Emergency: 119
AMDA-IMIC

Section A: Transportation Services and Medical Supplies

861 procedure codes. CMS quarterly release — October 2026.

HCPCS Level II codes are updated quarterly by CMS. This listing reflects the October 2026 quarterly release.
Code Description Pricing
A0021 Outside state ambulance serv 00
A0080 Noninterest escort in non er 00
A0090 Interest escort in non er 00
A0100 Nonemergency transport taxi 00
A0110 Nonemergency transport bus 00
A0120 Noner transport mini-bus 00
A0130 Noner transport wheelch van 00
A0140 Nonemergency transport air 00
A0160 Noner transport case worker 00
A0170 Transport parking fees/tolls 00
A0180 Noner transport lodgng recip 00
A0190 Noner transport meals recip 00
A0200 Noner transport lodgng escrt 00
A0210 Noner transport meals escort 00
A0225 Neonatal emergency transport 00
A0380 Basic life support mileage 00
A0382 Basic support routine suppls 00
A0384 Bls defibrillation supplies 00
A0390 Advanced life support mileag 00
A0392 Als defibrillation supplies 00
A0394 Als iv drug therapy supplies 00
A0396 Als esophageal intub suppls 00
A0398 Als routine disposble suppls 00
A0420 Ambulance waiting 1/2 hr 00
A0422 Ambulance 02 life sustaining 00
A0424 Extra ambulance attendant 00
A0425 Ground mileage 52
A0426 Als 1 52
A0427 Als1-emergency 52
A0428 Bls 52
A0429 Bls-emergency 52
A0430 Fixed wing air transport 52
A0431 Rotary wing air transport 52
A0432 Pi volunteer ambulance co 52
A0433 Als 2 52
A0434 Specialty care transport 52
A0435 Fixed wing air mileage 52
A0436 Rotary wing air mileage 52
A0888 Noncovered ambulance mileage 00
A0998 Ambulance response/treatment 00
A0999 Unlisted ambulance service 57
A2001 Innovamatrix ac, per sq cm 11
A2002 Mirragen adv wnd mat per sq 11
A2004 Xcellistem, 1 mg 13
A2005 Microlyte matrix, per sq cm 11
A2006 Novosorb synpath per sq cm 11
A2007 Restrata, per sq cm 11
A2008 Theragenesis, per sq cm 11
A2009 Symphony, per sq cm 11
A2010 Apis, per square centimeter 11
A2011 Supra sdrm, per sq cm 11
A2012 Suprathel, per sq cm 11
A2013 Innovamatrix fs, per sq cm 11
A2014 Omeza collag compl 100 mg 13
A2015 Phoenix wnd mtrx, per sq cm 11
A2016 Permeaderm b, per sq cm 11
A2017 Permeaderm glove, each 13
A2018 Permeaderm c, per sq cm 11
A2019 Kerecis marigen shld sq cm 11
A2020 Ac5 wound system 13
A2021 Neomatrix per sq cm 11
A2022 Innovabrn/innovamatx xl sqcm 11
A2023 Innovamatrix pd, 1 mg 13
A2024 Resolve or xenopatch sq cm 11
A2025 Miro3d per cubic cm 11
A2026 Restrata minimatrix, 5 mg 13
A2027 Matriderm per sq cm 11
A2028 Micromatrix flex per mg 13
A2029 Mirotract matrix sheet 11
A2030 Miro3d fibers, per mg 13
A2031 Mirodry, per sq cm 11
A2032 Myriad matrix, per sq cm 11
A2033 Myriad morcells, 4 mg 13
A2034 Found drs solo, per sq cm 11
A2035 Corpl p therac p allac p mg 13
A2036 Cohealyx col dml mx pr sq cm 11
A2037 G4derm plus/suprello, pr ml 13
A2038 Marigen pacto, per sq cm 11
A2039 Innovamatrix fd, per sq cm 11
A2040 Microlyte painguard pr sq cm 11
A2041 Foundation drs+ duo pr sq cm 11
A2042 Foundation drs+ solo, sq cm 11
A2043 Biobrane, per sq cm 11
A2044 Biobrane glove, each 13
A2045 Novashield/novogen pr sq cm 11
A2046 Dermisphere hdrt, per sq cm 11
A2047 Lacertamatrix, per sq cm 11
A2048 Puraply mz, per mg 13
A2049 Theracor, per sq cm 11
A2050 Fibrillar collagen, per mg 13
A4100 Nosht skin sub fda clrd nos 13
A4206 1 cc sterile syringe&needle 00
A4207 2 cc sterile syringe&needle 00
A4208 3 cc sterile syringe&needle 00
A4209 5+ cc sterile syringe&needle 00
A4210 Nonneedle injection device 00
A4211 Supp for self-adm injections 00
A4212 Non coring needle or stylet 57
A4213 20+ cc syringe only 00
A4215 Sterile needle 00
A4216 Sterile water/saline, 10 ml 37
A4217 Sterile water/saline, 500 ml 37
A4218 Sterile saline or water 51
A4220 Infusion pump refill kit 57
A4221 Supp non-insulin inf cath/wk 34
A4222 Infusion supplies with pump 34
A4223 Infusion supplies w/o pump 00
A4224 Supply insulin inf cath/wk 34
A4225 Sup/ext insulin inf pump syr 34
A4226 Weekly supply maint cgs pump 00
A4228 Dev-drug combo cath supplies 34
A4230 Infus insulin pump non needl 34
A4231 Infusion insulin pump needle 34
A4232 Syringe w/needle insulin 3cc 00
A4233 Alkalin batt for glucose mon 32
A4234 J-cell batt for glucose mon 32
A4235 Lithium batt for glucose mon 32
A4236 Silvr oxide batt glucose mon 32
A4238 Adju cgm supply allowance 34
A4239 Non-adju cgm supply allow 34
A4244 Alcohol or peroxide per pint 00
A4245 Alcohol wipes per box 00
A4246 Betadine/phisohex solution 00
A4247 Betadine/iodine swabs/wipes 00
A4248 Chlorhexidine antisept 00
A4250 Urine reagent strips/tablets 00
A4252 Blood ketone test or strip 00
A4253 Blood glucose/reagent strips 32
A4255 Glucose monitor platforms 34
A4256 Calibrator solution/chips 34
A4257 Replace lensshield cartridge 34
A4258 Lancet device each 34
A4259 Lancets per box 34
A4261 Cervical cap contraceptive 00
A4262 Temporary tear duct plug 00
A4263 Permanent tear duct plug 11
A4264 Intratubal occlusion device 00
A4265 Paraffin 34
A4266 Diaphragm 00
A4267 Male condom 00
A4268 Female condom 00
A4269 Spermicide 00
A4270 Disposable endoscope sheath 00
A4271 Home lancing/test cartridges 34
A4280 Brst prsths adhsv attchmnt 38
A4281 Replacement breastpump tube 00
A4282 Replacement breastpump adpt 00
A4283 Replacement breastpump cap 00
A4284 Replcmnt breast pump shield 00
A4285 Replcmnt breast pump bottle 00
A4286 Replcmnt breastpump lok ring 00
A4287 Disp col sto bag breast milk 46
A4288 Replacement breastpump valve 46
A4290 Sacral nerve stim test lead 00
A4295 Straigh tip hydrophilic cath 37
A4296 Coude tip hydrophilic cath 37
A4297 Hydrophilic coat insert sup 37
A4300 Cath impl vasc access portal 11
A4301 Implantable access syst perc 00
A4305 Drug delivery system >=50 ml 00
A4306 Drug delivery system <=50 ml 00
A4310 Insert tray w/o bag/cath 37
A4311 Catheter w/o bag 2-way latex 37
A4312 Cath w/o bag 2-way silicone 37
A4313 Catheter w/bag 3-way 37
A4314 Cath w/drainage 2-way latex 37
A4315 Cath w/drainage 2-way silcne 37
A4316 Cath w/drainage 3-way 37
A4318 Fem urinary cup w/wo attch 37
A4320 Irrigation tray 37
A4321 Cath therapeutic irrig agent 37
A4322 Irrigation syringe 37
A4326 Male external catheter 37
A4327 Fem urinary collect dev cup 37
A4328 Fem urinary collect pouch 37
A4330 Stool collection pouch 37
A4331 Extension drainage tubing 37
A4332 Lube sterile packet 37
A4333 Urinary cath anchor device 37
A4334 Urinary cath leg strap 37
A4335 Incontinence supply 46
A4336 Urethral insert 37
A4337 Incontinent rectal insert 38
A4338 Indwelling catheter latex 37
A4340 Indwelling catheter special 37
A4341 Iduc valve pat inst repl 37
A4342 Iduc valve sply repl 37
A4344 Cath indw foley 2 way silicn 37
A4346 Cath indw foley 3 way 37
A4349 Disposable male external cat 37
A4351 Straight tip urine catheter 37
A4352 Coude tip urinary catheter 37
A4353 Intermittent urinary cath 37
A4354 Cath insertion tray w/bag 37
A4355 Bladder irrigation tubing 37
A4356 Ext ureth clmp or compr dvc 37
A4357 Bedside drainage bag 37
A4358 Urinary leg or abdomen bag 37
A4360 Disposable ext urethral dev 37
A4361 Ostomy face plate 37
A4362 Solid skin barrier 37
A4363 Ostomy clamp, replacement 37
A4364 Adhesive, liquid or equal 37
A4366 Ostomy vent 37
A4367 Ostomy belt 37
A4368 Ostomy filter 37
A4369 Skin barrier liquid per oz 37
A4371 Skin barrier powder per oz 37
A4372 Skin barrier solid 4x4 equiv 37
A4373 Skin barrier with flange 37
A4375 Drainable plastic pch w fcpl 37
A4376 Drainable rubber pch w fcplt 37
A4377 Drainable plstic pch w/o fp 37
A4378 Drainable rubber pch w/o fp 37
A4379 Urinary plastic pouch w fcpl 37
A4380 Urinary rubber pouch w fcplt 37
A4381 Urinary plastic pouch w/o fp 37
A4382 Urinary hvy plstc pch w/o fp 37
A4383 Urinary rubber pouch w/o fp 37
A4384 Ostomy faceplt/silicone ring 37
A4385 Ost skn barrier sld ext wear 37
A4387 Ost clsd pouch w att st barr 37
A4388 Drainable pch w ex wear barr 37
A4389 Drainable pch w st wear barr 37
A4390 Drainable pch ex wear convex 37
A4391 Urinary pouch w ex wear barr 37
A4392 Urinary pouch w st wear barr 37
A4393 Urine pch w ex wear bar conv 37
A4394 Ostomy pouch liq deodorant 37
A4395 Ostomy pouch solid deodorant 37
A4396 Peristomal hernia supprt blt 37
A4398 Ostomy irrigation bag 37
A4399 Ostomy irrig cone/cath w brs 37
A4400 Ostomy irrigation set 37
A4402 Lubricant per ounce 37
A4404 Ostomy ring each 37
A4405 Nonpectin based ostomy paste 37
A4406 Pectin based ostomy paste 37
A4407 Ext wear ost skn barr <=4sq" 37
A4408 Ext wear ost skn barr >4sq" 37
A4409 Ost skn barr convex <=4 sq i 37
A4410 Ost skn barr extnd >4 sq 37
A4411 Ost skn barr extnd =4sq 37
A4412 Ost pouch drain high output 37
A4413 2 pc drainable ost pouch 37
A4414 Ost sknbar w/o conv<=4 sq in 37
A4415 Ost skn barr w/o conv >4 sqi 37
A4416 Ost pch clsd w barrier/filtr 37
A4417 Ost pch w bar/bltinconv/fltr 37
A4418 Ost pch clsd w/o bar w filtr 37
A4419 Ost pch for bar w flange/flt 37
A4420 Ost pch clsd for bar w lk fl 37
A4421 Ostomy supply misc 46
A4422 Ost pouch absorbent material 37
A4423 Ost pch for bar w lk fl/fltr 37
A4424 Ost pch drain w bar & filter 37
A4425 Ost pch drain for barrier fl 37
A4426 Ost pch drain 2 piece system 37
A4427 Ost pch drain/barr lk flng/f 37
A4428 Urine ost pouch w faucet/tap 37
A4429 Urine ost pouch w bltinconv 37
A4430 Ost urine pch w b/bltin conv 37
A4431 Ost pch urine w barrier/tapv 37
A4432 Os pch urine w bar/fange/tap 37
A4433 Urine ost pch bar w lock fln 37
A4434 Ost pch urine w lock flng/ft 37
A4435 1pc ost pch drain hgh output 37
A4436 Irr supply sleev reus per mo 37
A4437 Irr supply sleev disp per mo 37
A4438 Adhesive clip ext ens contr 38
A4450 Non-waterproof tape 37
A4452 Waterproof tape 37
A4453 Rec cath any transanal, each 38
A4455 Adhesive remover per ounce 37
A4456 Adhesive remover, wipes 37
A4457 Enema tube any type repl 00
A4458 Reusable enema bag 00
A4459 Transanal irrigation, manual 38
A4461 Surgicl dress hold non-reuse 35
A4463 Surgical dress holder reuse 35
A4465 Non-elastic extremity binder 00
A4467 Belt strap sleev grmnt cover 00
A4468 Exsuff belt incl all sup acc 00
A4470 Gravlee jet washer 00
A4479 Transanal irrigation, electr 38
A4480 Vabra aspirator 00
A4481 Tracheostoma filter 37
A4483 Moisture exchanger 37
A4490 Above knee surgical stocking 00
A4495 Thigh length surg stocking 00
A4500 Below knee surgical stocking 00
A4510 Full length surg stocking 00
A4520 Incontinence garment anytype 00
A4540 Trans elec nerv periph nerv 00
A4541 Monthly supp use with e0733 34
A4542 Supp ext up limb tremor stim 34
A4543 Supply trans elec nerve stim 46
A4544 Electro nerve stimulator rls 34
A4545 Suppl accessor tibial stim 34
A4550 Surgical trays 11
A4553 Nondisp underpads, all sizes 00
A4554 Disposable underpads 00
A4555 Ca tx e-stim electr/transduc 00
A4556 Electrodes, pair 34
A4557 Lead wires, pair 34
A4558 Conductive gel or paste 34
A4559 Coupling gel or paste 34
A4560 Nmes disposable 00
A4561 Pessary reusable rub anytype 38
A4562 Pessary reusable nonrubber 38
A4563 Vag inser rectal control sys 38
A4564 Pessary, disposable any type 46
A4565 Slings 55
A4566 Should sling/vest/abrestrain 00
A4570 Splint 52
A4575 Hyperbaric o2 chamber disps 00
A4580 Cast supplies (plaster) 00
A4590 Special casting material 00
A4593 Neuromod sti sys adj rehab 36
A4594 Neuromod adj rehab mouthpie 32
A4595 Tens suppl 2 lead per month 34
A4596 Ces system monthly supp 34
A4600 Sleeve, inter limb comp dev 32
A4601 Lith ion non prosth recharge 32
A4602 Replace lithium battery 1.5v 32
A4604 Tubing with heating element 32
A4605 Trach suction cath close sys 32
A4606 Oxygen probe used w oximeter 00
A4608 Transtracheal oxygen cath 00
A4611 Heavy duty battery 00
A4612 Battery cables 00
A4613 Battery charger 00
A4614 Hand-held pefr meter 46
A4615 Cannula nasal 00
A4616 Tubing (oxygen) per foot 00
A4617 Mouth piece 00
A4618 Breathing circuits 32
A4619 Face tent 32
A4620 Variable concentration mask 00
A4623 Tracheostomy inner cannula 37
A4624 Tracheal suction tube 32
A4625 Trach care kit for new trach 37
A4626 Tracheostomy cleaning brush 37
A4627 Spacer bag/reservoir 00
A4628 Oropharyngeal suction cath 32
A4629 Tracheostomy care kit 37
A4630 Repl bat t.e.n.s. own by pt 32
A4633 Uvl replacement bulb 32
A4634 Replacement bulb th lightbox 00
A4635 Underarm crutch pad 32
A4636 Handgrip for cane etc 32
A4637 Repl tip cane/crutch/walker 32
A4638 Repl batt pulse gen sys 32
A4639 Infrared ht sys replcmnt pad 36
A4640 Alternating pressure pad 32
A4641 Radiopharm dx agent noc 51
A4642 In111 satumomab 51
A4648 Implantable tissue marker 57
A4649 Surgical supplies 46
A4650 Implant radiation dosimeter 57
A4651 Calibrated microcap tube 00
A4652 Microcapillary tube sealant 00
A4653 Pd catheter anchor belt 00
A4657 Syringe w/wo needle 00
A4660 Sphyg/bp app w cuff and stet 00
A4663 Dialysis blood pressure cuff 00
A4670 Automatic bp monitor, dial 00
A4671 Disposable cycler set 00
A4672 Drainage ext line, dialysis 00
A4673 Ext line w easy lock connect 00
A4674 Chem/antisept solution, 8oz 00
A4680 Activated carbon filter, ea 00
A4690 Dialyzer, each 00
A4706 Bicarbonate conc sol per gal 00
A4707 Bicarbonate conc pow per pac 00
A4708 Acetate conc sol per gallon 00
A4709 Acid conc sol per gallon 00
A4714 Treated water per gallon 00
A4719 "y set" tubing 00
A4720 Dialysat sol fld vol > 249cc 00
A4721 Dialysat sol fld vol > 999cc 00
A4722 Dialys sol fld vol > 1999cc 00
A4723 Dialys sol fld vol > 2999cc 00
A4724 Dialys sol fld vol > 3999cc 00
A4725 Dialys sol fld vol > 4999cc 00
A4726 Dialys sol fld vol > 5999cc 00
A4728 Dialysate solution, non-dex 00
A4730 Fistula cannulation set, ea 00
A4736 Topical anesthetic, per gram 00
A4737 Inj anesthetic per 10 ml 00
A4740 Shunt accessory 00
A4750 Art or venous blood tubing 00
A4755 Comb art/venous blood tubing 00
A4760 Dialysate sol test kit, each 00
A4765 Dialysate conc pow per pack 00
A4766 Dialysate conc sol add 10 ml 00
A4770 Blood collection tube/vacuum 00
A4771 Serum clotting time tube 00
A4772 Blood glucose test strips 00
A4773 Occult blood test strips 00
A4774 Ammonia test strips 00
A4802 Protamine sulfate per 50 mg 00
A4860 Disposable catheter tips 00
A4870 Plumb/elec wk hm hemo equip 00
A4890 Repair/maint cont hemo equip 00
A4911 Drain bag/bottle 00
A4913 Misc dialysis supplies noc 00
A4918 Venous pressure clamp 00
A4927 Non-sterile gloves 00
A4928 Surgical mask 00
A4929 Tourniquet for dialysis, ea 00
A4930 Sterile, gloves per pair 00
A4931 Reusable oral thermometer 00
A4932 Reusable rectal thermometer 00
A5051 Pouch clsd w barr attached 37
A5052 Clsd ostomy pouch w/o barr 37
A5053 Clsd ostomy pouch faceplate 37
A5054 Clsd ostomy pouch w/flange 37
A5055 Stoma cap 37
A5056 1 pc ost pouch w filter 37
A5057 1 pc ost pou w built-in conv 37
A5061 Pouch drainable w barrier at 37
A5062 Drnble ostomy pouch w/o barr 37
A5063 Drain ostomy pouch w/flange 37
A5071 Urinary pouch w/barrier 37
A5072 Urinary pouch w/o barrier 37
A5073 Urinary pouch on barr w/flng 37
A5081 Stoma plug or seal, any type 37
A5082 Continent stoma catheter 37
A5083 Stoma absorptive cover 37
A5093 Ostomy accessory convex inse 37
A5102 Bedside drain btl w/wo tube 37
A5105 Urinary suspensory 37
A5112 Urinary leg bag 37
A5113 Latex leg strap 37
A5114 Foam/fabric leg strap 37
A5120 Skin barrier, wipe or swab 37
A5121 Solid skin barrier 6x6 37
A5122 Solid skin barrier 8x8 37
A5126 Disk/foam pad +or- adhesive 37
A5131 Appliance cleaner 37
A5200 Percutaneous catheter anchor 37
A5500 Diab shoe for density insert 38
A5501 Diabetic custom molded shoe 38
A5503 Diabetic shoe w/roller/rockr 38
A5504 Diabetic shoe with wedge 38
A5505 Diab shoe w/metatarsal bar 38
A5506 Diabetic shoe w/off set heel 38
A5507 Modification diabetic shoe 38
A5508 Diabetic deluxe shoe 38
A5510 Compression form shoe insert 38
A5512 Multi den insert direct form 38
A5513 Multi den insert custom mold 38
A5514 Mult den insert dir carv/cam 38
A6000 Wound warming wound cover 00
A6010 Collagen based wound filler 35
A6011 Collagen gel/paste wound fil 35
A6021 Collagen dressing <=16 sq in 35
A6022 Collagen drsg>16<=48 sq in 35
A6023 Collagen dressing >48 sq in 35
A6024 Collagen dsg wound filler 35
A6025 Silicone gel sheet, each 00
A6154 Wound pouch each 35
A6196 Alginate dressing <=16 sq in 35
A6197 Alginate drsg >16 <=48 sq in 35
A6198 Alginate dressing > 48 sq in 46
A6199 Alginate drsg wound filler 35
A6203 Composite drsg <= 16 sq in 35
A6204 Composite drsg >16<=48 sq in 35
A6205 Composite drsg > 48 sq in 46
A6206 Contact layer <= 16 sq in 46
A6207 Contact layer >16<= 48 sq in 35
A6208 Contact layer > 48 sq in 46
A6209 Foam drsg <=16 sq in w/o bdr 35
A6210 Foam drg >16<=48 sq in w/o b 35
A6211 Foam drg > 48 sq in w/o brdr 35
A6212 Foam drg <=16 sq in w/border 35
A6213 Foam drg >16<=48 sq in w/bdr 46
A6214 Foam drg > 48 sq in w/border 35
A6215 Foam dressing wound filler 46
A6216 Non-sterile gauze<=16 sq in 35
A6217 Non-sterile gauze>16<=48 sq 35
A6218 Non-sterile gauze > 48 sq in 46
A6219 Gauze <= 16 sq in w/border 35
A6220 Gauze >16 <=48 sq in w/bordr 35
A6221 Gauze > 48 sq in w/border 46
A6222 Gauze <=16 in no w/sal w/o b 35
A6223 Gauze >16<=48 no w/sal w/o b 35
A6224 Gauze > 48 in no w/sal w/o b 35
A6228 Gauze <= 16 sq in water/sal 46
A6229 Gauze >16<=48 sq in watr/sal 35
A6230 Gauze > 48 sq in water/salne 46
A6231 Hydrogel dsg<=16 sq in 35
A6232 Hydrogel dsg>16<=48 sq in 35
A6233 Hydrogel dressing >48 sq in 35
A6234 Hydrocolld drg <=16 w/o bdr 35
A6235 Hydrocolld drg >16<=48 w/o b 35
A6236 Hydrocolld drg > 48 in w/o b 35
A6237 Hydrocolld drg <=16 in w/bdr 35
A6238 Hydrocolld drg >16<=48 w/bdr 35
A6239 Hydrocolld drg > 48 in w/bdr 46
A6240 Hydrocolld drg filler paste 35
A6241 Hydrocolloid drg filler dry 35
A6242 Hydrogel drg <=16 in w/o bdr 35
A6243 Hydrogel drg >16<=48 w/o bdr 35
A6244 Hydrogel drg >48 in w/o bdr 35
A6245 Hydrogel drg <= 16 in w/bdr 35
A6246 Hydrogel drg >16<=48 in w/b 35
A6247 Hydrogel drg > 48 sq in w/b 35
A6248 Hydrogel drsg gel filler 35
A6250 Skin seal protect moisturizr 00
A6251 Absorpt drg <=16 sq in w/o b 35
A6252 Absorpt drg >16 <=48 w/o bdr 35
A6253 Absorpt drg > 48 sq in w/o b 35
A6254 Absorpt drg <=16 sq in w/bdr 35
A6255 Absorpt drg >16<=48 in w/bdr 35
A6256 Absorpt drg > 48 sq in w/bdr 46
A6257 Transparent film <= 16 sq in 35
A6258 Transparent film >16<=48 in 35
A6259 Transparent film > 48 sq in 35
A6260 Wound cleanser any type/size 00
A6261 Wound filler gel/paste /oz 46
A6262 Wound filler dry form / gram 46
A6266 Impreg gauze no h20/sal/yard 35
A6402 Sterile gauze <= 16 sq in 35
A6403 Sterile gauze>16 <= 48 sq in 35
A6404 Sterile gauze > 48 sq in 35
A6407 Packing strips, non-impreg 35
A6410 Sterile eye pad 35
A6411 Non-sterile eye pad 35
A6412 Occlusive eye patch 00
A6413 Adhesive bandage, first-aid 00
A6441 Pad band w>=3" <5"/yd 35
A6442 Conform band n/s w<3"/yd 35
A6443 Conform band n/s w>=3"<5"/yd 35
A6444 Conform band n/s w>=5"/yd 35
A6445 Conform band s w <3"/yd 35
A6446 Conform band s w>=3" <5"/yd 35
A6447 Conform band s w >=5"/yd 35
A6448 Lt compres band <3"/yd 35
A6449 Lt compres band >=3" <5"/yd 35
A6450 Lt compres band >=5"/yd 35
A6451 Mod compres band w>=3"<5"/yd 35
A6452 High compres band w>=3"<5"yd 35
A6453 Self-adher band w <3"/yd 35
A6454 Self-adher band w>=3" <5"/yd 35
A6455 Self-adher band >=5"/yd 35
A6456 Zinc paste band w >=3"<5"/yd 35
A6457 Tubular dressing 35
A6460 Synthetic drsg <= 16 sq in 35
A6461 Synthetic drsg >16<=48 sq in 35
A6501 Compres burngarment bodysuit 35
A6502 Compres burngarment chinstrp 35
A6503 Compres burngarment facehood 35
A6504 Cmprsburngarment glove-wrist 35
A6505 Cmprsburngarment glove-elbow 35
A6506 Cmprsburngrmnt glove-axilla 35
A6507 Cmprs burngarment foot-knee 35
A6508 Cmprs burngarment foot-thigh 35
A6509 Compres burn garment jacket 35
A6510 Compres burn garment leotard 35
A6511 Compres burn garment panty 35
A6512 Compres burn garment, noc 35
A6513 Compress burn mask face/neck 00
A6515 Grad com wrap w str fu le cu 40
A6516 Grad com wrap w strap foo cu 40
A6517 Grad com wrap w strap bn cus 40
A6518 Grad com wrap w strap arm cu 40
A6519 Grad com garm noc night use 40
A6520 G com garmnt glove nghttime 40
A6521 G com garmnt glove nght cust 40
A6522 G com garment arm nighttime 40
A6523 G com garment arm nght custm 40
A6524 G com garmnt lwr leg/ft nght 40
A6525 G com garm lwrleg/ft ngt cus 40
A6526 G com garmt full leg/ft nght 40
A6527 G garmt full leg/ft nght cus 40
A6528 G com garment bra nighttime 40
A6529 G com garmt bra night custm 40
A6530 Compression stocking bk18-30 40
A6531 Compress stking bk30-40 surg 35
A6532 Compress stking bk40-50 surg 35
A6533 Gc stocking thighlngth 18-30 40
A6534 Gc stocking thighlngth 30-40 40
A6535 Gc stocking thighlngth 40+ 40
A6536 Gc stocking full lngth 18-30 40
A6537 Gc stocking full lngth 30-40 40
A6538 Gc stocking full lngth 40+ 40
A6539 Gc stocking waistlngth 18-30 40
A6540 Gc stocking waistlngth 30-40 40
A6541 Gc stocking waistlngth 40+ 40
A6544 Gc stocking garter belt 40
A6545 Grad com non-elastic bk surg 35
A6548 Acces cust grad silic band 40
A6549 Grad com garm noc day use 40
A6550 Neg pres wound ther drsg set 34
A6552 Grad com stocking bk 30-40 40
A6553 G com stcking bk 30-40 custm 40
A6554 Grad com stocking bk 40+ 40
A6555 G com stcking bk 40+ custm 40
A6556 G com stcking thgh18-30 cust 40
A6557 G com stcking thgh30-40 cust 40
A6558 G com stcking thgh 40+ cust 40
A6559 G stckng full/chap18-30 cust 40
A6560 G stckng full/chap30-40 cust 40
A6561 G stockng full/chap 40+ cust 40
A6562 G com stckng waist18-30 cust 40
A6563 G com stckng waist30-40 cust 40
A6564 G com stckng waist 40+ cust 40
A6565 Grad comp gauntlet custom 40
A6566 Grad com garment neck/head 40
A6567 G com garment neck/head cust 40
A6568 G com garment torso/shldr 40
A6569 G com garmnt torso/shdr cust 40
A6570 Grad com garment genital 40
A6571 G com garment genital custm 40
A6572 Grad com garment toe caps 40
A6573 Grad com garmnt toe cap cust 40
A6574 Custom gradient sleev/glov 40
A6575 Gradient comp sleev/glov 40
A6576 Custom grad com sleeve med 40
A6577 Custom grad cm sleeve heavy 40
A6578 Gradient comp sleeve 40
A6579 Custom grad com glove med 40
A6580 Custom grad com glove heavy 40
A6581 Gradient comp glove 40
A6582 Gradient comp gauntlet 40
A6583 Grad com wrap w straps bk 40
A6584 Grad com wrap w straps 40
A6585 Grad com wrap w straps ak 40
A6586 Grad com wrap w strap fu leg 40
A6587 Grad com wrap w straps foot 40
A6588 Grad com wrap w strap arm 40
A6589 Grad com wrap w straps bra 40
A6590 Urinary cath disp suc pump 34
A6591 Urinary cath suc pump 34
A6593 Grad com accessory gmt_wrap 40
A6594 G comp bandge liner lwr extr 40
A6595 G comp bandge liner upr extr 40
A6596 G comp bandge conform gauze 40
A6597 G comp bandage long stretch 40
A6598 G comp bandage med stretch 40
A6599 G comp bandage short stretch 40
A6600 G com bandge hgh dn foam sht 40
A6601 G com bandge hgh dn foam pad 40
A6602 G com bandge hgh dn foamroll 40
A6603 G com bandge low dn foamchnl 40
A6604 G com bandge low dn foam flt 40
A6605 G com bandage padded foam 40
A6606 G com bandage padded textile 40
A6607 G com bandage tub protct lyr 40
A6608 G com bandage tub protct pad 40
A6609 G compression bandaging 40
A6610 G com stcking bk 18-30 custm 40
A6611 Grad com wrap w strap ak cus 40
A6614 Sup ext oculr neg pres pump 32
A7000 Disposable canister for pump 32
A7001 Nondisposable pump canister 32
A7002 Tubing used w suction pump 32
A7003 Nebulizer administration set 32
A7004 Disposable nebulizer sml vol 32
A7005 Nondisposable nebulizer set 32
A7006 Filtered nebulizer admin set 32
A7007 Lg vol nebulizer disposable 32
A7008 Disposable nebulizer prefill 32
A7009 Nebulizer reservoir bottle 32
A7010 Disposable corrugated tubing 32
A7012 Nebulizer water collec devic 32
A7013 Disposable compressor filter 32
A7014 Compressor nondispos filter 32
A7015 Aerosol mask used w nebulize 32
A7016 Nebulizer dome & mouthpiece 32
A7017 Nebulizer not used w oxygen 32
A7018 Water distilled w/nebulizer 32
A7020 Interface, cough stim device 32
A7021 Suppl and access lung expan 32
A7023 Mech allergen parti barrier 00
A7025 Replace chest compress vest 36
A7026 Replace chst cmprss sys hose 32
A7027 Combination oral/nasal mask 32
A7028 Repl oral cushion combo mask 32
A7029 Repl nasal pillow comb mask 32
A7030 Cpap full face mask 32
A7031 Replacement facemask interfa 32
A7032 Replacement nasal cushion 32
A7033 Replacement nasal pillows 32
A7034 Nasal application device 32
A7035 Pos airway press headgear 32
A7036 Pos airway press chinstrap 32
A7037 Pos airway pressure tubing 32
A7038 Pos airway pressure filter 32
A7039 Filter, non disposable w pap 32
A7040 One way chest drain valve 38
A7041 Water seal drain container 38
A7044 Pap oral interface 32
A7045 Repl exhalation port for pap 32
A7046 Repl water chamber, pap dev 32
A7047 Resp suction oral interface 32
A7048 Vacuum drain bottle/tube kit 38
A7049 Epap nasal valve 00
A7501 Tracheostoma valve w diaphra 37
A7502 Replacement diaphragm/fplate 37
A7503 Hmes filter holder or cap 37
A7504 Tracheostoma hmes filter 37
A7505 Hmes or trach valve housing 37
A7506 Hmes/trachvalve adhesivedisk 37
A7507 Integrated filter & holder 37
A7508 Housing & integrated adhesiv 37
A7509 Heat & moisture exchange sys 37
A7520 Trach/laryn tube non-cuffed 37
A7521 Trach/laryn tube cuffed 37
A7522 Trach/laryn tube stainless 37
A7523 Tracheostomy shower protect 37
A7524 Tracheostoma stent/stud/bttn 37
A7525 Tracheostomy mask 37
A7526 Tracheostomy tube collar 37
A7527 Trach/laryn tube plug/stop 37
A8000 Soft protect helmet prefab 32
A8001 Hard protect helmet prefab 32
A8002 Soft protect helmet custom 45
A8003 Hard protect helmet custom 45
A8004 Repl soft interface, helmet 32
A8005 Grip glove w microprocessor 00
A8006 Grip glove replacement only 00
A9150 Misc/exper non-prescript dru 57
A9152 Single vitamin nos 00
A9153 Multi-vitamin nos 00
A9154 Artificial saliva, 1 ml 00
A9156 Oral mucoadhesive per 1 ml 00
A9180 Lice treatment, topical 00
A9268 Programmer orally ingest cap 00
A9269 Programable ingest capsule 00
A9270 Non-covered item or service 00
A9272 Disp wound suct, drsg/access 00
A9273 Hot/cold botle/cap/col/wrap 00
A9274 Ext amb insulin delivery sys 00
A9275 Disp home glucose monitor 00
A9276 Disposable sensor, cgm sys 00
A9277 External transmitter, cgm 00
A9278 External receiver, cgm sys 00
A9279 Monitoring feature/devicenoc 00
A9280 Alert device, noc 00
A9281 Reaching/grabbing device 00
A9282 Wig any type 00
A9283 Foot press off load supp dev 00
A9284 Non-electronic spirometer 00
A9285 Inversion eversion cor devic 00
A9286 Any hygienic item, device 00
A9291 Pres dig cog behav thera fda 99
A9292 Pres dig visual therapy fda 99
A9293 Fertility cycl tracking soft 00
A9294 Biofeed dig cog behav tx fda 00
A9300 Exercise equipment 00
A9500 Tc99m sestamibi 57
A9501 Technetium tc-99m teboroxime 57
A9502 Tc99m tetrofosmin 57
A9503 Tc99m medronate 57
A9504 Tc99m apcitide 57
A9505 Tl201 thallium 57
A9506 Tc-99m graphite crucible 99
A9507 In111 capromab 57
A9508 I131 iodobenguate, dx 51
A9509 Iodine i-123 sod iodide mil 57
A9510 Tc99m disofenin 51
A9512 Tc99m pertechnetate 57
A9513 Lutetium lu 177 dotatat ther 57
A9515 Choline c-11 57
A9516 Iodine i-123 sod iodide mic 57
A9517 I131 iodide cap, rx 57
A9520 Tc99 tilmanocept diag 0.5mci 57
A9521 Tc99m exametazime 57
A9524 I131 serum albumin, dx 57
A9526 Nitrogen n-13 ammonia 53
A9527 Iodine i-125 sodium iodide 57
A9528 Iodine i-131 iodide cap, dx 57
A9529 I131 iodide sol, dx 57
A9530 I131 iodide sol, rx 57
A9531 I131 max 100uci 57
A9532 I125 serum albumin, dx 57
A9536 Tc99m depreotide 57
A9537 Tc99m mebrofenin 57
A9538 Tc99m pyrophosphate 57
A9539 Tc99m pentetate 57
A9540 Tc99m maa 57
A9541 Tc99m sulfur colloid 57
A9542 In111 ibritumomab, dx 51
A9543 Y90 ibritumomab, rx 51
A9546 Co57/58 53
A9547 In111 oxyquinoline 53
A9548 In111 pentetate 53
A9550 Tc99m gluceptate 53
A9551 Tc99m succimer 53
A9552 F18 fdg 53
A9553 Cr51 chromate 53
A9554 I125 iothalamate, dx 53
A9555 Rb82 rubidium 99
A9556 Ga67 gallium 57
A9557 Tc99m bicisate 57
A9558 Xe133 xenon 10mci 57
A9559 Co57 cyano 57
A9560 Tc99m labeled rbc 57
A9561 Tc99m oxidronate 57
A9562 Tc99m mertiatide 57
A9563 P32 na phosphate 57
A9564 P32 chromic phosphate 57
A9566 Tc99m fanolesomab 57
A9567 Technetium tc-99m aerosol 57
A9568 Technetium tc99m arcitumomab 53
A9569 Technetium tc-99m auto wbc 57
A9570 Indium in-111 auto wbc 57
A9571 Indium in-111 auto platelet 57
A9572 Indium in-111 pentetreotide 57
A9573 Inj, gadopiclenol, 1 ml 51
A9574 Inj. ferumoxytol, 1 mg 57
A9575 Inj gadoterate meglumi 0.1ml 57
A9576 Inj prohance multipack 51
A9577 Inj multihance 51
A9578 Inj multihance multipack 51
A9579 Gad-base mr contrast nos,1ml 51
A9580 Sodium fluoride f-18 57
A9581 Gadoxetate disodium inj 51
A9582 Iodine i-123 iobenguane 51
A9583 Gadofosveset trisodium inj 51
A9584 Iodine i-123 ioflupane 57
A9585 Gadobutrol injection 57
A9586 Florbetapir f18 00
A9587 Gallium ga-68 57
A9588 Fluciclovine f-18 57
A9589 Insti hexaminolevulinate hcl 57
A9590 Iodine i-131 iobenguane 1mci 51
A9591 Fluoroestradiol f 18 57
A9592 Copper cu 64 dotatate diag 57
A9593 Gallium ga-68 psma-11 ucsf 57
A9594 Gallium ga-68 psma-11, ucla 57
A9595 Piflu f 18 pylarify dx 1 mci 57
A9596 Gallium illuccix 1 millicure 57
A9597 Pet, dx, for tumor id, noc 57
A9598 Pet dx for non-tumor id, noc 57
A9600 Sr89 strontium 57
A9601 Flortaucipir inj 1 millicuri 57
A9602 Fluorodopa f-18 diag per mci 57
A9603 Inj, pafolacianine, 0.1 mg 51
A9604 Sm 153 lexidronam 57
A9606 Radium ra223 dichloride ther 57
A9607 Lutetium lu 177 vipivotide 57
A9608 Flotufolastat f18 diag 1 mci 57
A9609 F18 fdg, 15 millicuries 57
A9610 Xe129 xenon, diagnostic 57
A9611 Flurpiridaz f18, diag, 1 mci 57
A9612 Inj, fluorescein, 1 mg 57
A9613 F 18 pylarify truvu, dx 1mci 57
A9615 Inj, pegulicianine, 1 mg 51
A9616 Gallium gozellix 1 millicuri 57
A9697 Inj, magtrace per study dose 51
A9698 Non-rad contrast materialnoc 51
A9699 Radiopharm rx agent noc 57
A9700 Echocardiography contrast 57
A9800 Gallium locametz 1 millicuri 57
A9900 Supply/accessory/service 46
A9901 Delivery/set up/dispensing 46
A9999 Dme supply or accessory, nos 46

Last reviewed: September 2026