Myocardial Infarction, Expired without CC/MCC
- DRG 286 - Circulatory Disorders Except AMI, with Cardiac Catheterization with MCC
- DRG 287 - Circulatory Disorders Except AMI, with Cardiac Catheterization withou...
- DRG 288 - Acute and Subacute Endocarditis with MCC
- DRG 289 - Acute and Subacute Endocarditis with CC
- DRG 290 - Acute and Subacute Endocarditis without CC/MCC
- DRG 291 - Heart Failure and Shock with MCC
- DRG 292 - Heart Failure and Shock with CC
- DRG 293 - Heart Failure and Shock without CC/MCC
- DRG 296 - Cardiac Arrest, Unexplained with MCC
- DRG 297 - Cardiac Arrest, Unexplained with CC
- DRG 298 - Cardiac Arrest, Unexplained without CC/MCC
- DRG 299 - Peripheral Vascular Disorders with MCC
- DRG 300 - Peripheral Vascular Disorders with CC
- DRG 301 - Peripheral Vascular Disorders without CC/MCC
- DRG 302 - Atherosclerosis with MCC
- DRG 303 - Atherosclerosis without MCC
- DRG 304 - Hypertension with MCC
- DRG 305 - Hypertension without MCC
- DRG 306 - Cardiac Congenital and Valvular Disorders with MCC
- DRG 307 - Cardiac Congenital and Valvular Disorders without MCC
- DRG 308 - Cardiac Arrhythmia and Conduction Disorders with MCC
- DRG 309 - Cardiac Arrhythmia and Conduction Disorders with CC
- DRG 310 - Cardiac Arrhythmia and Conduction Disorders without CC/MCC
- DRG 311 - Angina Pectoris
- DRG 312 - Syncope and Collapse
- DRG 313 - Chest Pain
- DRG 314 - Other Circulatory System Diagnoses with MCC
- DRG 315 - Other Circulatory System Diagnoses with CC
- DRG 316 - Other Circulatory System Diagnoses without CC/MCC
- DRG 317 - Concomitant Left Atrial Appendage Closure and Cardiac Ablation
- DRG 318 - Percutaneous Coronary Atherectomy without Intraluminal Device
- DRG 319 - Other Endovascular Cardiac Valve Procedures with MCC
- DRG 320 - Other Endovascular Cardiac Valve Procedures without MCC
- DRG 321 - Percutaneous Cardiovascular Procedures with Intraluminal Device with...
- DRG 322 - Percutaneous Cardiovascular Procedures with Intraluminal Device witho...
- DRG 323 - Coronary Intravascular Lithotripsy with Intraluminal Device with MCC
- DRG 324 - Coronary Intravascular Lithotripsy with Intraluminal Device without MCC
- DRG 325 - Coronary Intravascular Lithotripsy without Intraluminal Device
- DRG 326 - Stomach, Esophageal and Duodenal Procedures with MCC
- DRG 327 - Stomach, Esophageal and Duodenal Procedures with CC
- DRG 328 - Stomach, Esophageal and Duodenal Procedures without CC/MCC
- DRG 329 - Major Small and Large Bowel Procedures with MCC
- DRG 330 - Major Small and Large Bowel Procedures with CC
- DRG 331 - Major Small and Large Bowel Procedures without CC/MCC
- DRG 332 - Rectal Resection with MCC
- DRG 333 - Rectal Resection with CC
- DRG 334 - Rectal Resection without CC/MCC
- DRG 335 - Peritoneal Adhesiolysis with MCC
- DRG 336 - Peritoneal Adhesiolysis with CC
- DRG 337 - Peritoneal Adhesiolysis without CC/MCC
- DRG 344 - Minor Small and Large Bowel Procedures with MCC
- DRG 345 - Minor Small and Large Bowel Procedures with CC
- DRG 346 - Minor Small and Large Bowel Procedures without CC/MCC
- DRG 347 - Anal and Stomal Procedures with MCC
- DRG 348 - Anal and Stomal Procedures with CC
- DRG 349 - Anal and Stomal Procedures without CC/MCC
- DRG 350 - Inguinal and Femoral Hernia Procedures with MCC
- DRG 351 - Inguinal and Femoral Hernia Procedures with CC
- DRG 352 - Inguinal and Femoral Hernia Procedures without CC/MCC
- DRG 353 - Hernia Procedures Except Inguinal and Femoral with MCC
- DRG 354 - Hernia Procedures Except Inguinal and Femoral with CC
- DRG 355 - Hernia Procedures Except Inguinal and Femoral without CC/MCC
- DRG 356 - Other Digestive System O.R. Procedures with MCC
- DRG 357 - Other Digestive System O.R. Procedures with CC
- DRG 358 - Other Digestive System O.R. Procedures without CC/MCC
- DRG 359 - Percutaneous Coronary Atherectomy with Intraluminal Device with MCC
- DRG 360 - Percutaneous Coronary Atherectomy with Intraluminal Device without MCC
- DRG 361 - Other Circulatory System O.R. Procedures with MCC
- DRG 362 - Other Circulatory System O.R. Procedures without MCC
- DRG 368 - Major Esophageal Disorders with MCC
- DRG 369 - Major Esophageal Disorders with CC
- DRG 370 - Major Esophageal Disorders without CC/MCC
- DRG 371 - Major Gastrointestinal Disorders and Peritoneal Infections with MCC
- DRG 372 - Major Gastrointestinal Disorders and Peritoneal Infections with CC
- DRG 373 - Major Gastrointestinal Disorders and Peritoneal Infections without CC...
- DRG 374 - Digestive Malignancy with MCC
- DRG 375 - Digestive Malignancy with CC
- DRG 376 - Digestive Malignancy without CC/MCC
- DRG 377 - Gastrointestinal Hemorrhage with MCC
- DRG 378 - Gastrointestinal Hemorrhage with CC
- DRG 379 - Gastrointestinal Hemorrhage without CC/MCC
- DRG 380 - Complicated Peptic Ulcer with MCC
- DRG 381 - Complicated Peptic Ulcer with CC
- DRG 382 - Complicated Peptic Ulcer without CC/MCC
- DRG 383 - Uncomplicated Peptic Ulcer with MCC
- DRG 384 - Uncomplicated Peptic Ulcer without MCC
- DRG 385 - Inflammatory Bowel Disease with MCC
- DRG 386 - Inflammatory Bowel Disease with CC
- DRG 387 - Inflammatory Bowel Disease without CC/MCC
- DRG 388 - Gastrointestinal Obstruction with MCC
- DRG 389 - Gastrointestinal Obstruction with CC
- DRG 390 - Gastrointestinal Obstruction without CC/MCC
- DRG 391 - Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders wi...
- DRG 392 - Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders wi...
- DRG 393 - Other Digestive System Diagnoses with MCC
- DRG 394 - Other Digestive System Diagnoses with CC
- DRG 395 - Other Digestive System Diagnoses without CC/MCC
- DRG 397 - Appendix Procedures with MCC
- DRG 398 - Appendix Procedures with CC
- DRG 399 - Appendix Procedures without CC/MCC
- DRG 400 - Knee Procedures with Principal Diagnosis of Infection
- DRG 402 - Single Level Combined Anterior and Posterior Spinal Fusion Except Cer...
- DRG 403 - Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joi...
- DRG 404 - Hip or Knee Procedures with Principal Diagnosis of Periprosthetic Joi...
- DRG 405 - Pancreas, Liver and Shunt Procedures with MCC
- DRG 406 - Pancreas, Liver and Shunt Procedures with CC
- DRG 407 - Pancreas, Liver and Shunt Procedures without CC/MCC
- DRG 408 - Biliary Tract Procedures Except Only Cholecystectomy with or without...
- DRG 409 - Biliary Tract Procedures Except Only Cholecystectomy with or without...
- DRG 410 - Biliary Tract Procedures Except Only Cholecystectomy with or without...
- DRG 411 - Cholecystectomy with C.D.E. with MCC
- DRG 412 - Cholecystectomy with C.D.E. with CC
- DRG 413 - Cholecystectomy with C.D.E. without CC/MCC
- DRG 414 - Cholecystectomy Except by Laparoscope without C.D.E. with MCC
- DRG 415 - Cholecystectomy Except by Laparoscope without C.D.E. with CC
- DRG 416 - Cholecystectomy Except by Laparoscope without C.D.E. without CC/MCC
- DRG 417 - Laparoscopic Cholecystectomy without C.D.E. with MCC
- DRG 418 - Laparoscopic Cholecystectomy without C.D.E. with CC
- DRG 419 - Laparoscopic Cholecystectomy without C.D.E. without CC/MCC
- DRG 420 - Hepatobiliary Diagnostic Procedures with MCC
- DRG 421 - Hepatobiliary Diagnostic Procedures with CC
- DRG 422 - Hepatobiliary Diagnostic Procedures without CC/MCC
- DRG 423 - Other Hepatobiliary or Pancreas O.R. Procedures with MCC
- DRG 424 - Other Hepatobiliary or Pancreas O.R. Procedures with CC
- DRG 425 - Other Hepatobiliary or Pancreas O.R. Procedures without CC/MCC
- DRG 426 - Multiple Level Combined Anterior and Posterior Spinal Fusion Except C...
- DRG 427 - Multiple Level Combined Anterior and Posterior Spinal Fusion Except C...
- DRG 428 - Multiple Level Combined Anterior and Posterior Spinal Fusion Except C...
- DRG 429 - Combined Anterior and Posterior Cervical Spinal Fusion with MCC
- DRG 430 - Combined Anterior and Posterior Cervical Spinal Fusion without MCC
- DRG 432 - Cirrhosis and Alcoholic Hepatitis with MCC
- DRG 433 - Cirrhosis and Alcoholic Hepatitis with CC
- DRG 434 - Cirrhosis and Alcoholic Hepatitis without CC/MCC
- DRG 435 - Malignancy of Hepatobiliary System or Pancreas with MCC
- DRG 436 - Malignancy of Hepatobiliary System or Pancreas with CC
- DRG 437 - Malignancy of Hepatobiliary System or Pancreas without CC/MCC
- DRG 438 - Disorders of Pancreas Except Malignancy with MCC
- DRG 439 - Disorders of Pancreas Except Malignancy with CC
- DRG 440 - Disorders of Pancreas Except Malignancy without CC/MCC
- DRG 441 - Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatiti...
- DRG 442 - Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatiti...
- DRG 443 - Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatiti...
- DRG 444 - Disorders of the Biliary Tract with MCC
- DRG 445 - Disorders of the Biliary Tract with CC
- DRG 446 - Disorders of the Biliary Tract without CC/MCC
- DRG 447 - Multiple Level Spinal Fusion Except Cervical with MCC
- DRG 448 - Multiple Level Spinal Fusion Except Cervical without MCC
- DRG 449 - Revision of Hip or Knee Prosthesis
- DRG 450 - Single Level Spinal Fusion Except Cervical with MCC
- DRG 451 - Single Level Spinal Fusion Except Cervical without MCC
- DRG 456 - Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or I...
- DRG 457 - Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or I...
- DRG 458 - Spinal Fusion Except Cervical with Spinal Curvature, Malignancy, or I...
- DRG 461 - Bilateral or Multiple Major Joint Procedures of Lower Extremity with MCC
- DRG 462 - Bilateral or Multiple Major Joint Procedures of Lower Extremity witho...
- DRG 463 - Wound Debridement or Skin Graft Except Hand for Musculoskeletal and C...
- DRG 464 - Wound Debridement or Skin Graft Except Hand for Musculoskeletal and C...
- DRG 465 - Wound Debridement or Skin Graft Except Hand for Musculoskeletal and C...
- DRG 469 - Major Hip and Knee Joint Replacement or Reattachment of Lower Extremi...
- DRG 470 - Major Hip and Knee Joint Replacement or Reattachment of Lower Extremi...
- DRG 471 - Cervical Spinal Fusion with MCC
- DRG 472 - Cervical Spinal Fusion with CC
- DRG 473 - Cervical Spinal Fusion without CC/MCC
- DRG 474 - Amputation for Musculoskeletal System and Connective Tissue Disorders...
- DRG 475 - Amputation for Musculoskeletal System and Connective Tissue Disorders...
- DRG 476 - Amputation for Musculoskeletal System and Connective Tissue Disorders...
- DRG 477 - Biopsies of Musculoskeletal System and Connective Tissue with MCC or...
- DRG 478 - Biopsies of Musculoskeletal System and Connective Tissue with CC
- DRG 479 - Biopsies of Musculoskeletal System and Connective Tissue without CC/MCC
- DRG 480 - Hip and Femur Procedures Except Major Joint with MCC or Insertion of...
- DRG 481 - Hip and Femur Procedures Except Major Joint with CC
- DRG 482 - Hip and Femur Procedures Except Major Joint without CC/MCC
- DRG 483 - Major Joint or Limb Reattachment Procedures of Upper Extremities
- DRG 488 - Knee Procedures without Principal Diagnosis of Infection with CC/MCC
- DRG 489 - Knee Procedures without Principal Diagnosis of Infection without CC/MCC
- DRG 492 - Lower Extremity and Humerus Procedures Except Hip, Foot and Femur wit...
- DRG 493 - Lower Extremity and Humerus Procedures Except Hip, Foot and Femur wit...
- DRG 494 - Lower Extremity and Humerus Procedures Except Hip, Foot and Femur wit...
- DRG 495 - Local Excision and Removal of Internal Fixation Devices Except Hip an...
- DRG 496 - Local Excision and Removal of Internal Fixation Devices Except Hip an...
- DRG 497 - Local Excision and Removal of Internal Fixation Devices Except Hip an...
- DRG 498 - Local Excision and Removal of Internal Fixation Devices of Hip and Fe...
- DRG 499 - Local Excision and Removal of Internal Fixation Devices of Hip and Fe...
- DRG 500 - Soft Tissue Procedures with MCC
- DRG 501 - Soft Tissue Procedures with CC
- DRG 502 - Soft Tissue Procedures without CC/MCC
- DRG 503 - Foot Procedures with MCC
- DRG 504 - Foot Procedures with CC
- DRG 505 - Foot Procedures without CC/MCC
- DRG 506 - Major Thumb or Joint Procedures
- DRG 507 - Major Shoulder or Elbow Joint Procedures with CC/MCC
- DRG 508 - Major Shoulder or Elbow Joint Procedures without CC/MCC
- DRG 510 - Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures...
- DRG 511 - Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures...
- DRG 512 - Shoulder, Elbow or Forearm Procedures, Except Major Joint Procedures...
- DRG 513 - Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with...
- DRG 514 - Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with...
- DRG 515 - Other Musculoskeletal System and Connective Tissue O.R. Procedures wi...
- DRG 516 - Other Musculoskeletal System and Connective Tissue O.R. Procedures wi...
- DRG 517 - Other Musculoskeletal System and Connective Tissue O.R. Procedures wi...
- DRG 518 - Back and Neck Procedures Except Spinal Fusion with MCC or Disc Device...
- DRG 519 - Back and Neck Procedures Except Spinal Fusion with CC
- DRG 520 - Back and Neck Procedures Except Spinal Fusion without CC/MCC
- DRG 521 - Hip Replacement with Principal Diagnosis of Hip Fracture with MCC
- DRG 522 - Hip Replacement with Principal Diagnosis of Hip Fracture without MCC
- DRG 523 - Extensive or Complex Spinal Fusion Procedures Except Cervical with MCC
- DRG 524 - Extensive or Complex Spinal Fusion Procedures Except Cervical with CC
- DRG 525 - Extensive or Complex Spinal Fusion Procedures Except Cervical without...
- DRG 533 - Fractures of Femur with MCC
- DRG 534 - Fractures of Femur without MCC
- DRG 535 - Fractures of Hip and Pelvis with MCC
- DRG 536 - Fractures of Hip and Pelvis without MCC
- DRG 537 - Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh with CC/MCC
- DRG 538 - Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without C...
- DRG 539 - Osteomyelitis with MCC
- DRG 540 - Osteomyelitis with CC
- DRG 541 - Osteomyelitis without CC/MCC
- DRG 542 - Pathological Fractures and Musculoskeletal and Connective Tissue Mali...
- DRG 543 - Pathological Fractures and Musculoskeletal and Connective Tissue Mali...
- DRG 544 - Pathological Fractures and Musculoskeletal and Connective Tissue Mali...
- DRG 545 - Connective Tissue Disorders with MCC
- DRG 546 - Connective Tissue Disorders with CC
- DRG 547 - Connective Tissue Disorders without CC/MCC
- DRG 548 - Septic Arthritis with MCC
- DRG 549 - Septic Arthritis with CC
- DRG 550 - Septic Arthritis without CC/MCC
- DRG 551 - Medical Back Problems with MCC
- DRG 552 - Medical Back Problems without MCC
- DRG 553 - Bone Diseases and Arthropathies with MCC
- DRG 554 - Bone Diseases and Arthropathies without MCC
- DRG 555 - Signs and Symptoms of Musculoskeletal System and Connective Tissue wi...
- DRG 556 - Signs and Symptoms of Musculoskeletal System and Connective Tissue wi...
- DRG 557 - Tendonitis, Myositis and Bursitis with MCC
- DRG 558 - Tendonitis, Myositis and Bursitis without MCC
- DRG 559 - Aftercare, Musculoskeletal System and Connective Tissue with MCC
- DRG 560 - Aftercare, Musculoskeletal System and Connective Tissue with CC
- DRG 561 - Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC
- DRG 562 - Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis an...
- DRG 563 - Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis an...
- DRG 564 - Other Musculoskeletal System and Connective Tissue Diagnoses with MCC
- DRG 565 - Other Musculoskeletal System and Connective Tissue Diagnoses with CC
- DRG 566 - Other Musculoskeletal System and Connective Tissue Diagnoses without...
- DRG 570 - Skin Debridement with MCC
- DRG 571 - Skin Debridement with CC
- DRG 572 - Skin Debridement without CC/MCC
- DRG 573 - Skin Graft for Skin Ulcer or Cellulitis with MCC
- DRG 574 - Skin Graft for Skin Ulcer or Cellulitis with CC
- DRG 575 - Skin Graft for Skin Ulcer or Cellulitis without CC/MCC
- DRG 576 - Skin Graft Except for Skin Ulcer or Cellulitis with MCC
- DRG 577 - Skin Graft Except for Skin Ulcer or Cellulitis with CC
- DRG 578 - Skin Graft Except for Skin Ulcer or Cellulitis without CC/MCC
- DRG 579 - Other Skin, Subcutaneous Tissue and Breast Procedures with MCC
- DRG 580 - Other Skin, Subcutaneous Tissue and Breast Procedures with CC
- DRG 581 - Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC
- DRG 582 - Mastectomy for Malignancy with CC/MCC
- DRG 583 - Mastectomy for Malignancy without CC/MCC
- DRG 584 - Breast Biopsy, Local Excision and Other Breast Procedures with CC/MCC
- DRG 585 - Breast Biopsy, Local Excision and Other Breast Procedures without CC/MCC
- DRG 592 - Skin Ulcers with MCC
- DRG 593 - Skin Ulcers with CC
- DRG 594 - Skin Ulcers without CC/MCC
- DRG 595 - Major Skin Disorders with MCC
- DRG 596 - Major Skin Disorders without MCC
- DRG 597 - Malignant Breast Disorders with MCC
- DRG 598 - Malignant Breast Disorders with CC
- DRG 599 - Malignant Breast Disorders without CC/MCC
- DRG 600 - Non-Malignant Breast Disorders with CC/MCC
- DRG 601 - Non-Malignant Breast Disorders without CC/MCC
- DRG 602 - Cellulitis with MCC
- DRG 603 - Cellulitis without MCC
- DRG 604 - Trauma to the Skin, Subcutaneous Tissue and Breast with MCC
- DRG 605 - Trauma to the Skin, Subcutaneous Tissue and Breast without MCC
- DRG 606 - Minor Skin Disorders with MCC
- DRG 607 - Minor Skin Disorders without MCC
- DRG 614 - Adrenal and Pituitary Procedures with CC/MCC
- DRG 615 - Adrenal and Pituitary Procedures without CC/MCC
- DRG 616 - Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Dis...
- DRG 617 - Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Dis...
- DRG 618 - Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Dis...
- DRG 619 - O.R. Procedures for Obesity with MCC
- DRG 620 - O.R. Procedures for Obesity with CC
- DRG 621 - O.R. Procedures for Obesity without CC/MCC
- DRG 622 - Skin Grafts and Wound Debridement for Endocrine, Nutritional and Meta...
- DRG 623 - Skin Grafts and Wound Debridement for Endocrine, Nutritional and Meta...
- DRG 624 - Skin Grafts and Wound Debridement for Endocrine, Nutritional and Meta...
- DRG 625 - Thyroid, Parathyroid and Thyroglossal Procedures with MCC
- DRG 626 - Thyroid, Parathyroid and Thyroglossal Procedures with CC
- DRG 627 - Thyroid, Parathyroid and Thyroglossal Procedures without CC/MCC
- DRG 628 - Other Endocrine, Nutritional and Metabolic O.R. Procedures with MCC o...
- DRG 629 - Other Endocrine, Nutritional and Metabolic O.R. Procedures with CC
- DRG 630 - Other Endocrine, Nutritional and Metabolic O.R. Procedures without CC...
- DRG 637 - Diabetes with MCC
- DRG 638 - Diabetes with CC
- DRG 639 - Diabetes without CC/MCC
- DRG 640 - Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrol...
- DRG 641 - Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrol...
- DRG 642 - Inborn and Other Disorders of Metabolism
- DRG 643 - Endocrine Disorders with MCC
- DRG 644 - Endocrine Disorders with CC
- DRG 645 - Endocrine Disorders without CC/MCC
- DRG 650 - Kidney Transplant with Hemodialysis with MCC
- DRG 651 - Kidney Transplant with Hemodialysis without MCC
- DRG 652 - Kidney Transplant
- DRG 653 - Major Bladder Procedures with MCC
- DRG 654 - Major Bladder Procedures with CC
- DRG 655 - Major Bladder Procedures without CC/MCC
- DRG 656 - Kidney and Ureter Procedures for Neoplasm with MCC
- DRG 657 - Kidney and Ureter Procedures for Neoplasm with CC
- DRG 658 - Kidney and Ureter Procedures for Neoplasm without CC/MCC
- DRG 659 - Kidney and Ureter Procedures for Non-Neoplasm with MCC
- DRG 660 - Kidney and Ureter Procedures for Non-Neoplasm with CC
- DRG 661 - Kidney and Ureter Procedures for Non-Neoplasm without CC/MCC
- DRG 662 - Minor Bladder Procedures with MCC
- DRG 663 - Minor Bladder Procedures with CC
- DRG 664 - Minor Bladder Procedures without CC/MCC
- DRG 665 - Prostatectomy with MCC
- DRG 666 - Prostatectomy with CC
- DRG 667 - Prostatectomy without CC/MCC
- DRG 668 - Transurethral Procedures with MCC
- DRG 669 - Transurethral Procedures with CC
- DRG 670 - Transurethral Procedures without CC/MCC
- DRG 671 - Urethral Procedures with CC/MCC
- DRG 672 - Urethral Procedures without CC/MCC
- DRG 673 - Other Kidney and Urinary Tract Procedures with MCC
- DRG 674 - Other Kidney and Urinary Tract Procedures with CC
- DRG 675 - Other Kidney and Urinary Tract Procedures without CC/MCC
- DRG 682 - Renal Failure with MCC
- DRG 683 - Renal Failure with CC
- DRG 684 - Renal Failure without CC/MCC
- DRG 686 - Kidney and Urinary Tract Neoplasms with MCC
- DRG 687 - Kidney and Urinary Tract Neoplasms with CC
- DRG 688 - Kidney and Urinary Tract Neoplasms without CC/MCC
- DRG 689 - Kidney and Urinary Tract Infections with MCC
- DRG 690 - Kidney and Urinary Tract Infections without MCC
- DRG 693 - Urinary Stones with MCC
- DRG 694 - Urinary Stones without MCC
- DRG 695 - Kidney and Urinary Tract Signs and Symptoms with MCC
- DRG 696 - Kidney and Urinary Tract Signs and Symptoms without MCC
- DRG 697 - Urethral Stricture
- DRG 698 - Other Kidney and Urinary Tract Diagnoses with MCC
- DRG 699 - Other Kidney and Urinary Tract Diagnoses with CC
- DRG 700 - Other Kidney and Urinary Tract Diagnoses without CC/MCC
- DRG 707 - Major Male Pelvic Procedures with CC/MCC
- DRG 708 - Major Male Pelvic Procedures without CC/MCC
- DRG 709 - Penis Procedures with CC/MCC
- DRG 710 - Penis Procedures without CC/MCC
- DRG 711 - Testes Procedures with CC/MCC
- DRG 712 - Testes Procedures without CC/MCC
- DRG 713 - Transurethral Prostatectomy with CC/MCC
- DRG 714 - Transurethral Prostatectomy without CC/MCC
- DRG 715 - Male Reproductive System and Other O.R. Procedures for Malignancy wit...
- DRG 716 - Male Reproductive System and Other O.R. Procedures for Malignancy wit...
- DRG 717 - Other Male Reproductive System O.R. Procedures with CC/MCC
- DRG 718 - Other Male Reproductive System O.R. Procedures without CC/MCC
- DRG 722 - Malignancy, Male Reproductive System with MCC
- DRG 723 - Malignancy, Male Reproductive System with CC
- DRG 724 - Malignancy, Male Reproductive System without CC/MCC
- DRG 725 - Benign Prostatic Hypertrophy with MCC
- DRG 726 - Benign Prostatic Hypertrophy without MCC
- DRG 727 - Inflammation of the Male Reproductive System with MCC
- DRG 728 - Inflammation of the Male Reproductive System without MCC
- DRG 729 - Other Male Reproductive System Diagnoses with CC/MCC
- DRG 730 - Other Male Reproductive System Diagnoses without CC/MCC
- DRG 731 - Uterine and Adnexa Procedures for Malignancy with MCC
- DRG 732 - Uterine and Adnexa Procedures for Malignancy with CC
- DRG 733 - Uterine and Adnexa Procedures for Malignancy without CC/MCC
- DRG 734 - Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy with...
- DRG 735 - Pelvic Evisceration, Radical Hysterectomy and Radical Vulvectomy with...
- DRG 742 - Uterine and Adnexa Procedures for Non-Malignancy with CC/MCC
- DRG 743 - Uterine and Adnexa Procedures for Non-Malignancy without CC/MCC
- DRG 744 - D&C, Conization, Laparoscopy and Tubal Interruption with CC/MCC
- DRG 745 - D&C, Conization, Laparoscopy and Tubal Interruption without CC/MCC
- DRG 746 - Vagina, Cervix and Vulva Procedures with CC/MCC
- DRG 747 - Vagina, Cervix and Vulva Procedures without CC/MCC
- DRG 748 - Female Reproductive System Reconstructive Procedures
- DRG 749 - Other Female Reproductive System O.R. Procedures with CC/MCC
- DRG 750 - Other Female Reproductive System O.R. Procedures without CC/MCC
- DRG 754 - Malignancy, Female Reproductive System with MCC
- DRG 755 - Malignancy, Female Reproductive System with CC
- DRG 756 - Malignancy, Female Reproductive System without CC/MCC
- DRG 757 - Infections, Female Reproductive System with MCC
- DRG 758 - Infections, Female Reproductive System with CC
- DRG 759 - Infections, Female Reproductive System without CC/MCC
- DRG 760 - Menstrual and Other Female Reproductive System Disorders with CC/MCC
- DRG 761 - Menstrual and Other Female Reproductive System Disorders without CC/MCC
- DRG 768 - Vaginal Delivery with O.R. Procedures Except Sterilization and/or D&C
- DRG 769 - Postpartum and Post Abortion Diagnoses with O.R. Procedures
- DRG 770 - Abortion with D&C, Aspiration Curettage or Hysterotomy
- DRG 776 - Postpartum and Post Abortion Diagnoses without O.R. Procedures
- DRG 779 - Abortion without D&C
- DRG 783 - Cesarean Section with Sterilization with MCC
- DRG 784 - Cesarean Section with Sterilization with CC
- DRG 785 - Cesarean Section with Sterilization without CC/MCC
- DRG 786 - Cesarean Section without Sterilization with MCC
- DRG 787 - Cesarean Section without Sterilization with CC
- DRG 788 - Cesarean Section without Sterilization without CC/MCC
- DRG 789 - Neonates, Died or Transferred to Another Acute Care Facility
- DRG 790 - Extreme Immaturity or Respiratory Distress Syndrome, Neonate
- DRG 793 - Full Term Neonate with Major Problems
- DRG 794 - Neonate with Other Significant Problems
- DRG 795 - Normal Newborn
- DRG 796 - Vaginal Delivery with Sterilization and/or D&C with MCC
- DRG 797 - Vaginal Delivery with Sterilization and/or D&C with CC
- DRG 798 - Vaginal Delivery with Sterilization and/or D&C without CC/MCC
- DRG 799 - Splenic Procedures with MCC
- DRG 800 - Splenic Procedures with CC
- DRG 801 - Splenic Procedures without CC/MCC
- DRG 802 - Other O.R. Procedures of the Blood and Blood Forming Organs with MCC
- DRG 803 - Other O.R. Procedures of the Blood and Blood Forming Organs with CC
- DRG 804 - Other O.R. Procedures of the Blood and Blood Forming Organs without C...
- DRG 805 - Vaginal Delivery without Sterilization or D&C with MCC
- DRG 806 - Vaginal Delivery without Sterilization or D&C with CC
- DRG 807 - Vaginal Delivery without Sterilization or D&C without CC/MCC
- DRG 808 - Major Hematological and Immunological Diagnoses Except Sickle Cell Cr...
- DRG 809 - Major Hematological and Immunological Diagnoses Except Sickle Cell Cr...
- DRG 810 - Major Hematological and Immunological Diagnoses Except Sickle Cell Cr...
- DRG 811 - Red Blood Cell Disorders with MCC
- DRG 812 - Red Blood Cell Disorders without MCC
- DRG 813 - Coagulation Disorders
- DRG 814 - Reticuloendothelial and Immunity Disorders with MCC
- DRG 815 - Reticuloendothelial and Immunity Disorders with CC
- DRG 816 - Reticuloendothelial and Immunity Disorders without CC/MCC
- DRG 817 - Other Antepartum Diagnoses with O.R. Procedures with MCC
- DRG 818 - Other Antepartum Diagnoses with O.R. Procedures with CC
- DRG 819 - Other Antepartum Diagnoses with O.R. Procedures without CC/MCC
- DRG 820 - Lymphoma and Leukemia with Major O.R. Procedures with MCC
- DRG 821 - Lymphoma and Leukemia with Major O.R. Procedures with CC
- DRG 822 - Lymphoma and Leukemia with Major O.R. Procedures without CC/MCC
- DRG 823 - Lymphoma and Non-Acute Leukemia with Other Procedures with MCC
- DRG 824 - Lymphoma and Non-Acute Leukemia with Other Procedures with CC
- DRG 825 - Lymphoma and Non-Acute Leukemia with Other Procedures without CC/MCC
- DRG 826 - Myeloproliferative Disorders or Poorly Differentiated Neoplasms with...
- DRG 827 - Myeloproliferative Disorders or Poorly Differentiated Neoplasms with...
- DRG 828 - Myeloproliferative Disorders or Poorly Differentiated Neoplasms with...
- DRG 829 - Myeloproliferative Disorders or Poorly Differentiated Neoplasms with...
- DRG 830 - Myeloproliferative Disorders or Poorly Differentiated Neoplasms with...
- DRG 831 - Other Antepartum Diagnoses without O.R. Procedures with MCC
- DRG 832 - Other Antepartum Diagnoses without O.R. Procedures with CC
- DRG 833 - Other Antepartum Diagnoses without O.R. Procedures without CC/MCC
- DRG 834 - Acute Leukemia with MCC
- DRG 835 - Acute Leukemia with CC
- DRG 836 - Acute Leukemia without CC/MCC
- DRG 837 - Chemotherapy with Acute Leukemia as Secondary Diagnosis or with High...
- DRG 838 - Chemotherapy with Acute Leukemia as Secondary Diagnosis with CC or Hi...
- DRG 839 - Chemotherapy with Acute Leukemia as Secondary Diagnosis without CC/MCC
- DRG 840 - Lymphoma and Non-Acute Leukemia with MCC
- DRG 841 - Lymphoma and Non-Acute Leukemia with CC
- DRG 842 - Lymphoma and Non-Acute Leukemia without CC/MCC
- DRG 843 - Other Myeloproliferative Disorders or Poorly Differentiated Neoplasti...
- DRG 844 - Other Myeloproliferative Disorders or Poorly Differentiated Neoplasti...
- DRG 845 - Other Myeloproliferative Disorders or Poorly Differentiated Neoplasti...
- DRG 846 - Chemotherapy without Acute Leukemia as Secondary Diagnosis with MCC
- DRG 847 - Chemotherapy without Acute Leukemia as Secondary Diagnosis with CC
- DRG 848 - Chemotherapy without Acute Leukemia as Secondary Diagnosis without CC...
- DRG 849 - Radiotherapy
- DRG 850 - Acute Leukemia with Other Procedures
- DRG 853 - Infectious and Parasitic Diseases with O.R. Procedures with MCC
- DRG 854 - Infectious and Parasitic Diseases with O.R. Procedures with CC
- DRG 855 - Infectious and Parasitic Diseases with O.R. Procedures without CC/MCC
- DRG 856 - Postoperative or Post-Traumatic Infections with O.R. Procedures with MCC
- DRG 857 - Postoperative or Post-Traumatic Infections with O.R. Procedures with CC
- DRG 858 - Postoperative or Post-Traumatic Infections with O.R. Procedures witho...
- DRG 862 - Postoperative and Post-Traumatic Infections with MCC
- DRG 863 - Postoperative and Post-Traumatic Infections without MCC
- DRG 864 - Fever and Inflammatory Conditions
- DRG 865 - Viral Illness with MCC
- DRG 866 - Viral Illness without MCC
- DRG 867 - Other Infectious and Parasitic Diseases Diagnoses with MCC
- DRG 868 - Other Infectious and Parasitic Diseases Diagnoses with CC
- DRG 869 - Other Infectious and Parasitic Diseases Diagnoses without CC/MCC
- DRG 870 - Septicemia or Severe Sepsis with MV >96 Hours
- DRG 871 - Septicemia or Severe Sepsis without MV >96 Hours with MCC
- DRG 872 - Septicemia or Severe Sepsis without MV >96 Hours without MCC
- DRG 876 - O.R. Procedures with Principal Diagnosis of Mental Illness
- DRG 880 - Acute Adjustment Reaction and Psychosocial Dysfunction
- DRG 881 - Depressive Neuroses
- DRG 882 - Neuroses Except Depressive
- DRG 883 - Disorders of Personality and Impulse Control
- DRG 884 - Organic Disturbances and Intellectual Disability
- DRG 885 - Psychoses
- DRG 886 - Behavioral and Developmental Disorders
- DRG 887 - Other Mental Disorder Diagnoses
- DRG 894 - Alcohol, Drug Abuse or Dependence, Left AMA
- DRG 895 - Alcohol, Drug Abuse or Dependence with Rehabilitation Therapy
- DRG 896 - Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with...
- DRG 897 - Alcohol, Drug Abuse or Dependence without Rehabilitation Therapy with...
- DRG 901 - Wound Debridements for Injuries with MCC
- DRG 902 - Wound Debridements for Injuries with CC
- DRG 903 - Wound Debridements for Injuries without CC/MCC
- DRG 904 - Skin Grafts for Injuries with CC/MCC
- DRG 905 - Skin Grafts for Injuries without CC/MCC
- DRG 906 - Hand Procedures for Injuries
- DRG 907 - Other O.R. Procedures for Injuries with MCC
- DRG 908 - Other O.R. Procedures for Injuries with CC
- DRG 909 - Other O.R. Procedures for Injuries without CC/MCC
- DRG 913 - Traumatic Injury with MCC
- DRG 914 - Traumatic Injury without MCC
- DRG 915 - Allergic Reactions with MCC
- DRG 916 - Allergic Reactions without MCC
- DRG 917 - Poisoning and Toxic Effects of Drugs with MCC
- DRG 918 - Poisoning and Toxic Effects of Drugs without MCC
- DRG 919 - Complications of Treatment with MCC
- DRG 920 - Complications of Treatment with CC
- DRG 921 - Complications of Treatment without CC/MCC
- DRG 922 - Other Injury, Poisoning and Toxic Effect Diagnoses with MCC
- DRG 923 - Other Injury, Poisoning and Toxic Effect Diagnoses without MCC
- DRG 927 - Extensive Burns or Full Thickness Burns with MV >96 Hours with Skin G...
- DRG 928 - Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC
- DRG 929 - Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC
- DRG 933 - Extensive Burns or Full Thickness Burns with MV >96 Hours without Ski...
- DRG 934 - Full Thickness Burn without Skin Graft or Inhalation Injury
- DRG 935 - Non-Extensive Burns
- DRG 939 - O.R. Procedures with Diagnoses of Other Contact with Health Services...
- DRG 940 - O.R. Procedures with Diagnoses of Other Contact with Health Services...
- DRG 941 - O.R. Procedures with Diagnoses of Other Contact with Health Services...
- DRG 945 - Rehabilitation with CC/MCC
- DRG 946 - Rehabilitation without CC/MCC
- DRG 947 - Signs and Symptoms with MCC
- DRG 948 - Signs and Symptoms without MCC
- DRG 949 - Aftercare with CC/MCC
- DRG 950 - Aftercare without CC/MCC
- DRG 951 - Other Factors Influencing Health Status
- DRG 955 - Craniotomy for Multiple Significant Trauma
- DRG 956 - Limb Reattachment, Hip and Femur Procedures for Multiple Significant...
- DRG 957 - Other O.R. Procedures for Multiple Significant Trauma with MCC
- DRG 958 - Other O.R. Procedures for Multiple Significant Trauma with CC
- DRG 959 - Other O.R. Procedures for Multiple Significant Trauma without CC/MCC
- DRG 963 - Other Multiple Significant Trauma with MCC
- DRG 964 - Other Multiple Significant Trauma with CC
- DRG 965 - Other Multiple Significant Trauma without CC/MCC
- DRG 969 - HIV with Extensive O.R. Procedures with MCC
- DRG 970 - HIV with Extensive O.R. Procedures without MCC
- DRG 974 - HIV with Major Related Condition with MCC
- DRG 975 - HIV with Major Related Condition with CC
- DRG 976 - HIV with Major Related Condition without CC/MCC
- DRG 977 - HIV with or without Other Related Condition
- DRG 981 - Extensive O.R. Procedures Unrelated to Principal Diagnosis with MCC
- DRG 982 - Extensive O.R. Procedures Unrelated to Principal Diagnosis with CC
- DRG 983 - Extensive O.R. Procedures Unrelated to Principal Diagnosis without CC...
- DRG 987 - Non-Extensive O.R. Procedures Unrelated to Principal Diagnosis with MCC
- DRG 988 - Non-Extensive O.R. Procedures Unrelated to Principal Diagnosis with CC
- DRG 989 - Non-Extensive O.R. Procedures Unrelated to Principal Diagnosis withou...
HCPCS Drug Codes
- A9573 - Injection, gadopiclenol, 1 ml
- A9575 - Injection, gadoterate meglumine, 0.1 ml
- A9576 - Injection, gadoteridol, (prohance multipack), per ml
- A9577 - Injection, gadobenate dimeglumine (multihance), per ml
- A9578 - Injection, gadobenate dimeglumine (multihance multipack), per ml
- A9579 - Injection, gadolinium-based magnetic resonance contrast agent, not ot...
- A9581 - Injection, gadoxetate disodium, 1 ml
- A9585 - Injection, gadobutrol, 0.1 ml
- A9589 - Instillation, hexaminolevulinate hydrochloride, 100 mg
- A9606 - Radium ra-223 dichloride, therapeutic, per microcurie
- J0121 - Injection, omadacycline, 1 mg
- J0122 - Injection, eravacycline, 1 mg
- J0129 - Injection, abatacept, 10 mg (code may be used for medicare when drug
- J0131 - Injection, acetaminophen, not otherwise specified,10 mg
- J0132 - Injection, acetylcysteine, 100 mg
- J0133 - Injection, acyclovir, 5 mg
- J0134 - Injection, acetaminophen (fresenius kabi), not therapeutically equiva...
- J0136 - Injection, acetaminophen (b braun), not therapeutically equivalent to...
- J0137 - Injection, acetaminophen (hikma), not therapeutically equivalent to j...
- J0138 - Injection, acetaminophen 10 mg and ibuprofen 3 mg
- J0153 - Injection, adenosine, 1 mg (not to be used to report any adenosine ph...
- J0162 - Injection, epinephrine (fresenius), not therapeutically equivalent to...
- J0165 - Injection, epinephrine, not otherwise specified, 0.1 mg
- J0166 - Injection, epinephrine (bpi), not therapeutically equivalent to j0165...
- J0167 - Injection, epinephrine (hospira), not therapeutically equivalent to j...
- J0168 - Injection, epinephrine (international medication systems), not therap...
- J0169 - Injection, epinephrine (adrenalin), not therapeutically equivalent to...
- J0175 - Injection, donanemab-azbt, 2 mg
- J0177 - Injection, aflibercept hd, 1 mg
- J0178 - Injection, aflibercept, 1 mg
- J0179 - Injection, brolucizumab-dbll, 1 mg
- J0180 - Injection, agalsidase beta, 1 mg
- J0185 - Injection, aprepitant, 1 mg
- J0202 - Injection, alemtuzumab, 1 mg
- J0206 - Injection, allopurinol sodium, 1 mg
- J0217 - Injection, velmanase alfa-tycv, 1 mg
- J0218 - Injection, olipudase alfa-rpcp, 1 mg
- J0219 - Injection, avalglucosidase alfa-ngpt, 4 mg
- J0221 - Injection, alglucosidase alfa, (lumizyme), 10 mg
- J0222 - Injection, patisiran, 0.1 mg
- J0223 - Injection, givosiran, 0.5 mg
- J0224 - Injection, lumasiran, 0.5 mg
- J0225 - Injection, vutrisiran, 1 mg
- J0248 - Injection, remdesivir, 1 mg
- J0256 - Injection, alpha 1 proteinase inhibitor (human), not otherwise specif...
- J0257 - Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg
- J0278 - Injection, amikacin sulfate, 100 mg
- J0280 - Injection, aminophyllin, up to 250 mg
- J0281 - Injection, aminocaproic acid, 1 gram
- J0282 - Injection, amiodarone hydrochloride, 30 mg
- J0283 - Injection, amiodarone hydrochloride (nexterone), 30 mg
- J0285 - Injection, amphotericin b, 50 mg
- J0289 - Injection, amphotericin b liposome, 10 mg
- J0290 - Injection, ampicillin sodium, 500 mg
- J0291 - Injection, plazomicin, 5 mg
- J0295 - Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm
- J0348 - Injection, anidulafungin, 1 mg
- J0349 - Injection, rezafungin, 1 mg
- J0360 - Injection, hydralazine hcl, up to 20 mg
- J0401 - Injection, aripiprazole (abilify maintena), 1 mg
- J0402 - Injection, aripiprazole (abilify asimtufii), 1 mg
- J0456 - Injection, azithromycin, 500 mg
- J0457 - Injection, aztreonam, 100 mg
- J0461 - Injection, atropine sulfate, 0.01 mg
- J0475 - Injection, baclofen, 10 mg
- J0476 - Injection, baclofen, 50 mcg for intrathecal trial
- J0480 - Injection, basiliximab, 20 mg
- J0485 - Injection, belatacept, 1 mg
- J0490 - Injection, belimumab, 10 mg
- J0491 - Injection, anifrolumab-fnia, 1 mg
- J0500 - Injection, dicyclomine hcl, up to 20 mg
- J0515 - Injection, benztropine mesylate, per 1 mg
- J0517 - Injection, benralizumab, 1 mg
- J0558 - Injection, penicillin g benzathine and penicillin g procaine, 100,000...
- J0561 - Injection, penicillin g benzathine, 100,000 units
- J0577 - Injection, buprenorphine extended-release (brixadi), less than or equ...
- J0578 - Injection, buprenorphine extended release (brixadi), greater than 7 d...
- J0583 - Injection, bivalirudin, 1 mg
- J0584 - Injection, burosumab-twza 1 mg
- J0585 - Injection, onabotulinumtoxina, 1 unit
- J0586 - Injection, abobotulinumtoxina, 5 units
- J0587 - Injection, rimabotulinumtoxinb, 100 units
- J0588 - Injection, incobotulinumtoxin a, 1 unit
- J0589 - Injection, daxibotulinumtoxina-lanm, 1 unit
- J0592 - Injection, buprenorphine hydrochloride, 0.1 mg
- J0593 - Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when...
- J0594 - injection, busulfan, 1 mg
- J0595 - Injection, butorphanol tartrate, 1 mg
- J0596 - Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units
- J0597 - Injection, c-1 esterase inhibitor (human), berinert, 10 units
- J0598 - Injection, c-1 esterase inhibitor (human), cinryze, 10 units
- J0600 - Injection, edetate calcium disodium, up to 1000 mg
- J0612 - Injection, calcium gluconate, not otherwise specified, 10 mg
- J0613 - Injection, calcium gluconate (wg critical care), not therapeutically...
- J0614 - Injection, treosulfan, 50 mg
- J0616 - Injection, metoprolol tartrate, 1 mg
- J0637 - Injection, caspofungin acetate, 5 mg
- J0638 - Injection, canakinumab, 1 mg
- J0641 - Injection, levoleucovorin, not otherwise specified, 0.5 mg
- J0642 - Injection, levoleucovorin (khapzory), 0.5 mg
- J0650 - Injection, levothyroxine sodium, not otherwise specified, 10 mcg
- J0651 - Injection, levothyroxine sodium (fresenius kabi), not therapeutically
- J0652 - Injection, levothyroxine sodium (hikma), not therapeutically equivale...
- J0666 - Injection, bupivacaine liposome, 1 mg
- J0670 - Injection, mepivacaine hydrochloride, per 10 ml
- J0687 - Injection, cefazolin sodium (wg critical care), not therapeutically e...
- J0688 - Injection, cefazolin sodium (hikma), not therapeutically equivalent t...
- J0689 - Injection, cefazolin sodium (baxter), not therapeutically equivalent...
- J0690 - Injection, cefazolin sodium, 500 mg
- J0692 - Injection, cefepime hydrochloride, 500 mg
- J0694 - Injection, cefoxitin sodium, 1 gm
- J0695 - Injection, ceftolozane 50 mg and tazobactam 25 mg
- J0696 - Injection, ceftriaxone sodium, per 250 mg
- J0697 - Injection, sterile cefuroxime sodium, per 750 mg
- J0699 - Injection, cefiderocol, 10 mg
- J0701 - Injection, cefepime hydrochloride (baxter), not therapeutically equiv...
- J0702 - Injection, betamethasone acetate 3 mg and betamethasone sodium phosph...
- J0703 - Injection, cefepime hydrochloride (b braun), not therapeutically equi...
- J0712 - Injection, ceftaroline fosamil, 10 mg
- J0713 - Injection, ceftazidime, per 500 mg
- J0714 - Injection, ceftazidime and avibactam, 0.5 g/0.125 g
- J0716 - Injection, centruroides immune f(ab)2, up to 120 milligrams
- J0717 - Injection, certolizumab pegol, 1 mg (code may be used for medicare wh...
- J0725 - Injection, chorionic gonadotropin, per 1,000 usp units
- J0735 - Injection, clonidine hydrochloride, 1 mg
- J0736 - Injection, clindamycin phosphate, 300 mg
- J0737 - Injection, clindamycin phosphate (baxter), not therapeutically equiva...
- J0739 - Injection, cabotegravir, 1mg, fda approved prescription, only for use...
- J0740 - Injection, cidofovir, 375 mg
- J0741 - Injection, cabotegravir and rilpivirine, 2mg/3mg
- J0742 - Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg
- J0743 - Injection, cilastatin sodium; imipenem, per 250 mg
- J0744 - Injection, ciprofloxacin for intravenous infusion, 200 mg
- J0759 - Injection, clevidipine butyrate, 1 mg
- J0770 - Injection, colistimethate sodium, up to 150 mg
- J0775 - Injection, collagenase, clostridium histolyticum, 0.01 mg
- J0780 - Injection, prochlorperazine, up to 10 mg
- J0791 - Injection, crizanlizumab-tmca, 5 mg
- J0801 - Injection, corticotropin (acthar gel), up to 40 units
- J0802 - Injection, corticotropin (ani), up to 40 units
- J0834 - Injection, cosyntropin, 0.25 mg
- J0840 - Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram
- J0841 - Injection, crotalidae immune f(ab')2 (equine), 120 mg
- J0850 - Injection, cytomegalovirus immune globulin intravenous (human), per vial
- J0870 - Injection, imetelstat, 1 mg
- J0872 - Injection, daptomycin (xellia), unrefrigerated, not therapeutically e...
- J0873 - Injection, daptomycin (xellia), not therapeutically equivalent to j08...
- J0874 - Injection, daptomycin (baxter), not therapeutically equivalent to j08...
- J0875 - Injection, dalbavancin, 5 mg
- J0877 - Injection, daptomycin (hospira), not therapeutically equivalent to j0...
- J0878 - Injection, daptomycin, 1 mg
- J0881 - Injection, darbepoetin alfa, 1 microgram (non-esrd use)
- J0882 - Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)
- J0885 - Injection, epoetin alfa, (for non-esrd use), 1000 units
- J0894 - Injection, decitabine, 1 mg
- J0895 - Injection, deferoxamine mesylate, 500 mg
- J0896 - Injection, luspatercept-aamt, 0.25 mg
- J0897 - Injection, denosumab, 1 mg
- J0901 - Vadadustat, oral, 1 mg (for esrd on dialysis)
- J1000 - Injection, depo-estradiol cypionate, up to 5 mg
- J1010 - Injection, methylprednisolone acetate, 1 mg
- J1071 - Injection, testosterone cypionate, 1 mg
- J1072 - Injection, testosterone cypionate (azmiro), 1 mg
- J1096 - Dexamethasone, lacrimal ophthalmic insert, 0.1 mg
- J1100 - Injection, dexamethasone sodium phosphate, 1 mg
- J1110 - Injection, dihydroergotamine mesylate, per 1 mg
- J1120 - Injection, acetazolamide sodium, up to 500 mg
- J1160 - Injection, digoxin, up to 0.5 mg
- J1162 - Injection, digoxin immune fab (ovine), per vial
- J1163 - Injection, diltiazem hydrochloride, 0.5 mg
- J1165 - Injection, phenytoin sodium, per 50 mg
- J1171 - Injection, hydromorphone, 0.1 mg
- J1190 - Injection, dexrazoxane hydrochloride, per 250 mg
- J1200 - Injection, diphenhydramine hcl, up to 50 mg
- J1201 - Injection, cetirizine hydrochloride, 0.5 mg
- J1203 - Injection, cipaglucosidase alfa-atga, 5 mg
- J1205 - Injection, chlorothiazide sodium, per 500 mg
- J1212 - Injection, dmso, dimethyl sulfoxide, 50%, 50 ml
- J1230 - Injection, methadone hcl, up to 10 mg
- J1240 - Injection, dimenhydrinate, up to 50 mg
- J1245 - Injection, dipyridamole, per 10 mg
- J1250 - Injection, dobutamine hydrochloride, per 250 mg
- J1265 - Injection, dopamine hcl, 40 mg
- J1270 - Injection, doxercalciferol, 1 mcg
- J1271 - Injection, doxycycline hyclate, 1 mg
- J1290 - Injection, ecallantide, 1 mg
- J1299 - Injection, eculizumab, 2 mg
- J1301 - Injection, edaravone, 1 mg
- J1302 - Injection, sutimlimab-jome, 10 mg
- J1303 - Injection, ravulizumab-cwvz, 10 mg
- J1304 - Injection, tofersen, 1 mg
- J1305 - Injection, evinacumab-dgnb, 5mg
- J1306 - Injection, inclisiran, 1 mg
- J1307 - Injection, crovalimab-akkz, 10 mg
- J1308 - Injection, famotidine, 0.25 mg
- J1322 - Injection, elosulfase alfa, 1 mg
- J1323 - Injection, elranatamab-bcmm, 1 mg
- J1325 - Injection, epoprostenol, 0.5 mg
- J1326 - Injection, zolbetuximab-clzb, 2 mg
- J1335 - Injection, ertapenem sodium, 500 mg
- J1364 - Injection, erythromycin lactobionate, per 500 mg
- J1380 - Injection, estradiol valerate, up to 10 mg
- J1410 - Injection, estrogen conjugated, per 25 mg
- J1430 - Injection, ethanolamine oleate, 100 mg
- J1434 - Injection, fosaprepitant (focinvez), 1 mg
- J1437 - Injection, ferric derisomaltose, 10 mg
- J1439 - Injection, ferric carboxymaltose, 1 mg
- J1440 - Fecal microbiota, live - jslm, 1 ml
- J1442 - Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram
- J1447 - Injection, tbo-filgrastim, 1 microgram
- J1448 - Injection, trilaciclib, 1mg
- J1449 - Injection, eflapegrastim-xnst, 0.1 mg
- J1450 - Injection fluconazole, 200 mg
- J1453 - Injection, fosaprepitant, 1 mg
- J1454 - Injection, fosnetupitant 235 mg and palonosetron 0.25 mg
- J1455 - Injection, foscarnet sodium, per 1000 mg
- J1456 - Injection, fosaprepitant (teva), not therapeutically equivalent to j1...
- J1458 - Injection, galsulfase, 1 mg
- J1459 - Injection, immune globulin (privigen), intravenous, non-lyophilized (...
- J1460 - Injection, gamma globulin, intramuscular, 1 cc
- J1551 - Injection, immune globulin (cutaquig), 100 mg
- J1552 - Injection, immune globulin (alyglo), 500 mg
- J1553 - Injection, immune globulin (yimmugo), 100 mg
- J1554 - Injection, immune globulin (asceniv), 500 mg
- J1555 - Injection, immune globulin (cuvitru), 100 mg
- J1556 - Injection, immune globulin (bivigam), 500 mg
- J1557 - Injection, immune globulin, (gammaplex), intravenous, non-lyophilized...
- J1558 - Injection, immune globulin (xembify), 100 mg
- J1559 - Injection, immune globulin (hizentra), 100 mg
- J1560 - Injection, gamma globulin, intramuscular, over 10 cc
- J1561 - Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g.,
- J1566 - Injection, immune globulin, intravenous, lyophilized (e.g., powder), not
- J1568 - Injection, immune globulin, (octagam), intravenous, non-lyophilized (...
- J1569 - Injection, immune globulin, (gammagard liquid/gammagard liquid erc),...
- J1570 - Injection, ganciclovir sodium, 500 mg
- J1575 - Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglob...
- J1576 - Injection, immune globulin (panzyga), intravenous, non-lyophilized (e...
- J1577 - Injection, immune globulin (qivigy), 100 mg
- J1580 - Injection, garamycin, gentamicin, up to 80 mg
- J1596 - Injection, glycopyrrolate, 0.1 mg
- J1597 - Injection, glycopyrrolate (glyrx-pf), 0.1 mg
- J1598 - Injection, glycopyrrolate (fresenius kabi), not therapeutically equiv...
- J1602 - Injection, golimumab, 1 mg, for intravenous use
- J1610 - Injection, glucagon hydrochloride, per 1 mg
- J1611 - Injection, glucagon hydrochloride (fresenius kabi), not therapeutically
- J1626 - Injection, granisetron hydrochloride, 100 mcg
- J1627 - Injection, granisetron, extended-release, 0.1 mg
- J1628 - Injection, guselkumab, 1 mg
- J1630 - Injection, haloperidol, up to 5 mg
- J1631 - Injection, haloperidol decanoate, per 50 mg
- J1640 - Injection, hemin, 1 mg
- J1642 - Injection, heparin sodium, (heparin lock flush), per 10 units
- J1643 - Injection, heparin sodium (pfizer), not therapeutically equivalent to...
- J1644 - Injection, heparin sodium, per 1000 units
- J1645 - Injection, dalteparin sodium, per 2500 iu
- J1650 - Injection, enoxaparin sodium, 10 mg
- J1652 - Injection, fondaparinux sodium, 0.5 mg
- J1670 - Injection, tetanus immune globulin, human, up to 250 units
- J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg
- J1737 - Injection, meloxicam (azurity), 1 mg
- J1740 - Injection, ibandronate sodium, 1 mg
- J1741 - Injection, ibuprofen, 100 mg
- J1743 - Injection, idursulfase, 1 mg
- J1746 - Injection, ibalizumab-uiyk, 10 mg
- J1747 - Injection, spesolimab-sbzo, 1 mg
- J1749 - Injection, iloprost, 0.1 mcg
- J1750 - Injection, iron dextran, 50 mg
- J1756 - Injection, iron sucrose, 1 mg
- J1786 - Injection, imiglucerase, 10 units
- J1790 - Injection, droperidol, up to 5 mg
- J1808 - Injection, folic acid, 0.1 mg
- J1817 - Insulin for administration through dme (i.e., insulin pump) per 50 units
- J1823 - Injection, inebilizumab-cdon, 1 mg
- J1836 - Injection, metronidazole, 10 mg
- J1837 - Injection, posaconazole, 1 mg
- J1885 - Injection, ketorolac tromethamine, per 15 mg
- J1930 - Injection, lanreotide, 1 mg
- J1931 - Injection, laronidase, 0.1 mg
- J1932 - Injection, lanreotide, (cipla), 1 mg
- J1938 - Injection, furosemide, 1 mg
- J1939 - Injection, bumetanide, 0.5 mg
- J1943 - Injection, aripiprazole lauroxil, (aristada initio), 1 mg
- J1944 - Injection, aripiprazole lauroxil, (aristada), 1 mg
- J1950 - Injection, leuprolide acetate (for depot suspension), per 3.75 mg
- J1951 - Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg
- J1952 - Leuprolide injectable, camcevi, 1 mg
- J1954 - Injection, leuprolide acetate for depot suspension (lutrate depot), 7...
- J1955 - Injection, levocarnitine, per 1 gm
- J1956 - Injection, levofloxacin, 250 mg
- J2002 - Injection, lidocaine hcl in 5% dextrose, 1 mg
- J2010 - Injection, lincomycin hcl, up to 300 mg
- J2020 - Injection, linezolid, 200 mg
- J2021 - Injection, linezolid (hospira), not therapeutically equivalent to j20...
- J2060 - Injection, lorazepam, 2 mg
- J2175 - Injection, meperidine hydrochloride, per 100 mg
- J2182 - Injection, mepolizumab, 1 mg
- J2183 - Injection, meropenem (wg critical care), not therapeutically equivale...
- J2184 - Injection, meropenem (b. braun), not therapeutically equivalent to j2...
- J2185 - Injection, meropenem, 100 mg
- J2210 - Injection, methylergonovine maleate, up to 0.2 mg
- J2246 - Injection, micafungin in sodium (baxter), not therapeutically equival...
- J2247 - Injection, micafungin sodium (par pharm) not thereapeutically equival...
- J2248 - Injection, micafungin sodium, 1 mg
- J2250 - Injection, midazolam hydrochloride, per 1 mg
- J2251 - Injection, midazolam in 0.9% sodium chloride, intravenous, not therap...
- J2260 - Injection, milrinone lactate, 5 mg
- J2267 - Injection, mirikizumab-mrkz, 1 mg
- J2270 - Injection, morphine sulfate, up to 10 mg
- J2272 - Injection, morphine sulfate (fresenius kabi), not therapeutically equ...
- J2274 - Injection, morphine sulfate, preservative-free for epidural or intrat...
- J2277 - Injection, motixafortide, 0.25 mg
- J2278 - Injection, ziconotide, 1 microgram
- J2280 - Injection, moxifloxacin, 100 mg
- J2281 - Injection, moxifloxacin (fresenius kabi), not therapeutically equival...
- J2290 - Injection, nafcillin sodium, 20 mg
- J2300 - Injection, nalbuphine hydrochloride, per 10 mg
- J2312 - Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg
- J2315 - Injection, naltrexone, depot form, 1 mg
- J2323 - Injection, natalizumab, 1 mg
- J2327 - Injection, risankizumab-rzaa, intravenous, 1 mg
- J2350 - Injection, ocrelizumab, 1 mg
- J2351 - Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq
- J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg
- J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous
- J2356 - Injection, tezepelumab-ekko, 1 mg
- J2357 - Injection, omalizumab, 5 mg
- J2358 - Injection, olanzapine, long-acting, 1 mg
- J2359 - Injection, olanzapine, 0.5 mg
- J2360 - Injection, orphenadrine citrate, up to 60 mg
- J2401 - Injection, chloroprocaine hydrochloride, per 1 mg
- J2403 - Chloroprocaine hcl ophthalmic, 3% gel, 1 mg
- J2404 - Injection, nicardipine, 0.1 mg
- J2405 - Injection, ondansetron hydrochloride, per 1 mg
- J2425 - Injection, palifermin, 50 micrograms
- J2426 - Injection, paliperidone palmitate extended release (invega sustenna),...
- J2427 - Injection, paliperidone palmitate extended release (invega hafyera, o...
- J2428 - Injection, paliperidone palmitate extended release (erzofri), 1 mg
- J2430 - Injection, pamidronate disodium, per 30 mg
- J2468 - Injection, palonosetron hydrochloride (posfrea), 25 micrograms
- J2469 - Injection, palonosetron hcl, 25 mcg
- J2501 - Injection, paricalcitol, 1 mcg
- J2502 - Injection, pasireotide long acting, 1 mg
- J2506 - Injection, pegfilgrastim, excludes biosimilar, 0.5 mg
- J2507 - Injection, pegloticase, 1 mg
- J2508 - Injection, pegunigalsidase alfa-iwxj, 1 mg
- J2516 - Injection, pentamidine isethionate, 1 mg
- J2540 - Injection, penicillin g potassium, up to 600,000 units
- J2543 - Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams...
- J2545 - Pentamidine isethionate, inhalation solution, fda-approved final prod...
- J2550 - Injection, promethazine hcl, up to 50 mg
- J2560 - Injection, phenobarbital sodium, up to 120 mg
- J2562 - Injection, plerixafor, 1 mg
- J2596 - Injection, vasopressin (long grove), not therapeutically equivalent t...
- J2597 - Injection, desmopressin acetate, per 1 mcg
- J2598 - Injection, vasopressin, 1 unit
- J2599 - Injection, vasopressin (american regent), not therapeutically equival...
- J2601 - Injection, vasopressin (baxter), 1 unit
- J2675 - Injection, progesterone, per 50 mg
- J2679 - Injection, fluphenazine hcl, 1.25 mg
- J2680 - Injection, fluphenazine decanoate, up to 25 mg
- J2690 - Injection, procainamide hcl, up to 1 gm
- J2700 - Injection, oxacillin sodium, up to 250 mg
- J2704 - Injection, propofol, 10 mg
- J2720 - Injection, protamine sulfate, per 10 mg
- J2724 - Injection, protein c concentrate, intravenous, human, 10 iu
- J2760 - Injection, phentolamine mesylate, up to 5 mg
- J2765 - Injection, metoclopramide hcl, up to 10 mg
- J2777 - Injection, faricimab-svoa, 0.1 mg
- J2778 - Injection, ranibizumab, 0.1 mg
- J2779 - Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg
- J2781 - Injection, pegcetacoplan, intravitreal, 1 mg
- J2782 - Injection, avacincaptad pegol, 0.1 mg
- J2783 - Injection, rasburicase, 0.5 mg
- J2785 - Injection, regadenoson, 0.1 mg
- J2786 - Injection, reslizumab, 1 mg
- J2788 - Injection, rho d immune globulin, human, minidose, 50 micrograms (250...
- J2790 - Injection, rho d immune globulin, human, full dose, 300 micrograms (1...
- J2791 - Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or
- J2792 - Injection, rho d immune globulin, intravenous, human, solvent deterge...
- J2794 - Injection, risperidone (risperdal consta), 0.5 mg
- J2795 - Injection, ropivacaine hydrochloride, 1 mg
- J2798 - Injection, risperidone, (perseris), 0.5 mg
- J2799 - Injection, risperidone (uzedy), 1 mg
- J2800 - Injection, methocarbamol, up to 10 ml
- J2802 - Injection, romiplostim, 1 microgram
- J2804 - Injection, rifampin, 1 mg
- J2805 - Injection, sincalide, 5 micrograms
- J2820 - Injection, sargramostim (gm-csf), 50 mcg
- J2860 - Injection, siltuximab, 10 mg
- J2865 - Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg
- J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg
- J2919 - Injection, methylprednisolone sodium succinate, 5 mg
- J2997 - Injection, alteplase recombinant, 1 mg
- J3000 - Injection, streptomycin, up to 1 gm
- J3010 - Injection, fentanyl citrate, 0.1 mg
- J3032 - Injection, eptinezumab-jjmr, 1 mg
- J3055 - Injection, talquetamab-tgvs, 0.25 mg
- J3060 - Injection, taliglucerase alfa, 10 units
- J3090 - Injection, tedizolid phosphate, 1 mg
- J3095 - Injection, telavancin, 10 mg
- J3101 - Injection, tenecteplase, 1 mg
- J3105 - Injection, terbutaline sulfate, up to 1 mg
- J3111 - Injection, romosozumab-aqqg, 1 mg
- J3121 - Injection, testosterone enanthate, 1 mg
- J3145 - Injection, testosterone undecanoate, 1 mg
- J3230 - Injection, chlorpromazine hcl, up to 50 mg
- J3240 - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
- J3241 - Injection, teprotumumab-trbw, 10 mg
- J3243 - Injection, tigecycline, 1 mg
- J3245 - Injection, tildrakizumab, 1 mg
- J3246 - Injection, tirofiban hcl, 0.25 mg
- J3247 - Injection, secukinumab, intravenous, 1 mg
- J3250 - Injection, trimethobenzamide hcl, up to 200 mg
- J3260 - Injection, tobramycin sulfate, up to 80 mg
- J3262 - Injection, tocilizumab, 1 mg
- J3263 - Injection, toripalimab-tpzi, 1 mg
- J3285 - Injection, treprostinil, 1 mg
- J3299 - Injection, triamcinolone acetonide (xipere), 1 mg
- J3300 - Injection, triamcinolone acetonide (triesence), preservative free, 1 mg
- J3301 - Injection, triamcinolone acetonide, not otherwise specified, 10 mg
- J3304 - Injection, triamcinolone acetonide, preservative-free, extended-release,
- J3315 - Injection, triptorelin pamoate, 3.75 mg
- J3316 - Injection, triptorelin, extended-release, 3.75 mg
- J3358 - Ustekinumab, for intravenous injection, 1 mg
- J3360 - Injection, diazepam, up to 5 mg
- J3373 - Injection, vancomycin hydrochloride, 10 mg
- J3374 - Injection, vancomycin hydrochloride (mylan) not therapeutically equiv...
- J3375 - Injection, vancomycin hydrochloride (tyzavan), not therapeutically eq...
- J3376 - Injection, vancomycin hcl (hikma), not therapeutically equivalent to...
- J3379 - Injection, valproate sodium, 5 mg
- J3380 - Injection, vedolizumab, intravenous, 1 mg
- J3385 - Injection, velaglucerase alfa, 100 units
- J3396 - Injection, verteporfin, 0.1 mg
- J3401 - Beremagene geperpavec-svdt for topical administration, containing nom...
- J3410 - Injection, hydroxyzine hcl, up to 25 mg
- J3411 - Injection, thiamine hcl, 100 mg
- J3415 - Injection, pyridoxine hcl, 100 mg
- J3420 - Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
- J3425 - Injection, hydroxocobalamin, intramuscular, 10 mcg
- J3430 - Injection, phytonadione (vitamin k), per 1 mg
- J3465 - Injection, voriconazole, 10 mg
- J3470 - Injection, hyaluronidase, up to 150 units
- J3473 - Injection, hyaluronidase, recombinant, 1 usp unit
- J3475 - Injection, magnesium sulfate, per 500 mg
- J3480 - Injection, potassium chloride, per 2 meq
- J3485 - Injection, zidovudine, 10 mg
- J3486 - Injection, ziprasidone mesylate, 10 mg
- J3489 - Injection, zoledronic acid, 1 mg
- J7030 - Infusion, normal saline solution , 1000 cc
- J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit)
- J7042 - 5% dextrose/normal saline (500 ml = 1 unit)
- J7050 - Infusion, normal saline solution, 250 cc
- J7060 - 5% dextrose/water (500 ml = 1 unit)
- J7070 - Infusion, d5w, 1000 cc
- J7120 - Ringers lactate infusion, up to 1000 cc
- J7170 - Injection, emicizumab-kxwh, 0.5 mg
- J7172 - Injection, marstacimab-hncq, 0.5 mg
- J7175 - Injection, factor x, (human), 1 i.u.
- J7177 - Injection, human fibrinogen concentrate (fibryga), 1 mg
- J7178 - Injection, human fibrinogen concentrate, not otherwise specified, 1 mg
- J7179 - Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vw...
- J7180 - Injection, factor xiii (antihemophilic factor, human), 1 i.u.
- J7181 - Injection, factor xiii a-subunit, (recombinant), per iu
- J7182 - Injection, factor viii, (antihemophilic factor, recombinant), (novoei...
- J7183 - Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco
- J7185 - Injection, factor viii (antihemophilic factor, recombinant) (xyntha),...
- J7186 - Injection, antihemophilic factor viii/von willebrand factor complex (...
- J7187 - Injection, von willebrand factor complex (humate-p), per iu vwf:rco
- J7188 - Injection, factor viii (antihemophilic factor, recombinant), (obizur)...
- J7189 - Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 m...
- J7190 - Factor viii (antihemophilic factor, human) per i.u.
- J7192 - Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise
- J7193 - Factor ix (antihemophilic factor, purified, non-recombinant) per i.u.
- J7194 - Factor ix, complex, per i.u.
- J7195 - Injection, factor ix (antihemophilic factor, recombinant) per iu, not...
- J7197 - Antithrombin iii (human), per i.u.
- J7198 - Anti-inhibitor, per i.u.
- J7200 - Injection, factor ix, (antihemophilic factor, recombinant), rixubis,...
- J7201 - Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
- J7202 - Injection, factor ix, albumin fusion protein, (recombinant), idelvion...
- J7203 - Injection factor ix, (antihemophilic factor, recombinant), glycopegyl...
- J7204 - Injection, factor viii, antihemophilic factor (recombinant), (esperoct),
- J7205 - Injection, factor viii fc fusion protein (recombinant), per iu
- J7207 - Injection, factor viii, (antihemophilic factor, recombinant), pegylat...
- J7208 - Injection, factor viii, (antihemophilic factor, recombinant), pegylat...
- J7209 - Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq)...
- J7210 - Injection, factor viii, (antihemophilic factor, recombinant), (afstyl...
- J7211 - Injection, factor viii, (antihemophilic factor, recombinant), (kovalt...
- J7212 - Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1...
- J7213 - Injection, coagulation factor ix (recombinant), ixinity, 1 i.u.
- J7214 - Injection, factor viii/von willebrand factor complex, recombinant (al...
- J7308 - Aminolevulinic acid hcl for topical administration, 20%, single unit...
- J7311 - Injection, fluocinolone acetonide, intravitreal implant (retisert), 0...
- J7312 - Injection, dexamethasone, intravitreal implant, 0.1 mg
- J7313 - Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0....
- J7318 - Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg
- J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection,...
- J7321 - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-arti...
- J7322 - Hyaluronan or derivative, hymovis or hymovis one, for intra-articular
- J7323 - Hyaluronan or derivative, euflexxa, for intra-articular injection, pe...
- J7325 - Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular
- J7326 - Hyaluronan or derivative, gel-one, for intra-articular injection, per...
- J7328 - Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0....
- J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg
- J7336 - Capsaicin 8% patch, per square centimeter
- J7340 - Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml
- J7345 - Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg
- J7351 - Injection, bimatoprost, intracameral implant, 1 microgram
- J7354 - Cantharidin for topical administration, 0.7%, single unit dose applic...
- J7355 - Injection, travoprost, intracameral implant, 1 microgram
- J7356 - Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg
- J7402 - Mometasone furoate sinus implant, (sinuva), 10 micrograms
- J7500 - Azathioprine, oral, 50 mg
- J7502 - Cyclosporine, oral, 100 mg
- J7503 - Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg
- J7504 - Lymphocyte immune globulin, antithymocyte globulin, equine, parentera...
- J7507 - Tacrolimus, immediate release, oral, 1 mg
- J7508 - Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg
- J7509 - Methylprednisolone oral, per 4 mg
- J7510 - Prednisolone oral, per 5 mg
- J7511 - Lymphocyte immune globulin, antithymocyte globulin, rabbit, parentera...
- J7512 - Prednisone, immediate release or delayed release, oral, 1 mg
- J7515 - Cyclosporine, oral, 25 mg
- J7516 - Injection, cyclosporine, 250 mg
- J7518 - Mycophenolic acid, oral, 180 mg
- J7520 - Sirolimus, oral, 1 mg
- J7521 - Tacrolimus, granules, oral suspension, 0.1 mg
- J7525 - Tacrolimus, parenteral, 5 mg
- J7527 - Everolimus, oral, 0.25 mg
- J7601 - Ensifentrine, inhalation suspension, fda approved final product,
- J7605 - Arformoterol, inhalation solution, fda approved final product, non-co...
- J7606 - Formoterol fumarate, inhalation solution, fda approved final product,
- J7608 - Acetylcysteine, inhalation solution, fda-approved final product,
- J7611 - Albuterol, inhalation solution, fda-approved final product, non-compo...
- J7612 - Levalbuterol, inhalation solution, fda-approved final product, non-co...
- J7613 - Albuterol, inhalation solution, fda-approved final product, non-compo...
- J7614 - Levalbuterol, inhalation solution, fda-approved final product, non-co...
- J7620 - Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-ap...
- J7626 - Budesonide, inhalation solution, fda-approved final product, non-comp...
- J7631 - Cromolyn sodium, inhalation solution, fda-approved final product,
- J7639 - Dornase alfa, inhalation solution, fda-approved final product, non-co...
- J7644 - Ipratropium bromide, inhalation solution, fda-approved final product,
- J7674 - Methacholine chloride administered as inhalation solution through a n...
- J7677 - Revefenacin inhalation solution, fda-approved final product, non-comp...
- J7682 - Tobramycin, inhalation solution, fda-approved final product, non-comp...
- J7686 - Treprostinil, inhalation solution, fda-approved final product, non-co...
- J8501 - Aprepitant, oral, 5 mg
- J8515 - Cabergoline, oral, 0.25 mg
- J8522 - Capecitabine, oral, 50 mg
- J8530 - Cyclophosphamide; oral, 25 mg
- J8540 - Dexamethasone, oral, 0.25 mg
- J8541 - Dexamethasone (hemady), oral, 0.25 mg
- J8560 - Etoposide; oral, 50 mg
- J8610 - Methotrexate; oral, 2.5 mg
- J8611 - Methotrexate (jylamvo), oral, 2.5 mg
- J8612 - Methotrexate (xatmep), oral, 2.5 mg
- J8655 - Netupitant 300 mg and palonosetron 0.5 mg, oral
- J8700 - Temozolomide, oral, 5 mg
- J8705 - Topotecan, oral, 0.25 mg
- J9000 - Injection, doxorubicin hydrochloride, 10 mg
- J9011 - Injection, datopotamab deruxtecan-dlnk, 1 mg
- J9017 - Injection, arsenic trioxide, 1 mg
- J9021 - Injection, asparaginase, recombinant, (rylaze), 0.1 mg
- J9022 - Injection, atezolizumab, 10 mg
- J9023 - Injection, avelumab, 10 mg
- J9024 - Injection, atezolizumab, 5 mg and hyaluronidase-tqjs
- J9025 - Injection, azacitidine, 1 mg
- J9026 - Injection, tarlatamab-dlle, 1 mg
- J9027 - Injection, clofarabine, 1 mg
- J9028 - Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1...
- J9029 - Intravesical instillation, nadofaragene firadenovec-vncg, per therape...
- J9030 - Bcg live intravesical instillation, 1 mg
- J9032 - Injection, belinostat, 10 mg
- J9033 - Injection, bendamustine hydrochloride, not otherwise specified, 1 mg
- J9034 - Injection, bendamustine hcl (bendeka), 1 mg
- J9035 - Injection, bevacizumab, 10 mg
- J9036 - Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg
- J9038 - Injection, axatilimab-csfr, 0.1 mg
- J9039 - Injection, blinatumomab, 1 microgram
- J9040 - Injection, bleomycin sulfate, 15 units
- J9041 - Injection, bortezomib, 0.1 mg
- J9042 - Injection, brentuximab vedotin, 1 mg
- J9043 - Injection, cabazitaxel, 1 mg
- J9045 - Injection, carboplatin, 50 mg
- J9047 - Injection, carfilzomib, 1 mg
- J9049 - Injection, bortezomib (hospira), not therapeutically equivalent to j9...
- J9050 - Injection, carmustine, 100 mg
- J9054 - Injection, bortezomib (boruzu), 0.1 mg
- J9055 - Injection, cetuximab, 10 mg
- J9056 - Injection, bendamustine hydrochloride (vivimusta), 1 mg
- J9060 - Injection, cisplatin, powder or solution, 10 mg
- J9061 - Injection, amivantamab-vmjw, 2 mg
- J9063 - Injection, mirvetuximab soravtansine-gynx, 1 mg
- J9065 - Injection, cladribine, per 1 mg
- J9071 - Injection, cyclophosphamide (auromedics), 5 mg
- J9072 - Injection, cyclophosphamide (frindovyx), 5 mg
- J9073 - Injection, cyclophosphamide (dr. reddy's), 5 mg
- J9074 - Injection, cyclophosphamide (sandoz), 5 mg
- J9075 - Injection, cyclophosphamide, not otherwise specified, 5 mg
- J9076 - Injection, cyclophosphamide (baxter), 5 mg
- J9100 - Injection, cytarabine, 100 mg
- J9118 - Injection, calaspargase pegol-mknl, 10 units
- J9119 - Injection, cemiplimab-rwlc, 1 mg
- J9120 - Injection, dactinomycin, 0.5 mg
- J9130 - Dacarbazine, 100 mg
- J9144 - Injection, daratumumab, 10 mg and hyaluronidase-fihj
- J9145 - Injection, daratumumab, 10 mg
- J9150 - Injection, daunorubicin, 10 mg
- J9153 - Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
- J9155 - Injection, degarelix, 1 mg
- J9161 - Injection, denileukin diftitox-cxdl, 1 mcg
- J9171 - Injection, docetaxel, 1 mg
- J9172 - Injection, docetaxel (docivyx), 1 mg
- J9173 - Injection, durvalumab, 10 mg
- J9174 - Injection, docetaxel (beizray), 1 mg
- J9176 - Injection, elotuzumab, 1 mg
- J9177 - Injection, enfortumab vedotin-ejfv, 0.25 mg
- J9178 - Injection, epirubicin hcl, 2 mg
- J9179 - Injection, eribulin mesylate, 0.1 mg
- J9184 - Injection, gemcitabine hydrochloride (avyxa), 200 mg
- J9185 - Injection, fludarabine phosphate, 50 mg
- J9200 - Injection, floxuridine, 500 mg
- J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
- J9203 - Injection, gemtuzumab ozogamicin, 0.1 mg
- J9204 - Injection, mogamulizumab-kpkc, 1 mg
- J9205 - Injection, irinotecan liposome, 1 mg
- J9206 - Injection, irinotecan, 20 mg
- J9207 - Injection, ixabepilone, 1 mg
- J9208 - Injection, ifosfamide, 1 gram
- J9209 - Injection, mesna, 200 mg
- J9210 - Injection, emapalumab-lzsg, 1 mg
- J9211 - Injection, idarubicin hydrochloride, 5 mg
- J9217 - Leuprolide acetate (for depot suspension), 7.5 mg
- J9223 - Injection, lurbinectedin, 0.1 mg
- J9226 - Histrelin implant (supprelin la), 50 mg
- J9227 - Injection, isatuximab-irfc, 10 mg
- J9228 - Injection, ipilimumab, 1 mg
- J9229 - Injection, inotuzumab ozogamicin, 0.1 mg
- J9245 - Injection, melphalan hydrochloride, not otherwise specified, 50 mg
- J9246 - Injection, melphalan (evomela), 1 mg
- J9248 - Injection, melphalan (hepzato), 1 mg
- J9256 - Injection, nipocalimab-aahu, 3 mg
- J9260 - Injection, methotrexate sodium, 50 mg
- J9261 - Injection, nelarabine, 50 mg
- J9263 - Injection, oxaliplatin, 0.5 mg
- J9264 - Injection, paclitaxel protein-bound particles, 1 mg
- J9266 - Injection, pegaspargase, per single dose vial
- J9267 - Injection, paclitaxel, 1 mg
- J9268 - Injection, pentostatin, 10 mg
- J9269 - Injection, tagraxofusp-erzs, 10 micrograms
- J9271 - Injection, pembrolizumab, 1 mg
- J9272 - Injection, dostarlimab-gxly, 10 mg
- J9273 - Injection, tisotumab vedotin-tftv, 1 mg
- J9274 - Injection, tebentafusp-tebn, 1 microgram
- J9275 - Injection, cosibelimab-ipdl, 2 mg
- J9276 - Injection, zanidatamab-hrii, 2 mg
- J9280 - Injection, mitomycin, 5 mg
- J9281 - Mitomycin pyelocalyceal instillation, 1 mg
- J9282 - Mitomycin, intravesical instillation, 1 mg
- J9286 - Injection, glofitamab-gxbm, 2.5 mg
- J9289 - Injection, nivolumab, 2 mg and hyaluronidase-nvhy
- J9292 - Injection, pemetrexed dipotassium, 10 mg
- J9293 - Injection, mitoxantrone hydrochloride, per 5 mg
- J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9...
- J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j93...
- J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg
- J9299 - Injection, nivolumab, 1 mg
- J9301 - Injection, obinutuzumab, 10 mg
- J9303 - Injection, panitumumab, 10 mg
- J9304 - Injection, pemetrexed (pemfexy), 10 mg
- J9305 - Injection, pemetrexed, not otherwise specified, 10 mg
- J9306 - Injection, pertuzumab, 1 mg
- J9307 - Injection, pralatrexate, 1 mg
- J9308 - Injection, ramucirumab, 5 mg
- J9309 - Injection, polatuzumab vedotin-piiq, 1 mg
- J9311 - Injection, rituximab 10 mg and hyaluronidase
- J9312 - Injection, rituximab, 10 mg
- J9314 - Injection, pemetrexed (teva), not therapeutically equivalent to j9305...
- J9316 - Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
- J9317 - Injection, sacituzumab govitecan-hziy, 2.5 mg
- J9318 - Injection, romidepsin, non-lyophilized, 0.1 mg
- J9319 - Injection, romidepsin, lyophilized, 0.1 mg
- J9321 - Injection, epcoritamab-bysp, 0.16 mg
- J9324 - Injection, pemetrexed (pemrydi rtu), 10 mg
- J9325 - Injection, talimogene laherparepvec, per 1 million plaque forming units
- J9326 - Injection, telisotuzumab vedotin-tllv, 1 mg
- J9328 - Injection, temozolomide, 1 mg
- J9329 - Injection, tislelizumab-jsgr, 1mg
- J9330 - Injection, temsirolimus, 1 mg
- J9331 - Injection, sirolimus protein-bound particles, 1 mg
- J9332 - Injection, efgartigimod alfa-fcab, 2mg
- J9333 - Injection, rozanolixizumab-noli, 1 mg
- J9334 - Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc
- J9341 - Injection, thiotepa (tepylute), 1 mg
- J9342 - Injection, thiotepa, not otherwise specified, 1 mg
- J9345 - Injection, retifanlimab-dlwr, 1 mg
- J9347 - Injection, tremelimumab-actl, 1 mg
- J9348 - Injection, naxitamab-gqgk, 1 mg
- J9349 - Injection, tafasitamab-cxix, 2 mg
- J9350 - Injection, mosunetuzumab-axgb, 1 mg
- J9351 - Injection, topotecan, 0.1 mg
- J9353 - Injection, margetuximab-cmkb, 5 mg
- J9354 - Injection, ado-trastuzumab emtansine, 1 mg
- J9355 - Injection, trastuzumab, excludes biosimilar, 10 mg
- J9356 - Injection, trastuzumab, 10 mg and hyaluronidase-oysk
- J9357 - Injection, valrubicin, intravesical, 200 mg
- J9358 - Injection, fam-trastuzumab deruxtecan-nxki, 1 mg
- J9359 - Injection, loncastuximab tesirine-lpyl, 0.075 mg
- J9360 - Injection, vinblastine sulfate, 1 mg
- J9361 - Injection, efbemalenograstim alfa-vuxw, 0.5 mg
- J9370 - Vincristine sulfate, 1 mg
- J9380 - Injection, teclistamab-cqyv, 0.5 mg
- J9381 - Injection, teplizumab-mzwv, 5 mcg
- J9382 - Injection, zenocutuzumab-zbco, 1 mg
- J9390 - Injection, vinorelbine tartrate, 10 mg
- J9395 - Injection, fulvestrant, 25 mg
- J9400 - Injection, ziv-aflibercept, 1 mg
- P9045 - Infusion, albumin (human), 5%, 250 ml
- P9046 - Infusion, albumin (human), 25%, 20 ml
- Q0162 - Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for us...
- Q0166 - Granisetron hydrochloride, 1 mg, oral, fda approved prescription anti...
- Q0167 - Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for...
- Q0224 - Injection, pemivibart, for the pre-exposure prophylaxis only, for cer...
- Q0249 - Injection, tocilizumab, for hospitalized adults and pediatric patient...
- Q2043 - Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated...
- Q2050 - Injection, doxorubicin hydrochloride, liposomal, not otherwise specif...
- Q2057 - Afamitresgene autoleucel, including leukapheresis and dose preparation
- Q2058 - Obecabtagene autoleucel, 10 up to 400 million cd19 car-positive viabl...
- Q4081 - Injection, epoetin alfa, 100 units (for esrd on dialysis)
- Q5098 - Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg
- Q5099 - Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg
- Q5100 - Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg
- Q5101 - Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram
- Q5105 - Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dia...
- Q5106 - Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd us...
- Q5108 - Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg
- Q5110 - Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram
- Q5111 - Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg
- Q5112 - Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg
- Q5113 - Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg
- Q5114 - Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg
- Q5116 - Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg
- Q5117 - Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg
- Q5120 - Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg
- Q5124 - Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg
- Q5125 - Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram
- Q5127 - Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg
- Q5128 - Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg
- Q5133 - Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg
- Q5134 - Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg
- Q5135 - Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg
- Q5136 - Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg
- Q5138 - Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg
- Q5146 - Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg
- Q5147 - Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg
- Q5148 - Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram
- Q5157 - Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg
- Q5158 - Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg
- Q5162 - Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg
- Q5167 - Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg
- Q5168 - Injection, ranibizumab-leyk (nufymco), biosimilar, 0.1 mg
- Q5169 - Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg
- Q9950 - Injection, sulfur hexafluoride lipid microspheres, per ml
- Q9958 - High osmolar contrast material, up to 149 mg/ml iodine concentration,...
- Q9961 - High osmolar contrast material, 250-299 mg/ml iodine concentration, p...
- Q9963 - High osmolar contrast material, 350-399 mg/ml iodine concentration, p...
- Q9965 - Low osmolar contrast material, 100-199 mg/ml iodine concentration, pe...
- Q9966 - Low osmolar contrast material, 200-299 mg/ml iodine concentration, pe...
- Q9967 - Low osmolar contrast material, 300-399 mg/ml iodine concentration, pe...
- Q9997 - Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg
- Q9998 - Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg
- Q9999 - Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg
National Coverage Determinations
- NCD 10.1 - Use of Visual Tests Prior to and General Anesthesia during Cataract S...
- NCD 10.2 - Transcutaneous Electrical Nerve Stimulation (TENS) for Acute Post-Ope...
- NCD 10.3 - Inpatient Hospital Pain Rehabilitation Programs
- NCD 10.4 - Outpatient Hospital Pain Rehabilitation Programs
- NCD 10.6 - Anesthesia in Cardiac Pacemaker Surgery
- NCD 20.1 - Vertebral Artery Surgery
- NCD 20.2 - Extracranial-Intracranial (EC-IC) Arterial Bypass Surgery
- NCD 20.3 - Thoracic Duct Drainage (TDD) in Renal Transplants
- NCD 20.4 - Implantable Cardioverter Defibrillators (ICDs)
- NCD 20.6 - Transmyocardial Revascularization (TMR)
- NCD 20.7 - Percutaneous Transluminal Angioplasty (PTA)
- NCD 20.8.1 - Cardiac Pacemaker Evaluation Services
- NCD 20.8.1.1 - Transtelephonic Monitoring of Cardiac Pacemakers
- NCD 20.8.2 - Self-Contained Pacemaker Monitors
- NCD 20.8.3 - Single Chamber and Dual Chamber Permanent Cardiac Pacemakers
- NCD 20.8.4 - Leadless Pacemakers
- NCD 20.9.1 - Ventricular Assist Devices
- NCD 20.10 - Cardiac Rehabilitation Programs - RETIRED
- NCD 20.10.1 - Cardiac Rehabilitation Programs for Chronic Heart Failure
- NCD 20.11 - Intraoperative Ventricular Mapping
- NCD 20.12 - Diagnostic Endocardial Electrical Stimulation (Pacing)
- NCD 20.13 - HIS Bundle Study
- NCD 20.14 - Plethysmography
- NCD 20.15 - Electrocardiographic Services
- NCD 20.16 - Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
- NCD 20.17 - Noninvasive Tests of Carotid Function
- NCD 20.18 - Carotid Body Resection/Carotid Body Denervation
- NCD 20.19 - Ambulatory Blood Pressure Monitoring
- NCD 20.20 - External Counterpulsation (ECP) Therapy for Severe Angina
- NCD 20.21 - Chelation Therapy for Treatment of Atherosclerosis
- NCD 20.23 - Fabric Wrapping of Abdominal Aneurysms
- NCD 20.24 - Displacement Cardiography
- NCD 20.26 - Partial Ventriculectomy
- NCD 20.27 - Cardiointegram (CIG) as an Alternative to Stress Test or Thallium Str...
- NCD 20.29 - Hyperbaric Oxygen Therapy
- NCD 20.30 - Microvolt T-Wave Alternans (MTWA)
- NCD 20.31 - Intensive Cardiac Rehabilitation (ICR) Programs
- NCD 20.31.3 - Benson-Henry Institute Cardiac Wellness Program
- NCD 20.32 - Transcatheter Aortic Valve Replacement (TAVR)
- NCD 20.33 - Transcatheter Edge-to-Edge Repair (TEER) for Mitral Valve Regurgitation
- NCD 20.34 - Percutaneous Left Atrial Appendage Closure (LAAC)
- NCD 20.35 - Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery D...
- NCD 20.36 - Implantable Pulmonary Artery Pressure Sensors for Heart Failure Manag...
- NCD 20.39 - Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
- NCD 20.40 - Renal Denervation (RDN) for Uncontrolled Hypertension
- NCD 30.1 - Biofeedback Therapy
- NCD 30.1.1 - Biofeedback Therapy for the Treatment of Urinary Incontinence
- NCD 30.2 - Thermogenic Therapy
- NCD 30.3 - Acupuncture
- NCD 30.3.3 - Acupuncture for Chronic Lower Back Pain (cLBP)
- NCD 30.5 - Transcendental Meditation
- NCD 30.6 - Intravenous Histamine Therapy
- NCD 30.7 - Laetrile and Related Substances
- NCD 40.2 - Home Blood Glucose Monitors
- NCD 40.3 - Closed-Loop Blood Glucose Control Device (CBGCD)
- NCD 40.7 - Outpatient Intravenous Insulin Treatment
- NCD 50.1 - Speech Generating Devices
- NCD 50.2 - Electronic Speech Aids
- NCD 50.3 - Cochlear Implantation
- NCD 50.8 - Ultrasonic Surgery
- NCD 70.1 - Consultations with a Beneficiary's Family and Associates
- NCD 70.2 - Consultation Services Rendered by a Podiatrist in a Skilled Nursing F...
- NCD 70.2.1 - Services Provided for the Diagnosis and Treatment of Diabetic Sensory...
- NCD 70.3 - Physician's Office within an Institution Coverage of Services and Sup...
- NCD 70.5 - Hospital and Skilled Nursing Facility Admission Diagnostic Procedures
- NCD 80.1 - Hydrophilic Contact Lens For Corneal Bandage
- NCD 80.2 - Photodynamic Therapy
- NCD 80.2.1 - Ocular Photodynamic Therapy (OPT)
- NCD 80.3 - Photosensitive Drugs
- NCD 80.3.1 - Verteporfin
- NCD 80.4 - Hydrophilic Contact Lenses
- NCD 80.5 - Scleral Shell
- NCD 80.7 - Refractive Keratoplasty
- NCD 80.8 - Endothelial Cell Photography
- NCD 80.11 - Vitrectomy
- NCD 90.1 - Pharmacogenomic Testing for Warfarin Response
- NCD 90.2 - Next Generation Sequencing (NGS)
- NCD 100.1 - Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Mo...
- NCD 100.3 - 24-Hour Ambulatory Esophageal pH Monitoring
- NCD 100.4 - Esophageal Manometry
- NCD 100.5 - Diagnostic Breath Analyses
- NCD 100.12 - Gastrophotography
- NCD 110.2 - Certain Drugs Distributed by the National Cancer Institute
- NCD 110.4 - Extracorporeal Photopheresis
- NCD 110.7 - Blood Transfusions
- NCD 110.10 - Intravenous Iron Therapy
- NCD 110.12 - Challenge Ingestion Food Testing
- NCD 110.14 - Apheresis (Therapeutic Pheresis)
- NCD 110.15 - Ultrafiltration, Hemoperfusion and Hemofiltration
- NCD 110.16 - Nonselective (Random) Transfusions and Living Related Donor Specific...
- NCD 110.17 - Anti-Cancer Chemotherapy for Colorectal Cancer - RETIRED
- NCD 110.18 - Aprepitant for Chemotherapy-Induced Emesis
- NCD 110.20 - Blood Brain Barrier Osmotic Disruption for Treatment of Brain Tumors
- NCD 110.21 - Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neopla...
- NCD 110.22 - Autologous Cellular Immunotherapy Treatment
- NCD 110.23 - Stem Cell Transplantation (Formerly 110.8.1)
- NCD 110.24 - Chimeric Antigen Receptor (CAR) T-cell Therapy
- NCD 130.1 - Inpatient Hospital Stays for Treatment of Alcoholism
- NCD 130.2 - Outpatient Hospital Services for Treatment of Alcoholism
- NCD 130.3 - Chemical Aversion Therapy for Treatment of Alcoholism
- NCD 130.5 - Treatment of Alcoholism and Drug Abuse in a Freestanding Clinic
- NCD 130.6 - Treatment of Drug Abuse (Chemical Dependency)
- NCD 130.7 - Withdrawal Treatments for Narcotic Addictions
- NCD 140.2 - Breast Reconstruction Following Mastectomy
- NCD 140.4 - Plastic Surgery to Correct "Moon Face"
- NCD 140.5 - Laser Procedures
- NCD 140.9 - Gender Dysphoria and Gender Reassignment Surgery
- NCD 150.2 - Osteogenic Stimulators
- NCD 150.5 - Diathermy Treatment
- NCD 150.9 - Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthrit...
- NCD 150.10 - Lumbar Artificial Disc Replacement (LADR)
- NCD 150.11 - Thermal Intradiscal Procedures (TIPs)
- NCD 150.12 - Collagen Meniscus Implant
- NCD 150.13 - Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Sten...
- NCD 160.1 - Induced Lesions of Nerve Tracts
- NCD 160.2 - Treatment of Motor Function Disorders with Electric Nerve Stimulation
- NCD 160.5 - Stereotaxic Depth Electrode Implantation
- NCD 160.7 - Electrical Nerve Stimulators
- NCD 160.7.1 - Assessing Patient's Suitability for Electrical Nerve Stimulation Therapy
- NCD 160.8 - Electroencephalographic Monitoring During Surgical Procedures Involvi...
- NCD 160.12 - Neuromuscular Electrical Stimulation (NMES)
- NCD 160.13 - Supplies Used in the Delivery of Transcutaneous Electrical Nerve Stim...
- NCD 160.15 - Electrotherapy for Treatment of Facial Nerve Paralysis (Bell's Palsy)
- NCD 160.17 - L-Dopa
- NCD 160.18 - Vagus Nerve Stimulation (VNS)
- NCD 160.19 - Phrenic Nerve Stimulator
- NCD 160.21 - Telephone Transmission of EEGs
- NCD 160.22 - Ambulatory EEG Monitoring - RETIRED
- NCD 160.23 - Sensory Nerve Conduction Threshold Tests (sNCTs)
- NCD 160.24 - Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease
- NCD 160.26 - Cavernous Nerves by Electrical Stimulation with Penile Plethsmography
- NCD 160.27 - Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low Ba...
- NCD 170.1 - Institutional and Home Care Patient Education Programs
- NCD 170.2 - Melodic Intonation Therapy
- NCD 170.3 - Speech-Language Pathology Services for the Treatment of Dysphagia
- NCD 180.1 - Medical Nutrition Therapy
- NCD 180.2 - Enteral and Parenteral Nutritional Therapy - RETIRED
- NCD 190.1 - Histocompatibility Testing
- NCD 190.2 - Diagnostic Pap Smears
- NCD 190.3 - Cytogenetic Studies
- NCD 190.7 - Human Tumor Stem Cell Drug Sensitivity Assays
- NCD 190.9 - Serologic Testing for Acquired Immunodeficiency Syndrome (AIDS)
- NCD 190.10 - Laboratory Tests - CRD Patients
- NCD 190.11 - Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitor...
- NCD 190.12 - Urine Culture, Bacterial
- NCD 190.13 - Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monit...
- NCD 190.14 - Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
- NCD 190.15 - Blood Counts
- NCD 190.16 - Partial Thromboplastin Time (PTT)
- NCD 190.17 - Prothrombin Time (PT)
- NCD 190.18 - Serum Iron Studies
- NCD 190.19 - Collagen Crosslinks, any Method
- NCD 190.20 - Blood Glucose Testing
- NCD 190.21 - Glycated Hemoglobin/Glycated Protein
- NCD 190.22 - Thyroid Testing
- NCD 190.23 - Lipid Testing
- NCD 190.24 - Digoxin Therapeutic Drug Assay
- NCD 190.25 - Alpha-fetoprotein
- NCD 190.26 - Carcinoembryonic Antigen
- NCD 190.27 - Human Chorionic Gonadotropin
- NCD 190.28 - Tumor Antigen by Immunoassay - CA 125
- NCD 190.29 - Tumor Antigen by Immunoassay - CA 15-3/CA 27.29
- NCD 190.30 - Tumor Antigen by Immunoassay - CA 19-9
- NCD 190.31 - Prostate Specific Antigen
- NCD 190.32 - Gamma Glutamyl Transferase
- NCD 190.33 - Hepatitis Panel/Acute Hepatitis Panel
- NCD 190.34 - Fecal Occult Blood Test
- NCD 200.1 - Nesiritide for Treatment of Heart Failure Patients
- NCD 200.2 - Nebulized Beta Adrenergic Agonist Therapy for Lung Diseases
- NCD 200.3 - Monoclonal Antibodies Directed Against Amyloid for the Treatment of A...
- NCD 210.1 - Prostate Cancer Screening Tests
- NCD 210.2 - Screening Pap Smears and Pelvic Examinations for Early Detection of C...
- NCD 210.2.1 - Screening for Cervical Cancer with Human Papillomavirus (HPV)
- NCD 210.3 - Colorectal Cancer Screening Tests
- NCD 210.4.1 - Counseling to Prevent Tobacco Use
- NCD 210.6 - Screening for Hepatitis B Virus (HBV) Infection
- NCD 210.7 - Screening for the Human Immunodeficiency Virus (HIV) Infection
- NCD 210.8 - Screening and Behavioral Counseling Interventions in Primary Care to...
- NCD 210.9 - Screening for Depression in Adults
- NCD 210.10 - Screening for Sexually Transmitted Infections (STIs) and High-Intensi...
- NCD 210.11 - Intensive Behavioral Therapy for Cardiovascular Disease
- NCD 210.12 - Intensive Behavioral Therapy for Obesity
- NCD 210.13 - Screening for Hepatitis C Virus (HCV) in Adults
- NCD 210.14 - Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
- NCD 210.15 - Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV...
- NCD 220.1 - Computed Tomography
- NCD 220.2 - Magnetic Resonance Imaging
- NCD 220.4 - Mammograms
- NCD 220.5 - Ultrasound Diagnostic Procedures
- NCD 220.6 - Positron Emission Tomography (PET) Scans - RETIRED
- NCD 220.6.1 - PET for Perfusion of the Heart
- NCD 220.6.8 - FDG PET for Myocardial Viability
- NCD 220.6.13 - FDG PET for Dementia and Neurodegenerative Diseases
- NCD 220.6.17 - Positron Emission Tomography (FDG) for Oncologic Conditions
- NCD 220.6.19 - Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of...
- NCD 220.9 - Digital Subtraction Angiography
- NCD 220.10 - Portable Hand-Held X-Ray Instrument
- NCD 220.11 - Thermography
- NCD 220.12 - Single Photon Emission Computed Tomography (SPECT)
- NCD 220.13 - Percutaneous Image-Guided Breast Biopsy
- NCD 230.1 - Treatment of Kidney Stones
- NCD 230.3 - Sterilization
- NCD 230.4 - Diagnosis and Treatment of Impotence
- NCD 230.6 - Vabra Aspirator
- NCD 230.7 - Water Purification and Softening Systems Used in Conjunction with Hom...
- NCD 230.8 - Non-Implantable Pelvic Floor Electrical Stimulator
- NCD 230.9 - Cryosurgery of Prostate
- NCD 230.10 - Incontinence Control Devices
- NCD 230.12 - Dimethyl Sulfoxide (DMSO)
- NCD 230.13 - Peridex CAPD Filter Set
- NCD 230.14 - Ultrafiltration Monitor
- NCD 230.15 - Electrical Continence Aid
- NCD 230.16 - Bladder Stimulators (Pacemakers)
- NCD 230.17 - Urinary Drainage Bags
- NCD 230.18 - Sacral Nerve Stimulation For Urinary Incontinence
- NCD 230.19 - Levocarnitine for use in the Treatment of Carnitine Deficiency in ESR...
- NCD 240.1 - Lung Volume Reduction Surgery (Reduction Pneumoplasty)
- NCD 240.2 - Home Use of Oxygen
- NCD 240.2.1 - Home Use of Oxygen in Approved Clinical Trials
- NCD 240.2.2 - Home Oxygen Use to Treat Cluster Headache (CH) - RETIRED
- NCD 240.4 - Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sl...
- NCD 240.4.1 - Sleep Testing for Obstructive Sleep Apnea (OSA)
- NCD 240.5 - Intrapulmonary Percussive Ventilator (IPV)
- NCD 240.7 - Postural Drainage Procedures and Pulmonary Exercises
- NCD 240.8 - Pulmonary Rehabilitation Services
- NCD 240.9 - Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the...
- NCD 250.1 - Treatment of Psoriasis
- NCD 250.2 - Hemorheograph
- NCD 250.3 - Intravenous Immune Globulin for the Treatment of Autoimmune Mucocutan...
- NCD 250.4 - Treatment of Actinic Keratosis
- NCD 250.5 - Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome...
- NCD 260.1 - Adult Liver Transplantation
- NCD 260.2 - Pediatric Liver Transplantation
- NCD 260.3 - Pancreas Transplants
- NCD 260.3.1 - Islet Cell Transplantation in the Context of a Clinical Trial
- NCD 260.5 - Intestinal and Multi-Visceral Transplantation
- NCD 260.6 - Dental Examination Prior to Kidney Transplantation
- NCD 260.7 - Lymphocyte Immune Globulin, Anti-Thymocyte Globulin (Equine)
- NCD 260.9 - Heart Transplants
- NCD 260.10 - Heartsbreath Test for Heart Transplant Rejection
- NCD 270.1 - Electrical Stimulation (ES) and Electromagnetic Therapy for the Treat...
- NCD 270.3 - Blood-Derived Products for Chronic Non-Healing Wounds
- NCD 270.4 - Treatment of Decubitus Ulcers
- NCD 270.6 - Infrared Therapy Devices
- NCD 280.1 - Durable Medical Equipment Reference List
- NCD 280.3 - Mobility Assistive Equipment (MAE)
- NCD 280.4 - Seat Lift
- NCD 280.6 - Pneumatic Compression Devices
- NCD 280.7 - Hospital Beds
- NCD 280.8 - Air-Fluidized Bed
- NCD 280.10 - Prosthetic Shoe
- NCD 280.12 - Sykes Hernia Control
- NCD 280.14 - Infusion Pumps
- NCD 280.15 - INDEPENDENCE iBOT 4000 Mobility System
- NCD 280.16 - Seat Elevation Equipment (Power Operated) on Power Wheelchairs
- NCD 290.1 - Home Health Visits to a Blind Diabetic
- NCD 290.2 - Home Health Nurses' Visits to Patients Requiring Heparin Injection
- NCD 300.1 - Obsolete or Unreliable Diagnostic Tests
- NCD 310.1 - Routine Costs in Clinical Trials
CMS-HCC V28 Categories
- HCC 1 - HIV/AIDS
- HCC 2 - Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
- HCC 6 - Opportunistic Infections
- HCC 17 - Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myel...
- HCC 18 - Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; A...
- HCC 19 - Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers
- HCC 20 - Lung and Other Severe Cancers
- HCC 21 - Lymphoma and Other Cancers
- HCC 22 - Bladder, Colorectal, and Other Cancers
- HCC 23 - Prostate, Breast, and Other Cancers and Tumors
- HCC 35 - Pancreas Transplant Status
- HCC 37 - Diabetes with Chronic Complications
- HCC 38 - Diabetes with Glycemic, Unspecified, or No Complications
- HCC 48 - Morbid Obesity
- HCC 50 - Amyloidosis, Porphyria, and Other Specified Metabolic Disorders
- HCC 51 - Addison's and Cushing's Diseases, Acromegaly, and Other Specified End...
- HCC 62 - Liver Transplant Status/Complications
- HCC 64 - Cirrhosis of Liver
- HCC 77 - Intestine Transplant Status/Complications
- HCC 78 - Intestinal Obstruction/Perforation
- HCC 79 - Chronic Pancreatitis
- HCC 80 - Crohn's Disease (Regional Enteritis)
- HCC 81 - Ulcerative Colitis
- HCC 92 - Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- HCC 93 - Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disor...
- HCC 94 - Systemic Lupus Erythematosus and Other Specified Systemic Connective...
- HCC 107 - Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero
- HCC 108 - Sickle Cell Disorders, Except Sickle Cell Anemia (Hb-SS) and Thalasse...
- HCC 109 - Acquired Hemolytic, Aplastic, and Sideroblastic Anemias
- HCC 111 - Hemophilia, Male
- HCC 112 - Immune Thrombocytopenia and Specified Coagulation Defects and Hemorrh...
- HCC 114 - Common Variable and Combined Immunodeficiencies
- HCC 127 - Dementia, Mild or Unspecified
- HCC 135 - Drug Use with Psychotic Complications
- HCC 136 - Alcohol Use with Psychotic Complications
- HCC 137 - Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Co...
- HCC 138 - Drug Use Disorder, Mild, Uncomplicated, Except Cannabis
- HCC 139 - Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified...
- HCC 153 - Personality Disorders; Anorexia/Bulimia Nervosa
- HCC 154 - Bipolar Disorders without Psychosis
- HCC 155 - Major Depression, Moderate or Severe, without Psychosis
- HCC 180 - Quadriplegia
- HCC 182 - Spinal Cord Disorders/Injuries
- HCC 193 - Chronic Inflammatory Demyelinating Polyneuritis and Multifocal Motor...
- HCC 200 - Friedreich and Other Hereditary Ataxias; Huntington Disease
- HCC 201 - Seizure Disorders and Convulsions
- HCC 202 - Coma, Brain Compression/Anoxic Damage
- HCC 212 - Respiratory Arrest
- HCC 213 - Cardio-Respiratory Failure and Shock
- HCC 222 - End-Stage Heart Failure
- HCC 224 - Acute on Chronic Heart Failure
- HCC 226 - Heart Failure, Except End-Stage and Acute
- HCC 227 - Cardiomyopathy/Myocarditis
- HCC 228 - Acute Myocardial Infarction
- HCC 229 - Unstable Angina and Other Acute Ischemic Heart Disease
- HCC 238 - Specified Heart Arrhythmias
- HCC 248 - Intracranial Hemorrhage
- HCC 249 - Ischemic or Unspecified Stroke
- HCC 253 - Hemiplegia/Hemiparesis
- HCC 254 - Monoplegia, Other Paralytic Syndromes
- HCC 263 - Atherosclerosis of Arteries of the Extremities with Ulceration or Gan...
- HCC 264 - Vascular Disease with Complications
- HCC 267 - Deep Vein Thrombosis and Pulmonary Embolism
- HCC 279 - Severe Persistent Asthma
- HCC 280 - Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, a...
- HCC 298 - Severe Diabetic Eye Disease, Retinal Vein Occlusion, and Vitreous Hem...
- HCC 300 - Exudative Macular Degeneration
- HCC 326 - Chronic Kidney Disease, Stage 5
- HCC 327 - Chronic Kidney Disease, Severe (Stage 4)
- HCC 329 - Chronic Kidney Disease, Moderate (Stage 3, Except 3B)
- HCC 379 - Pressure Ulcer of Skin with Necrosis Through to Muscle, Tendon, or Bone
- HCC 380 - Chronic Ulcer of Skin, Except Pressure, Through to Bone or Muscle
- HCC 381 - Pressure Ulcer of Skin with Full Thickness Skin Loss
- HCC 382 - Pressure Ulcer of Skin with Partial Thickness Skin Loss
- HCC 383 - Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to B...
- HCC 385 - Severe Skin Burn
- HCC 387 - Pemphigus, Pemphigoid, and Other Specified Autoimmune Skin Disorders
- HCC 397 - Major Head Injury with Loss of Consciousness > 1 Hour
- HCC 398 - Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified
- HCC 399 - Major Head Injury without Loss of Consciousness
- HCC 401 - Vertebral Fractures without Spinal Cord Injury
- HCC 402 - Hip Fracture/Dislocation
- HCC 405 - Traumatic Amputations and Complications
- HCC 409 - Amputation Status, Lower Limb/Amputation Complications
- HCC 463 - Artificial Openings for Feeding or Elimination
LCD Topics Across Contractors
- 4Kscore Test Algorithm (2 contractors)
- Allergen Immunotherapy (2 contractors)
- Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT) (5 contractors)
- Allergy Diagnostic Testing (5 contractors)
- Allergy Testing (4 contractors)
- Allogeneic Hematopoietic Cell Transplantation for Primary Refractory... (4 contractors)
- Ambulatory Electrocardiograph (AECG) Monitoring (2 contractors)
- Amniotic and Placental-Derived Product Injections and/or Applications... (7 contractors)
- Artificial Intelligence Enabled CT Based Quantitative Coronary Topogr... (5 contractors)
- Autonomic Function Testing (2 contractors)
- Autonomic Function Tests (2 contractors)
- B-type Natriuretic Peptide (BNP) Testing (5 contractors)
- BDX-XL2 (3 contractors)
- BRCA1 and BRCA2 Genetic Testing (2 contractors)
- Blepharoplasty, Eyelid Surgery, and Brow Lift (2 contractors)
- Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the... (2 contractors)
- Bone Mass Measurement (2 contractors)
- Botulinum Toxin Injections (6 contractors)
- Botulinum Toxins (2 contractors)
- Cardiac Catheterization and Coronary Angiography (2 contractors)
- Cardiac Computed Tomography (CCT) and Coronary Computed Tomography An... (2 contractors)
- Cardiology Non-emergent Outpatient Stress Testing (2 contractors)
- Cardiovascular Nuclear Medicine (2 contractors)
- Cataract Extraction (4 contractors)
- Cataract Surgery (2 contractors)
- Cervical Fusion (7 contractors)
- Chiropractic Services (2 contractors)
- Colon Capsule Endoscopy (CCE) (7 contractors)
- Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy (2 contractors)
- Computed Tomography Cerebral Perfusion Analysis (CTP) (4 contractors)
- Controlled Substance Monitoring and Drugs of Abuse Testing (2 contractors)
- Corneal Hysteresis (3 contractors)
- Corneal Pachymetry (3 contractors)
- Cosmetic and Reconstructive Surgery (5 contractors)
- Cystatin C Measurement (2 contractors)
- Debridement Services (2 contractors)
- Diagnostic Colonoscopy (2 contractors)
- Electroretinography (ERG) (3 contractors)
- Endovenous Stenting (2 contractors)
- Epidural Steroid Injections for Pain Management (7 contractors)
- Erythropoiesis Stimulating Agents (4 contractors)
- Facet Joint Interventions for Pain Management (7 contractors)
- Frequency of Hemodialysis (7 contractors)
- Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Ac... (2 contractors)
- Genetic Testing for Cardiovascular Disease (2 contractors)
- Genetic Testing in Oncology: Specific Tests (2 contractors)
- GlycoMark® Testing for Glycemic Control (3 contractors)
- Hospice - Determining Terminal Status (2 contractors)
- Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep... (6 contractors)
- Immune Globulin (2 contractors)
- Implantable Continuous Glucose Monitors (I-CGM) (7 contractors)
- In Vitro Chemosensitivity & Chemoresistance Assays (2 contractors)
- Intervertebral Disc Repair (3 contractors)
- Intraoperative Neurophysiological Testing (2 contractors)
- Intravenous Immune Globulin (2 contractors)
- Lab: Bladder/Urothelial Tumor Markers (2 contractors)
- Lab: Coenzyme Q10 (CoQ10) (2 contractors)
- Lab: Cystatin C Measurement (2 contractors)
- Lab: Flow Cytometry (2 contractors)
- Lab: Special Histochemical Stains and Immunohistochemical Stains (4 contractors)
- MDS FISH (4 contractors)
- Magnetic Resonance Angiography (MRA) (4 contractors)
- Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Ess... (3 contractors)
- Micro-Invasive Glaucoma Surgery (MIGS) (7 contractors)
- Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) (3 contractors)
- Mohs Micrographic Surgery (MMS) (6 contractors)
- MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatoti... (4 contractors)
- MolDX: Biomarkers in Cardiovascular Risk Assessment (4 contractors)
- MolDX: Blood Product Molecular Antigen Typing (4 contractors)
- MolDX: Breast Cancer Assay: Prosigna® (4 contractors)
- MolDX: Breast Cancer Index® (BCI) Gene Expression Test (4 contractors)
- MolDX: DecisionDx-UM (Uveal Melanoma) (3 contractors)
- MolDX: EndoPredict Breast Cancer Gene Expression Test (4 contractors)
- MolDX: Envisia™, Veracyte™, Idiopathic Pulmonary Fibrosis Diagnostic... (4 contractors)
- MolDX: Gene Expression Profile Tests for Decision-Making in Castratio... (4 contractors)
- MolDX: Genetic Testing for Hereditary Thrombophilia (4 contractors)
- MolDX: Genetic Testing for Heritable Thoracic Aortic Disease (4 contractors)
- MolDX: Genetic Testing for Hypercoagulability / Thrombophilia (Factor... (4 contractors)
- MolDX: HLA-DQB1*06:02 Testing for Narcolepsy (3 contractors)
- MolDX: Inivata™, InVisionFirst®, Liquid Biopsy for Patients with Lung... (4 contractors)
- MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients... (4 contractors)
- MolDX: MGMT Promoter Methylation Analysis (4 contractors)
- MolDX: Melanoma Risk Stratification Molecular Testing (4 contractors)
- MolDX: Minimal Residual Disease Testing for Cancer (4 contractors)
- MolDX: Molecular Assays for the Diagnosis of Cutaneous Melanoma (4 contractors)
- MolDX: Molecular Biomarker Testing for Risk Stratification of Cutaneo... (4 contractors)
- MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selectio... (4 contractors)
- MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate... (4 contractors)
- MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Ri... (4 contractors)
- MolDX: Molecular Diagnostic Tests (MDT) (4 contractors)
- MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Ide... (4 contractors)
- MolDX: Molecular Testing for Detection of Upper Gastrointestinal Meta... (4 contractors)
- MolDX: Molecular Testing for Identification and Management of Heredit... (4 contractors)
- MolDX: Molecular Testing for Risk Stratification of Thyroid Nodules (4 contractors)
- MolDX: Molecular Testing for Solid Organ Allograft Rejection (5 contractors)
- MolDX: NRAS Genetic Testing (4 contractors)
- MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Mal... (4 contractors)
- MolDX: Next-Generation Sequencing for Solid Tumors (4 contractors)
- MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests... (4 contractors)
- MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-... (4 contractors)
- MolDX: Oncotype DX® Breast Cancer for DCIS (Genomic Health™) (4 contractors)
- MolDX: Pharmacogenomics Testing (4 contractors)
- MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells (3 contractors)
- MolDX: Pigmented Lesion Assay (4 contractors)
- MolDX: Plasma-Based Genomic Profiling in Solid Tumors (4 contractors)
- MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer (4 contractors)
- MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Ca... (4 contractors)
- MolDX: Prometheus® IBD sgi Diagnostic® Policy (4 contractors)
- MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localize... (4 contractors)
- MolDX: Repeat Germline Testing (4 contractors)
- Molecular Pathology Procedures (2 contractors)
- Nerve Blocks for Peripheral Neuropathy (2 contractors)
- Nerve Conduction Studies and Electromyography (7 contractors)
- Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease (5 contractors)
- Non-Invasive Vascular Studies (2 contractors)
- Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extrem... (2 contractors)
- Off-label Use of Rituximab and Rituximab Biosimilars (2 contractors)
- Ophthalmic Angiography (Fluorescein and Indocyanine Green) (2 contractors)
- Ophthalmic Biometry for Intraocular Lens Power Calculation (2 contractors)
- Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and... (2 contractors)
- Outpatient Physical and Occupational Therapy Services (2 contractors)
- Panretinal (Scatter) Laser Photocoagulation (2 contractors)
- Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral... (2 contractors)
- Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression F... (5 contractors)
- Peripheral Nerve Blocks (2 contractors)
- Peripheral Nerve Injections and Procedures for Chronic Pain (5 contractors)
- Peripheral Venous Ultrasound (2 contractors)
- Pharmacogenomics Testing (2 contractors)
- Platelet Rich Plasma (4 contractors)
- Platelet Rich Plasma Injections for Non-Wound Injections (2 contractors)
- Polysomnography and Other Sleep Studies (3 contractors)
- ProMark® Risk Score (4 contractors)
- Proton Beam Therapy (2 contractors)
- Psychiatric Inpatient Hospitalization (4 contractors)
- Psychiatric Partial Hospitalization Programs (2 contractors)
- Psychiatry and Psychology Services (2 contractors)
- RAST Type Tests (2 contractors)
- Removal of Benign Skin Lesions (3 contractors)
- Respiratory Pathogen Panel Testing (3 contractors)
- Routine Foot Care (3 contractors)
- Routine Foot Care and Debridement of Nails (2 contractors)
- Sacroiliac Joint Injections and Procedures (5 contractors)
- Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (6 contractors)
- Somatosensory Testing (4 contractors)
- Speech-Language Pathology (3 contractors)
- Spinal Cord Stimulators for Chronic Pain (2 contractors)
- Stretta Procedure (2 contractors)
- Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma... (5 contractors)
- Surgical Treatment of Nails (3 contractors)
- Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices (3 contractors)
- Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for... (2 contractors)
- Total Joint Arthroplasty (4 contractors)
- Transcranial Magnetic Stimulation (TMS) (6 contractors)
- Transesophageal Echocardiography (TEE) (3 contractors)
- Transthoracic Echocardiography (TTE) (2 contractors)
- Transurethral Waterjet Ablation of the Prostate (5 contractors)
- Treatment of Chronic Venous Insufficiency of the Lower Extremities (2 contractors)
- Treatment of Males with Low Testosterone (2 contractors)
- Treatment of Varicose Veins of the Lower Extremities (3 contractors)
- Trigger Point Injections (TPI) (7 contractors)
- Upper Gastrointestinal Endoscopy and Visualization (2 contractors)
- Urine Drug Testing (5 contractors)
- Urodynamics (2 contractors)
- Varicose Veins of the Lower Extremity, Treatment of (2 contractors)
- Visual Electrophysiology Testing (2 contractors)
- Visual Fields Testing (2 contractors)
- Vitamin D Assay Testing (5 contractors)
- Wireless Capsule Endoscopy (3 contractors)
- Wound Care (3 contractors)
Local Coverage Determinations
- L33252 - Psychiatric Diagnostic Evaluation and Psychotherapy Services
- L33312 - Wheelchair Seating
- L33317 - External Breast Prostheses
- L33318 - Knee Orthoses
- L33369 - Therapeutic Shoes for Persons with Diabetes
- L33370 - Nebulizers
- L33393 - Hospice - Determining Terminal Status
- L33394 - Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
- L33396 - Posterior Tibial Nerve Stimulation for Voiding Dysfunction
- L33399 - EEG – Ambulatory Monitoring
- L33405 - Polysomnography and Sleep Testing
- L33411 - Surgical Management of Morbid Obesity
- L33417 - Allergy Skin Testing
- L33423 - Cardiac Computed Tomography & Angiography (CCTA)
- L33438 - Octreotide Acetate for Injectable Suspension (Sandostatin® LAR Depot)
- L33444 - Pulmonary Stress Testing
- L33445 - Removal of Benign and Malignant Skin Lesions
- L33446 - Respiratory Therapy and Oximetry Services
- L33447 - Special Electroencephalography
- L33449 - Swallowing Studies for Dysphagia
- L33457 - Cardiac Radionuclide Imaging
- L33459 - Computerized Axial Tomography (CT), Thorax
- L33461 - Implantable Infusion Pump
- L33467 - Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- L33557 - Cardiac Catheterization and Coronary Angiography
- L33558 - Cataract Extraction
- L33559 - Cardiac Computed Tomography (CCT) and Coronary Computed Tomography An...
- L33560 - Cardiovascular Nuclear Medicine
- L33563 - Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous an...
- L33567 - Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and...
- L33569 - Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral...
- L33574 - Visual Fields Testing
- L33575 - Varicose Veins of the Lower Extremity, Treatment of
- L33576 - Urodynamics
- L33577 - Transthoracic Echocardiography (TTE)
- L33578 - Transrectal Ultrasound
- L33583 - Diagnostic and Therapeutic Esophagogastroduodenoscopy
- L33585 - Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
- L33610 - Intravenous Immune Globulin
- L33611 - Oral Appliances for Obstructive Sleep Apnea
- L33612 - Suction Pumps
- L33614 - Debridement Services
- L33616 - Osteopathic Manipulative Treatment
- L33618 - Major Joint Replacement (Hip and Knee)
- L33619 - Nonvascular Extremity Ultrasound
- L33621 - Ophthalmic Biometry for Intraocular Lens Power Calculation
- L33622 - Pain Management - Injection of tendon sheaths, ligaments, bursa, and...
- L33623 - Percutaneous Coronary Intervention
- L33624 - Psychiatric Inpatient Hospitalization
- L33626 - Psychiatric Partial Hospitalization Programs
- L33627 - Non-Invasive Vascular Studies
- L33631 - Outpatient Physical and Occupational Therapy Services
- L33632 - Psychiatry and Psychology Services
- L33636 - Routine Foot Care and Debridement of Nails
- L33641 - Orthopedic Footwear
- L33642 - Pressure Reducing Support Surfaces - Group 2
- L33674 - Duplex Scanning
- L33686 - Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33690 - Automatic External Defibrillators
- L33692 - Pressure Reducing Support Surfaces - Group 3
- L33695 - Non-invasive Extracranial Arterial Studies
- L33718 - Positive Airway Pressure (PAP) Devices for the Treatment of Obstructi...
- L33733 - Canes and Crutches
- L33736 - Commodes
- L33737 - Eye Prostheses
- L33739 - Speech Generating Devices (SGD)
- L33766 - Visual Field Examination
- L33771 - Vitamin D; 25 hydroxy, includes fraction(s), if performed
- L33784 - Heating Pads and Heat Lamps
- L33785 - High Frequency Chest Wall Oscillation Devices
- L33787 - Lower Limb Prostheses
- L33788 - Manual Wheelchair Bases
- L33789 - Power Mobility Devices
- L33790 - Spinal Orthoses: TLSO and LSO
- L33791 - Walkers
- L33792 - Wheelchair Options/Accessories
- L33793 - Refractive Lenses
- L33794 - External Infusion Pumps
- L33795 - Mechanical In-exsufflation Devices
- L33796 - Osteogenesis Stimulators
- L33797 - Oxygen and Oxygen Equipment
- L33799 - Patient Lifts
- L33800 - Respiratory Assist Devices
- L33801 - Seat Lift Mechanisms
- L33802 - Transcutaneous Electrical Nerve Stimulators (TENS)
- L33803 - Urological Supplies
- L33820 - Hospital Beds And Accessories
- L33821 - Negative Pressure Wound Therapy Pumps
- L33822 - Glucose Monitors
- L33823 - Cervical Traction Devices
- L33824 - Immunosuppressive Drugs
- L33826 - Oral Anticancer Drugs
- L33827 - Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)
- L33828 - Ostomy Supplies
- L33830 - Pressure Reducing Support Surfaces - Group 1
- L33831 - Surgical Dressings
- L33832 - Tracheostomy Care Supplies
- L33937 - Proton Beam Radiotherapy
- L33942 - Physical Therapy - Home Health
- L33944 - Blepharoplasty
- L33946 - Capsule Opacification Following Cataract Surgery: Discission and YAG...
- L33950 - Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/...
- L33966 - Vestibular Function Tests
- L33977 - Transcranial Doppler Studies
- L34008 - Computerized Corneal Topography
- L34018 - Parathormone (Parathyroid Hormone)
- L34037 - Flow Cytometry
- L34062 - Dialysis Access Maintenance
- L34064 - Panretinal (Scatter) Laser Photocoagulation
- L34081 - Endoscopy by Capsule
- L34084 - Transcatheter Infusion Therapy
- L34085 - Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
- L34087 - Surveillance of Implantable or Wearable Cardioverter Defibrillators (...
- L34090 - Laser Ablation of the Prostate
- L34149 - Respiratory Care
- L34163 - Total Hip Arthroplasty
- L34171 - Nasal Punctum-Nasolacrimal Duct Dilation and Probing with or without...
- L34194 - Blepharoplasty, Eyelid Surgery, and Brow Lift
- L34203 - Cataract Surgery in Adults
- L34211 - Trigger Point Injections (TPI)
- L34213 - Diagnostic and Therapeutic Colonoscopy
- L34215 - Lab: Flow Cytometry
- L34218 - Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Mo...
- L34220 - Lumbar MRI
- L34233 - Benign Skin Lesion Removal (Excludes Actinic Keratosis, and Mohs)
- L34314 - Immune Globulin Intravenous (IVIg)
- L34315 - Electrocardiograms
- L34324 - Cardiovascular Stress Testing, Including Exercise and/or Pharmacologi...
- L34328 - Peripheral Nerve Stimulation
- L34353 - Outpatient Psychiatry and Psychology Services
- L34415 - CT of the Abdomen and Pelvis
- L34419 - Homocysteine Level, Serum
- L34425 - Magnetic Resonance Imaging of the Head and Neck
- L34426 - Ophthalmic Angiography (Fluorescein and Indocyanine Green)
- L34427 - Outpatient Occupational Therapy
- L34428 - Outpatient Physical Therapy
- L34429 - Outpatient Speech Language Pathology
- L34430 - Respiratory Therapy (Respiratory Care)
- L34454 - Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy
- L34520 - Psychological and Neuropsychological Tests
- L34521 - Special EEG Tests
- L34526 - Surgical Treatment of Obstructive Sleep Apnea (OSA)
- L34528 - Blepharoplasty, Blepharoptosis and Brow Lift
- L34536 - Treatment of Varicose Veins of the Lower Extremities
- L34537 - Vestibular Function Testing
- L34539 - Psychological Services Coverage under the Incident to Provision for P...
- L34544 - Hospice - Liver Disease
- L34547 - Hospice - Neurological Conditions
- L34548 - Hospice Cardiopulmonary Conditions
- L34551 - One Day Stays for Chest Pain
- L34552 - Outpatient Observation Bed/Room Services
- L34553 - Stretta Procedure
- L34558 - Hospice The Adult Failure To Thrive Syndrome
- L34559 - Hospice - Renal Care
- L34560 - Home Health Occupational Therapy
- L34561 - Home Health - Psychiatric Care
- L34562 - Home Health Skilled Nursing Care-Teaching and Training: Alzheimer's D...
- L34563 - Home Health Speech-Language Pathology
- L34564 - Home Health Physical Therapy
- L34567 - Hospice Alzheimer's Disease & Related Disorders
- L34576 - Laparoscopic Sleeve Gastrectomy for Severe Obesity
- L34577 - Retroperitoneal Ultrasound
- L34580 - Intravenous Immunoglobulin (IVIG)
- L34594 - Nerve Conduction Studies and Electromyography
- L34596 - Immunizations
- L34614 - Colonoscopy and Sigmoidoscopy-Diagnostic
- L34615 - Visual Fields
- L34623 - Intraoperative Neurophysiological Testing
- L34624 - Somatosensory Testing
- L34636 - Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Mon...
- L34641 - Transcranial Magnetic Stimulation (TMS)
- L34645 - Urine Drug Testing
- L34646 - Psychological and Neuropsychological Testing
- L34648 - Bisphosphonate Drug Therapy
- L34658 - Vitamin D Assay Testing
- L34659 - Endoscopic Treatment of GERD
- L34761 - Percutaneous Coronary Interventions
- L34771 - Immune Globulins
- L34821 - Transcutaneous Electrical Joint Stimulation Devices (TEJSD)
- L34823 - Tumor Treatment Field Therapy (TTFT)
- L34833 - Cardiac Rhythm Device Evaluation
- L34865 - Magnetic Resonance Angiography (MRA)
- L34869 - Repetitive Transcranial Magnetic Stimulation (rTMS) in Adults
- L34887 - Surgical Treatment of Nails
- L34892 - Facet Joint Interventions for Pain Management
- L34912 - Genetic Testing for Lynch Syndrome
- L34914 - Assays for Vitamins and Metabolic Function
- L34924 - Treatment of Chronic Venous Insufficiency of the Lower Extremities
- L34938 - Removal of Benign Skin Lesions
- L34961 - Mohs Micrographic Surgery (MMS)
- L34975 - Neurophysiology Evoked Potentials (NEPs)
- L34976 - Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression F...
- L35000 - Molecular Pathology Procedures
- L35001 - Reduction Mammaplasty
- L35004 - Blepharoplasty, Blepharoptosis Repair and Surgical Procedures of the...
- L35006 - Controlled Substance Monitoring and Drugs of Abuse Testing
- L35007 - Vestibular and Audiologic Function Studies
- L35010 - Trigger Point Injections
- L35013 - Debridement of Mycotic Nails
- L35016 - Transesophageal Echocardiography (TEE)
- L35022 - Bariatric Surgical Management of Morbid Obesity
- L35025 - MolDX: Molecular Diagnostic Tests (MDT)
- L35026 - Rituximab
- L35028 - Venous Angioplasty with or without Stent Placement for the Treatment...
- L35035 - Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography
- L35038 - Scanning Computerized Ophthalmic Diagnostic Imaging
- L35041 - Application of Bioengineered Skin Substitutes to Lower Extremity Chro...
- L35049 - Monitored Anesthesia Care
- L35050 - Outpatient Sleep Studies
- L35062 - Biomarkers Overview
- L35070 - Speech - Language Pathology (SLP) Services: Communication Disorders
- L35074 - Heavy Metal Testing
- L35075 - Proton Beam Therapy
- L35076 - Stereotactic Radiation Therapy: Stereotactic Radiosurgery (SRS) and S...
- L35083 - Cardiology Non-emergent Outpatient Stress Testing
- L35089 - Wireless Capsule Endoscopy
- L35092 - Diagnostic Abdominal Aortography and Renal Angiography
- L35093 - Immune Globulin
- L35099 - Frequency of Laboratory Tests
- L35101 - Psychiatric Codes
- L35121 - Coronary Computed Tomography Angiography (CCTA)
- L35124 - Autonomic Function Testing
- L35132 - Home Health Plans of Care: Monitoring Glucose Control in the Medicare...
- L35136 - Spinal Cord Stimulators for Chronic Pain
- L35138 - Routine Foot Care
- L35163 - Plastic Surgery
- L35222 - Nerve Blocks for Peripheral Neuropathy
- L35350 - Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
- L35391 - Multiple Imaging in Oncology
- L35395 - Autonomic Function Tests
- L35396 - Biomarkers for Oncology
- L35397 - Non-Invasive Cerebrovascular Arterial Studies
- L35434 - Oximetry Services
- L35451 - Peripheral Venous Ultrasound
- L35456 - Nerve Blockade for Treatment of Chronic Pain and Neuropathy
- L35486 - Pelvic Floor Dysfunction: Anorectal Manometry and EMG
- L35490 - Category III Codes
- L35498 - Removal of Benign Skin Lesions
- L35526 - B-type Natriuretic Peptide (BNP) Testing
- L35677 - Infliximab
- L35724 - Urine Drug Testing
- L35751 - Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies
- L35753 - Non-Invasive Cerebrovascular Studies
- L35755 - Non-Invasive Abdominal / Visceral Vascular Studies
- L35761 - Non-Invasive Peripheral Arterial Vascular Studies
- L35936 - Facet Joint Interventions for Pain Management
- L35986 - Special Histochemical Stains and Immunohistochemical Stains
- L35998 - Non-Coronary Vascular Stents
- L36000 - Percutaneous minimally invasive fusion/stabilization of the sacroilia...
- L36007 - Lower Extremity Major Joint Replacement (Hip and Knee)
- L36240 - Allergen Immunotherapy
- L36267 - Bowel Management Devices
- L36377 - Application of Skin Substitute Grafts for Treatment of DFU and VLU of...
- L36400 - MolDX: Genetic Testing for Hypercoagulability/Thrombophilia (Factor V...
- L36402 - Allergy Testing
- L36406 - Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
- L36523 - MolDX: Biomarkers in Cardiovascular Risk Assessment
- L36538 - Treatment of Males with Low Testosterone
- L36575 - Total Knee Arthroplasty
- L36593 - Polysomnography
- L36678 - Lab: Bladder/Urothelial Tumor Markers
- L36702 - Serum Magnesium
- L36715 - BRCA1 and BRCA2 Genetic Testing
- L36767 - Aortography and peripheral angiography
- L36797 - MolDX: NRAS Genetic Testing
- L36805 - Lab: Special Histochemical Stains and Immunohistochemical Stains
- L36811 - MolDX: Breast Cancer Assay: Prosigna®
- L36839 - Polysomnography and Other Sleep Studies
- L36850 - Peripheral Nerve Blocks
- L36920 - Epidural Steroid Injections for Pain Management
- L37003 - MolDX: HLA-DQB1*06:02 Testing for Narcolepsy
- L37015 - Visual Electrophysiology Testing
- L37176 - White Cell Colony Stimulating Factors
- L37228 - Wound Care
- L37373 - MRI and CT Scans of the Head and Neck
- L37379 - Echocardiography
- L37387 - Chiropractic Services
- L37537 - Frequency of Hemodialysis
- L37547 - Chest X-Ray Policy
- L37561 - Cystatin C Measurement
- L37606 - Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid D...
- L37616 - Lab: Cystatin C Measurement
- L37633 - Partial Hospitalization Programs
- L37638 - Health and Behavior Assessment/Intervention
- L37641 - Continuous Peripheral Nerve Blocks (CPNB)
- L37774 - Supervised Exercise Therapy for the Treatment of Peripheral Arterial...
- L37779 - Intraoperative Radiation Therapy
- L37792 - 4Kscore Test Algorithm
- L37794 - MolDX: Breast Cancer Index® (BCI) Gene Expression Test
- L37810 - Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neop...
- L37848 - Lumbar Spinal Fusion
- L37873 - Topical Oxygen Therapy
- L37893 - Endovenous Stenting
- L38033 - Cervical Disc Replacement
- L38043 - MolDX: Plasma-Based Genomic Profiling in Solid Tumors
- L38111 - MolDX: Pigmented Lesion Assay
- L38229 - Gastrointestinal Pathogen (GIP) Panels Utilizing Multiplex Nucleic Ac...
- L38268 - Immune Thrombocytopenia (ITP) Therapy
- L38276 - Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea
- L38303 - MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localize...
- L38371 - Multimarker Serum Tests Related to Ovarian Cancer Testing
- L38378 - Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
- L38435 - MolDX: Pharmacogenomics Testing
- L38441 - MolDX: Blood Product Molecular Antigen Typing
- L38506 - Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) for Ess...
- L38528 - Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep...
- L38566 - MolDX: Phenotypic Biomarker Detection in Circulating Tumor Cells
- L38678 - MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells
- L38682 - Transurethral Waterjet Ablation of the Prostate
- L38684 - MolDX: Prognostic and Predictive Molecular Classifiers for Bladder Ca...
- L38686 - Implantable Continuous Glucose Monitors (I-CGM)
- L38709 - Computed Tomography Cerebral Perfusion Analysis (CTP)
- L38747 - Peroral Endoscopic Myotomy (POEM)
- L38765 - Facet Joint Interventions for Pain Management
- L38805 - Colon Capsule Endoscopy (CCE)
- L38809 - Botulinum Toxins
- L38812 - Diagnostic Colonoscopy
- L38814 - MolDX: Minimal Residual Disease Testing for Cancer
- L38839 - Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease
- L38841 - Facet Joint Interventions for Pain Management
- L38902 - Wound and Ulcer Care
- L38916 - Respiratory Pathogen Panel Testing
- L38953 - Parenteral Nutrition
- L38955 - Enteral Nutrition
- L38970 - Advance Care Planning
- L38992 - Electroretinography (ERG)
- L39036 - Epidural Steroid Injections for Pain Management
- L39040 - MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients...
- L39042 - MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Ri...
- L39044 - MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Ide...
- L39051 - Cosmetic and Reconstructive Surgery
- L39054 - Epidural Steroid Injections for Pain Management
- L39080 - Cardiac Resynchronization Therapy (CRT)
- L39082 - Genetic Testing for Cardiovascular Disease
- L39237 - Erythropoiesis Stimulating Agents
- L39240 - Epidural Steroid Injections for Pain Management
- L39260 - Hyaluronic Acid Injections for Knee Osteoarthritis
- L39266 - Cognitive Assessment and Care Plan Service
- L39268 - Bone Mass Measurement
- L39297 - Off-label Use of Rituximab and Rituximab Biosimilars
- L39314 - Off-Label Use of Intravenous Immune Globulin (IVIG)
- L39365 - Genetic Testing in Oncology: Specific Tests
- L39387 - Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
- L39400 - Magnesium
- L39475 - Sacroiliac Joint Injections and Procedures
- L39477 - Allogeneic Hematopoietic Cell Transplantation for Primary Refractory...
- L39481 - MolDX: Molecular Biomarker Testing to Guide Targeted Therapy Selectio...
- L39490 - Ambulatory Electrocardiograph (AECG) Monitoring
- L39513 - Allogeneic Hematopoietic Cell Transplantation for Primary Refractory...
- L39521 - Positron Emission Tomography (PET) Scan for Inflammation and Infection
- L39529 - Intraarticular Knee Injections of Hyaluronan
- L39543 - Sacral Nerve Stimulation for the Treatment of Urinary and Fecal Incon...
- L39553 - Radiation Therapies
- L39591 - External Upper Limb Tremor Stimulator Therapy
- L39624 - Amniotic and Placental Derived Product Injections and/or Applications...
- L39642 - Intraosseous Basivertebral Nerve Ablation
- L39671 - Trigger Point Injections (TPI)
- L39709 - MolDX: Gene Expression Profile Tests for Decision-Making in Castratio...
- L39711 - MolDX: Molecular Biomarkers for Risk Stratification of Indeterminate...
- L39780 - Lower Esophageal Magnetic Sphincter Augmentation
- L39788 - Cervical Fusion
- L39849 - Opioid Treatment Programs
- L39853 - Outpatient Psychotherapy
- L39905 - Cataract Surgery
- L39907 - Micro-Invasive Glaucoma Surgery (MIGS)
- L39909 - Botulinum Toxin Injections
- L39911 - Total Joint Arthroplasty
- L39913 - Artificial Intelligence Enabled CT Based Quantitative Coronary Topogr...
- L39956 - Total Shoulder Arthroplasty
- L39995 - Pharmacogenomic Testing
- L40022 - MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-...
- L40048 - Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)
- L40140 - MolDX: Molecular Testing for Solid Organ Allograft Rejection
- L40193 - Superficial Radiation Therapy (SRT) for the Treatment of Nonmelanoma...
- L40205 - Irreversible Electroporation for Cancer
- L40224 - Automated Detection and Quantification of Brain MRIs
- L40228 - Endovascular Management for Peripheral Arterial Disease of the Upper...
- L40255 - Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices
- L40272 - MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatoti...
- L40274 - MolDX: Genetic Testing for Hereditary Thrombophilia
- L40276 - Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extrem...
- L40278 - MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests...
- L40300 - Peripheral Nerve Injections and Procedures for Chronic Pain
- L40302 - Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for...
- L40341 - Allergy Diagnostic Testing
Glossary
- Glossary
- 21st Century Cures Act
- 277CA (Claim Acknowledgment)
- 340B Drug Pricing Program
- 835 File (Electronic Remittance Advice)
- 837 File (Healthcare Claim)
- ABN Form (CMS-R-131)
- ACA Marketplace
- Accountable Care Organization
- Accounts Receivable Aging Report
- Accounts Receivable Days
- ACO Benchmark
- ACO REACH
- Add-On Code
- Additional Development Request (ADR)
- Advance Beneficiary Notice
- Advanced Alternative Payment Model (Advanced APM)
- Agentic AI in Revenue Cycle Management
- AI Denial Prediction
- AI Governance in Healthcare
- AI Medical Scribe
- ALJ Hearing (Medicare Level 3 Appeal)
- Allowed Amount
- Alternative Payment Model (APM)
- Ambient Clinical Documentation
- Ambulatory Payment Classification (APC)
- Ambulatory Surgery Center (ASC)
- Anti-Kickback Statute
- Appeal Success Rate
- AR Aging
- Attribution Methodology
- Authorization Denial
- Autonomous Coding
- Bad Debt
- Balance Billing
- Behavioral Health Integration (BHI)
- Benchmark Population
- Blended National Average Risk Score
- Bundled Payment
- Bundled Payments for Care Improvement Advanced (BPCI-A)
- CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- Capitation
- CAQH (Council for Affordable Quality Healthcare)
- CARC Code
- Carequality
- Case Mix Index (CMI)
- Cash Posting
- CDI Program
- CDI Query Process
- CDS Hooks
- Certified Risk Adjustment Coder (CRC)
- Charge Capture
- Charge Entry
- Charge Lag
- Chargemaster
- Charity Care
- Chart Chase
- Children's Health Insurance Program (CHIP)
- Chronic Care Management
- Claim Appeal
- Claim Denial
- Claim Edit Engine
- Claim Follow-Up
- Claim Rejection
- Claim Scrubber
- Claim Triage AI
- Clean Claim Rate
- Clearinghouse
- Clearinghouse in Medical Billing
- Clearinghouse Rejection vs Payer Denial
- Clinical AI Bias
- Clinical AI Model Validation
- Clinical Denial
- Clinical Documentation Improvement
- Clinically Integrated Network (CIN)
- CMS Star Ratings
- CMS-1500 Form
- CMS-HCC V24 Risk Adjustment Model
- CMS-HCC V28 Risk Adjustment Model
- CMS-HCC V28 Transition Schedule
- COBRA Insurance
- Coding Compliance
- Coding Gap Analysis
- Coding Intensity Factor
- Coinsurance
- CommonWell Health Alliance
- Companion Guide (EDI)
- Computer-Assisted Coding (CAC)
- Computer-Assisted Physician Documentation (CAPD)
- Concurrent Risk Adjustment
- Condition Category
- Consolidated Clinical Document Architecture (C-CDA)
- Consultation Note
- Contractual Adjustment
- Conversion Factor (Medicare)
- Coordination of Benefits
- Copay
- Cost to Collect
- CPT Code (Current Procedural Terminology)
- Credit Balance
- Da Vinci Coverage Requirements Discovery (CRD)
- Da Vinci Documentation Templates and Rules (DTR)
- Da Vinci Payer Data Exchange (PDex)
- Da Vinci Prior Authorization Support (PAS)
- Days in Accounts Receivable
- De-identification (HIPAA)
- Deductible
- Denial Management
- Denial Prevention
- Denial Rate
- Denial Reason Code
- Denial Root Cause Analysis
- Denial Work Queue
- Diagnosis-Related Group (DRG)
- Direct Contracting Entity (DCE)
- Direct Secure Messaging
- Discharge Summary
- Downcoding
- Downside Risk
- E/M Leveling
- EDI Clearinghouse
- EDI Transaction
- EDIFACT
- EHR Copilot
- EHR Integration
- Electronic Clinical Quality Measure (eCQM)
- Electronic Prescribing of Controlled Substances (EPCS)
- Electronic Remittance Advice
- Electronic Remittance Advice (835)
- Eligibility Verification
- Encounter Data Processing System (EDPS)
- Encounter Data Submission
- EOB (Explanation of Benefits)
- Evaluation and Management (E&M) Coding
- Exclusive Provider Organization (EPO)
- Explainable AI in Healthcare (XAI)
- Explanation of Benefits
- False Claims Act
- FDA Software as a Medical Device (SaMD)
- Fee Schedule
- Fee-for-Service
- FHIR API
- FHIR Bulk Data Access
- FHIR Bundle
- FHIR Consent Resource
- FHIR Questionnaire Resource
- FHIR R4 (Release 4)
- FHIR Resource
- FHIR Subscription
- Financial Assistance Policy
- First-Pass Resolution Rate
- Flat FHIR (Bulk Data Export)
- Flexible Spending Account (FSA)
- Formulary
- Generative AI Medical Coding
- Global Budget Payment
- Global Surgical Package
- Global Surgical Period
- Good Faith Estimate
- Gross Collection Rate
- GS Segment (Functional Group Header)
- Hallucination Risk (AI)
- Hard Denial
- HCAHPS (Hospital CAHPS)
- HCC Capture Rate
- HCC Coding Accuracy
- HCC Gap Closure
- HCC Recapture
- HCPCS Code
- Health Maintenance Organization (HMO)
- Health Savings Account (HSA)
- Healthcare Clearinghouse under HIPAA
- HEDIS (Healthcare Effectiveness Data and Information Set)
- HHS-HCC Commercial Risk Adjustment Model
- Hierarchical Condition Category
- High Deductible Health Plan
- HIPAA Compliance
- HIPAA Safe Harbor De-identification
- History and Physical
- HITRUST CSF Certification
- HL7 Interface
- HL7 v2 vs FHIR
- Hospital Price Transparency
- Hospital-Acquired Condition (HAC)
- ICD-10 Code
- ICD-10-PCS
- In-Home Assessment (Risk Adjustment)
- In-Network
- Incident To Billing
- Information Blocking
- Inpatient Prospective Payment System (IPPS)
- Insurance Verification
- Intelligent Document Processing (IDP)
- ISA Segment (Interchange Control Header)
- J-Code (HCPCS Level II Drug Code)
- Kidney Care Choices (KCC) Model
- Large Language Models in Healthcare
- Length of Stay (LOS)
- Letter of Medical Necessity (LMN)
- Local Coverage Determination (LCD)
- Loop 2300 (Claim Information) in 837
- Making Care Primary (MCP) Model
- MEAT Criteria
- Medicaid Managed Care
- Medical Claims Clearinghouse
- Medical Coding Audit
- Medical Decision Making (MDM)
- Medical Loss Ratio (MLR)
- Medical Necessity
- Medical Necessity Denial
- Medical Record Retrieval (Risk Adjustment)
- Medically Unlikely Edits (MUE)
- Medicare Access and CHIP Reauthorization Act
- Medicare Administrative Contractor (MAC)
- Medicare Advantage
- Medicare Advantage Benchmark
- Medicare Appeals Council (Level 4 Appeal)
- Medicare Cost Report
- Medicare Part A
- Medicare Part B
- Medicare Part D
- Medicare Physician Fee Schedule (MPFS)
- Medicare Redetermination
- Medicare Secondary Payer
- Medicare Shared Savings Program (MSSP)
- Medigap (Medicare Supplement Insurance)
- Merit-based Incentive Payment System
- Minimum Savings Rate (MSR)
- Modifier 22 (Increased Procedural Services)
- Modifier 24 (Unrelated E/M in Postoperative Period)
- Modifier 25
- Modifier 26 — Professional Component
- Modifier 33 (Preventive Services)
- Modifier 50 (Bilateral Procedure)
- Modifier 51 — Multiple Procedures
- Modifier 52 (Reduced Services)
- Modifier 53 (Discontinued Procedure)
- Modifier 57 — Decision for Surgery
- Modifier 58 (Staged or Related Procedure)
- Modifier 59
- Modifier 62 (Two Surgeons)
- Modifier 66 (Surgical Team)
- Modifier 76 — Repeat Procedure by Same Physician
- Modifier 78 (Unplanned Return to OR During Global Period)
- Modifier 79 (Unrelated Procedure During Global Period)
- Modifier 80 (Assistant Surgeon)
- Modifier 91 (Repeat Clinical Diagnostic Laboratory Test)
- Modifier AT (Active Treatment for Chiropractic)
- Modifier CS (Cost-Sharing Waived for COVID-19 Testing)
- Modifier GA (Waiver of Liability Statement on File)
- Modifier GY (Statutorily Excluded)
- Modifier GZ (Item or Service Expected to Be Denied)
- Modifier KX (Requirements Specified in Medical Policy Met)
- Modifier TC (Technical Component)
- Modifier XE (Separate Encounter)
- Modifier XS (Separate Structure)
- Modifier XU (Unusual Non-Overlapping Service)
- Modifiers LT and RT (Left/Right Side)
- MS-DRG (Medicare Severity Diagnosis-Related Group)
- Multiple Procedure Payment Reduction (MPPR)
- National Coverage Determination (NCD)
- National Drug Code (NDC)
- National Provider Identifier (NPI)
- NCCI Edits
- NCQA Accreditation
- Net Collection Rate
- Network Adequacy
- Never Event
- NLP in Healthcare
- No Surprises Act
- Normalization Factor
- OAuth Scopes (SMART on FHIR)
- OCR in Healthcare (Optical Character Recognition)
- OIG Exclusion
- Oncology Care Model (OCM) / Enhancing Oncology Model (EOM)
- Operative Report
- Out-of-Network
- Outpatient Prospective Payment System (OPPS)
- Overpayment
- Patient Access
- Patient Access API
- Patient Estimation
- Patient Financial Experience
- Patient Registration
- Patient-Centered Medical Home (PCMH)
- Payer Mix
- Payer Scorecard
- Payer-to-Payer API
- Payment Integrity
- PECOS (Provider Enrollment, Chain, and Ownership System)
- PEPPER Report
- Per Member Per Month (PMPM)
- Pharmacy Benefit Manager (PBM)
- Physician Signature Requirements
- Place of Service (POS) Code
- Point of Service (POS) Plan
- Point-of-Service (POS) Collections
- Policyholder
- Population Health Management (PHM)
- Practice Management System
- Pre-Claim Edit
- Predetermination
- Preferred Provider Organization (PPO)
- Present on Admission (POA Indicator)
- Primary Care First (PCF)
- Prior Authorization
- Prior Authorization API
- Prior Authorization Automation
- Problem List Management
- Procedure-to-Procedure (PTP) Edit
- Professional Component (Modifier 26)
- Program Integrity
- Progress Note
- Prompt Injection
- Propensity to Pay
- Prospective Risk Adjustment
- Protected Health Information (PHI)
- Provider Credentialing
- Provider Directory API
- QIC Reconsideration (Level 2 Medicare Appeal)
- Qualified Health Information Network (QHIN)
- Qualifying APM Participant (QP)
- Quality Payment Program (QPP)
- Quality Withhold
- RCM Software
- Readmission Rate
- Recovery Audit Contractor
- Relative Value Unit (RVU)
- Remark Code (RARC)
- Remittance Advice
- Remote Patient Monitoring
- Resource-Based Relative Value Scale (RBRVS)
- Retrieval-Augmented Generation (RAG)
- Retrospective Risk Adjustment
- Revenue Code (UB-04 Form Locator 42)
- Revenue Cycle Automation
- Risk Adjustment
- Risk Adjustment Audit Rate
- Risk Adjustment Data Validation (RADV) Audit
- Risk Adjustment Factor (RAF) Score
- Risk Score Reconciliation
- Robotic Process Automation (RPA)
- RxHCC (Prescription Drug Hierarchical Condition Category)
- Secondary Insurance
- Self Pay
- Service Line Reporting
- Shared Savings
- Single Case Agreement (SCA)
- SMART on FHIR
- SOAP Note
- SOC 2 Type II Report
- Social Determinants of Health (SDOH)
- Soft Denial
- Split Billing (Professional/Technical)
- Split/Shared Visit
- Stark Law
- Stars Bonus Payment (Quality Bonus Payment)
- States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model
- Step Therapy
- Subrogation
- Subscriber ID
- Surescripts
- Suspect Condition
- Targeted Probe and Educate (TPE)
- Taxonomy Code
- Teaching Physician Rules
- Technical Denial
- TEFCA (Trusted Exchange Framework and Common Agreement)
- Telehealth Billing
- The Joint Commission
- Third-Party Liability (TPL)
- Time-Based E/M Coding
- Timely Filing
- Timely Filing Denial
- Total Cost of Care (TCOC)
- Transitional Care Management (TCM)
- TRICARE Billing
- Two-Sided Risk
- Type of Bill (UB-04 Form Locator 04)
- UB-04 (Institutional Claim Form)
- UB-04 Condition Code (Form Locators 18–28)
- UB-04 Occurrence Code (Form Locators 31–34)
- UB-04 Value Code (Form Locators 39–41)
- Unbundling
- Uncompensated Care
- Underpayment
- Upcoding
- Upside-Only Risk
- US Core FHIR Implementation Guide
- USCDI (United States Core Data for Interoperability)
- Utilization Management
- Utilization Review
- Value-Based Care
- Voice AI Documentation
- Workers' Compensation Billing
- Write-Off
- X12 270 (Eligibility Inquiry)
- X12 271 (Eligibility Response)
- X12 276 (Claim Status Inquiry)
- X12 277 (Claim Status Response)
- X12 278 (Prior Authorization Request/Response)
- X12 820 (Premium Payment)
- X12 834 (Benefit Enrollment and Maintenance)
- X12 999 (Implementation Acknowledgement)
- X12 TA1 (Interchange Acknowledgement)
- Zero Balance Review
Alternatives
- Athelas (Commure) Alternatives
- athenahealth Alternatives
- Availity Clearinghouse Alternatives
- CareCloud Alternatives
- Change Healthcare Clearinghouse (Optum) Alternatives
- CharmHealth Alternatives
- Claim.MD Alternatives
- CureMD Alternatives
- Emdeon Clearinghouse Alternatives
- Ensemble Health Partners Alternatives
- Epic Systems Alternatives
- Fathom Health Alternatives
- Freed.ai Alternatives
- Guidehouse Alternatives
- Innovaccer Alternatives
- Office Ally Clearinghouse Alternatives
- Optum (Optum Insight) Alternatives
- R1 RCM Alternatives
- Stedi Clearinghouse Alternatives
- Sully.ai Alternatives
- Waystar Alternatives
Partners
Company
Resources and Calculators
- Resources — Blog
- Resources — Case Studies
- Resources — Whitepapers
- Resources — AI RCM Evaluation Toolkit
- Resources — Quickintell Workflow Manual
- Resources — QuickEHR Telehealth Patient Guides
- Resources — Blog — AI Medical Coding Evidence 2026
- Resources — Blog — AI Scribe vs. Human Scribe Cost
- Resources — Blog — Cfo Questions AI RCM
- Resources — Blog — Cms 2026 Physician Fee Schedule Impact
- Resources — Blog — CPT Icd10 2027 Release Readiness
- Resources — Blog — Healthcare AI Compliance Planning 2027
- Resources — Blog — HIPAA AI Billing Pipeline Controls
- Resources — Blog — Manual Eligibility Verification Cost
- Resources — Blog — Measure AI Clinical Documentation ROI
- Resources — Blog — Medicare Advantage Risk Adjustment 2027
- Resources — Blog — Payer AI Decisions Response Workflow
- Resources — Blog — Prior Authorization Turnaround Time
- Resources — Blog — Verify AI Claims RCM Vendors
- Resources — Blog — AI Voice Agents For Customer Experience
- Resources — Blog — Prior Verification Process Guide
- Resources — Blog — Guide To Healthcare Eligibility Verification
- Resources — Blog — Optimizing Healthcare Revenue Cycl__emanagement
- Resources — Blog — AI In Healthcare Top 5 Breakthroughs
- Resources — Blog — AI In Revenue Cycle Automation
- Resources — Blog — AI In Revenue Cycl__emanagement Benefits
- Resources — Blog — AI Medical Coding Improves Productivity
- Resources — Blog — EHR Systems Benefits Modern Healthcare
- Resources — Case Studies — Orthopedic Practice
- ROI Calculator — Claim Calculator