United States National Library of Medicine National Institutes of Health

2009AA Healthcare Common Procedure Coding System Source Information

Counts

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Attribute Name Description Count (MRSAT.RRF)
HTS HCPCS Type of Service Code - carrier assigned HCFA Type of Service which describes the particular kind(s) of service represented by the procedure code. 7582
HAC HCPCS action code - code denoting the change made to a procedure or modifier code within the HCPCS system. 5844
HAD HCPCS Action Effective Date - effective date of action to a procedure or modifier code. 5844
HAQ HCPCS Anesthesia Base Unit Quantity - base unit represents the level of intensity for anesthesia procedure services that reflects all activities except time. 5844
HCC HCPCS Coverage Code - code denoting Medicare coverage status. There are two subelements separated by "=". 5844
HCD HCPCS Code Added Date - year the HCPCS code was added to the HCFA Common Procedure Coding System. 5844
HPI HCPCS Pricing Indicator Code - used to identify the appropriate methodology for developing unique pricing amounts under Part B. 5565
HBT HCPCS Berenson-Eggers Type of Service Code - BETOS for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and services. 5545
HMP HCPCS Multiple Pricing Indicator Code - code used to identify instances where a procedure could be priced. 5545
HMR HCPCS Medicare Carriers Manual reference section number - number identifying a section of the Medicare Carriers Manual. 1314
HTD HCPCS Termination Date - last date for which a procedure or code may be used by Medicare Providers. 778
HPN HCPCS processing note number identifying the processing note contained in Appendix A of the HCPCS Manual. 762
HIR HCPCS Coverage Issues Manual Reference Section Number - number identifying the Reference Section of the Coverage Issues Manual. 606
HSN HCPCS Statute Number identifying statute reference for coverage or noncoverage of procedure or service. 432
HPD HCPCS ACD payment group effective date - date the procedure is assigned to the ASC payment group. 353
HPG HCPCS ASC payment group code which represents the dollar amount of the facility charge payable by Medicare for the procedure. 353
HXR HCPCS Cross reference code - an explicit reference crosswalking a deleted code or a code that is not valid for Medicare to a valid current code (or range of codes). 300
HLC HCPCS Lab Certification Code - code used to classify laboratory procedures according to the specialty certification categories listed by CMS(formerly HCFA). 24

Notes

  • Attributes included every discrete piece of information about a concept, an atom, or a relationship that is not part of the basic Metathesaurus concept structure or distributed in one of the relationship files.
  • Attribute Names (ATN) are based on source documentation or NLMs understanding of the source.
  • Sample attribute values (ATV) are provided for each ATN in the source.
  • Sample data highlight examples of ATNs and Attribute Values (ATV) in MRSAT.RRF.
  • See Appendix B.2 for a complete list of attribute names.
  • See UMLS Documentation Section 2.7.1.3.5 for more information on MRSAT.RRF.

Sample Data

HTS

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C1618910 A9064260 L5670566 S6503208 SCUI A4218 HTS 1=Medical care STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML
C1617881 A9064199 L5671099 S6503106 SCUI A4234 HTS P=Lump sum purchase of DME, prosthetics, orthotics REPLACEMENT BATTERY, ALKALINE, J CELL, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH
C0497835 A0964724 L0774523 S0907915 SCUI A4353 HTS P=Lump sum purchase of DME, prosthetics, orthotics INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES
C0497875 A0873397 L0741492 S0813557 SCUI A4612 HTS P=Lump sum purchase of DME, prosthetics, orthotics BATTERY CABLES; REPLACEMENT FOR PATIENT-OWNED VENTILATOR
C0497891 A1061786 L0770575 S1003757 SCUI A4637 HTS R=Rental of DME REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.
C0993689 A2231599 L2045875 S2383803 SCUI A4720 HTS L=ESRD supplies (eff 04/95) (renal supplier in the home before 04/95) DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 249CC, BUT LESS THAN OR EQUAL TO 999CC, FOR PERITONEAL DIALYSIS
C0500157 A9063217 L1218294 S1459883 SCUI A6536 HTS P=Lump sum purchase of DME, prosthetics, orthotics GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, EACH
C0499308 A1118908 L0789744 S1061049 SCUI A7012 HTS A=Used durable medical equipment (DME) WATER COLLECTION DEVICE, USED WITH LARGE VOLUME NEBULIZER
C0993733 A7184664 L2046634 S2383379 SCUI C1722 HTS 9=Other medical items or services CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE)

HAC

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C1144841 A2410764 L2342430 S2775359 SCUI A5 HAC N=No maintenance for this code DRESSING FOR FIVE WOUNDS
C0497594 A1038485 L0870405 S0980394 SCUI AM HAC N=No maintenance for this code PHYSICIAN, TEAM MEMBER SERVICE
C1144863 A2411087 L2342542 S2775661 SCUI HQ HAC N=No maintenance for this code GROUP SETTING
C1144864 A2411020 L2342310 S2775599 SCUI HR HAC N=No maintenance for this code FAMILY/COUPLE WITH CLIENT PRESENT
C0497656 A1075615 L0650148 S1018113 SCUI Q4 HAC N=No maintenance for this code SERVICE FOR ORDERING/REFERRING PHYSICIAN QUALIFIES AS A SERVICE EXEMPTION
C0497664 A1075949 L0780545 S1018498 SCUI QC HAC N=No maintenance for this code SINGLE CHANNEL MONITORING
C0497672 A0848874 L0651469 S0789323 SCUI QM HAC N=No maintenance for this code AMBULANCE SERVICE PROVIDED UNDER ARRANGEMENT BY A PROVIDER OF SERVICES
C1144898 A2411482 L2341659 S2776038 SCUI U5 HAC N=No maintenance for this code MEDICAID LEVEL OF CARE 5, AS DEFINED BY EACH STATE
C0918297 A1948581 L1776210 S2073416 SCUI A0432 HAC N=No maintenance for this code PARAMEDIC INTERCEPT (PI), RURAL AREA, TRANSPORT FURNISHED BY A VOLUNTEER AMBULANCE COMPANY WHICH IS PROHIBITED BY STATE LAW FROM BILLING THIRD PARTY PAYERS

HAD

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0497604 A1098599 L0638409 S1041078 SCUI BU HAD 19970101 THE BENEFICIARY HAS BEEN INFORMED OF THE PURCHASE AND RENTAL OPTIONS AND AFTER 30 DAYS HAS NOT INFORMED THE SUPPLIER OF HIS/HER DECISION
C0520013 A0992827 L0646760 S0936940 SCUI G3 HAD 19980101 MOST RECENT URR READING OF 65 TO 69.9
C1144857 A2411277 L2342395 S2775840 SCUI HI HAD 20030101 INTEGRATED MENTAL HEALTH AND MENTAL RETARDATION/DEVELOPMENTAL DISABILITIES PROGRAM
C0973442 A9064529 L1885743 S6503701 SCUI P6 HAD 20060101 A DECLARED BRAIN-DEAD PATIENT WHOSE ORGANS ARE BEING REMOVED FOR DONOR PURPOSES
C0993671 A2232523 L2047186 S2384778 SCUI TH HAD 20010701 OBSTETRICAL TREATMENT/SERVICES, PRENATAL OR POSTPARTUM
C1144890 A2411187 L2342579 S2775758 SCUI TT HAD 20021001 INDIVIDUALIZED SERVICE PROVIDED TO MORE THAN ONE PATIENT IN SAME SETTING
C0918291 A1946917 L1775404 S2071499 SCUI A0426 HAD 20010101 AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON-EMERGENCY TRANSPORT, LEVEL 1 (ALS 1)
C0497822 A11003024 L6139514 S7049939 SCUI A4326 HAD 20070101 MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH
C0497829 A0963925 L0774396 S0906874 SCUI A4340 HAD 19960101 INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH

HAQ

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0694907 A1413697 L1218954 S1460633 SCUI AS HAQ 0 PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR CLINICAL NURSE SPECIALIST SERVICES FOR ASSISTANT AT SURGERY
C1144847 A2411683 L2341877 S2776227 SCUI BO HAQ 0 ORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE
C0993651 A2231328 L2046020 S2383519 SCUI GB HAQ 0 CLAIM BEING RE-SUBMITTED FOR PAYMENT BECAUSE IT IS NO LONGER COVERED UNDER A GLOBAL PAYMENT DEMONSTRATION
C1144874 A2410427 L2341628 S2775047 SCUI KB HAQ 0 BENEFICIARY REQUESTED UPGRADE FOR ABN, MORE THAN 4 MODIFIERS IDENTIFIED ON CLAIM
C0694917 A1413457 L1218736 S1460377 SCUI QL HAQ 0 PATIENT PRONOUNCED DEAD AFTER AMBULANCE CALLED
C1621029 A9063652 L5671642 S6502156 SCUI SS HAQ 0 HOME INFUSION SERVICES PROVIDED IN THE INFUSION SUITE OF THE IV THERAPY PROVIDER
C1144901 A2411485 L2341693 S2776041 SCUI U8 HAQ 0 MEDICAID LEVEL OF CARE 8, AS DEFINED BY EACH STATE
C0497724 A1008657 L0699173 S0952261 SCUI A0190 HAQ 0 NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-RECIPIENT
C0918301 A1948807 L1776452 S2073674 SCUI A0436 HAQ 0 ROTARY WING AIR MILEAGE, PER STATUTE MILE

HCC

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0497619 A1062242 L0812594 S1004330 SCUI F9 HCC C=Carrier judgment RIGHT HAND, FIFTH DIGIT
C1144857 A2411277 L2342395 S2775840 SCUI HI HCC I=Not payable by Medicare INTEGRATED MENTAL HEALTH AND MENTAL RETARDATION/DEVELOPMENTAL DISABILITIES PROGRAM
C1144891 A2412225 L2342634 S2776707 SCUI TU HCC I=Not payable by Medicare SPECIAL PAYMENT RATE, OVERTIME
C0497765 A0848903 L0618787 S0789361 SCUI A0420 HCC C=Carrier judgment AMBULANCE WAITING TIME (ALS OR BLS), ONE HALF (1/2) HOUR INCREMENTS
C0918290 A1947792 L1777226 S2072494 SCUI A0425 HCC C=Carrier judgment GROUND MILEAGE, PER STATUTE MILE
C0918308 A1949220 L1776321 S2074142 SCUI A4333 HCC D=Special coverage instructions apply URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH
C1144915 A2411728 L2342083 S2776269 SCUI A4405 HCC D=Special coverage instructions apply OSTOMY SKIN BARRIER, NON-PECTIN BASED, PASTE, PER OUNCE
C0497886 A1076423 L0739283 S1019051 SCUI A4627 HCC M=Non-covered by Medicare SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE INHALER
C0497942 A1077212 L0770919 S1020060 SCUI A5055 HCC D=Special coverage instructions apply STOMA CAP

HCD

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0812594 A1752452 L1506316 S1800845 SCUI G7 HCD 19990701 PREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS LIFE THREATENING
C1618848 A9064307 L5670845 S6503306 SCUI GR HCD 20060101 THIS SERVICE WAS PERFORMED IN WHOLE OR IN PART BY A RESIDENT IN A DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER OR CLINIC, SUPERVISED IN ACCORDANCE WITH VA POLICY
C0497628 A0981998 L0631531 S0925461 SCUI K2 HCD 19930101 LOWER EXTREMITY PROSTHESIS FUNCTIONAL LEVEL 2 - HAS THE ABILITY OR POTENTIAL FOR AMBULATION WITH THE ABILITY TO TRAVERSE LOW LEVEL ENVIRONMENTAL BARRIERS SUCH AS CURBS, STAIRS OR UNEVEN SURFACES. TYPICAL OF THE LIMITED COMMUNITY AMBULATOR.
C1616862 A9064201 L5671315 S6503108 SCUI A4236 HCD 20060101 REPLACEMENT BATTERY, SILVER OXIDE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH
C1144911 A2410489 L2342168 S2775107 SCUI A4283 HCD 20030101 CAP FOR BREAST PUMP BOTTLE, REPLACEMENT
C1144919 A2411734 L2341622 S2776274 SCUI A4409 HCD 20030101 OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE OR ACCORDION), EXTENDED WEAR, WITHOUT BUILT-IN CONVEXITY, 4 X 4 INCHES OR SMALLER, EACH
C0918314 A1948597 L1776579 S2073434 SCUI A4562 HCD 20010101 PESSARY, NON RUBBER, ANY TYPE
C1144950 A2412087 L2342196 S2776581 SCUI A4633 HCD 20030101 REPLACEMENT BULB/LAMP FOR ULTRAVIOLET LIGHT THERAPY SYSTEM, EACH
C0993702 A2231122 L2045960 S2383307 SCUI A4772 HCD 19860101 BLOOD GLUCOSE TEST STRIPS, FOR DIALYSIS, PER 50

HPI

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0918300 A1947716 L1776449 S2072415 SCUI A0435 HPI 52=Reasonable charge FIXED WING AIR MILEAGE, PER STATUTE MILE
C0497827 A0963858 L0856701 S0906783 SCUI A4335 HPI 46=Carrier priced (e.g., not otherwise classified, individual determination, carrier discretion, gap-filled amounts) INCONTINENCE SUPPLY; MISCELLANEOUS
C1144927 A2410830 L2342072 S2775425 SCUI A4458 HPI 00=Service not separately priced by part B (e.g., services not covered, bundled, used by part a only, etc.) ENEMA BAG WITH TUBING, REUSABLE
C0694921 A1413955 L1219214 S1460932 SCUI A4483 HPI 37=Ostomy, tracheostomy and urological supplies (price subject to floors and ceilings) MOISTURE EXCHANGER, DISPOSABLE, FOR USE WITH INVASIVE MECHANICAL VENTILATION
C0497863 A1077597 L0743020 S1020599 SCUI A4500 HPI 00=Service not separately priced by part B (e.g., services not covered, bundled, used by part a only, etc.) SURGICAL STOCKINGS BELOW KNEE LENGTH, EACH
C0497866 A1752368 L1506284 S1800767 SCUI A4557 HPI 34=DME supplies (price subject to floors and ceilings) LEAD WIRES, (E.G., APNEA MONITOR), PER PAIR
C0520077 A0948341 L0643413 S0889839 SCUI A6404 HPI 35=Surgical dressings (price subject to floors and ceilings) GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING
C1144978 A2410552 L2342208 S2775166 SCUI A6508 HPI 35=Surgical dressings (price subject to floors and ceilings) COMPRESSION BURN GARMENT, FOOT TO THIGH LENGTH, CUSTOM FABRICATED
C0520080 A1008647 L0800516 S0952250 SCUI A9270 HPI 00=Service not separately priced by part B (e.g., services not covered, bundled, used by part a only, etc.) NON-COVERED ITEM OR SERVICE

HBT

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0497707 A0848901 L0694459 S0789356 SCUI A0021 HBT O1A=Ambulance AMBULANCE SERVICE, OUTSIDE STATE PER MILE, TRANSPORT (MEDICAID ONLY)
C0497786 A9063929 L5671201 S6502608 SCUI A4215 HBT D1A=Medical/surgical supplies NEEDLE, STERILE, ANY SIZE, EACH
C1314220 A3861289 L2341436 S2776235 SCUI A4416 HBT D1F=Prosthetic/Orthotic devices OSTOMY POUCH, CLOSED, WITH BARRIER ATTACHED, WITH FILTER (1 PIECE), EACH
C1314235 A3861312 L2341542 S2776263 SCUI A4433 HBT D1F=Prosthetic/Orthotic devices OSTOMY POUCH, URINARY; FOR USE ON BARRIER WITH LOCKING FLANGE (2 PIECE), EACH
C1508781 A7185142 L5316492 S6057561 SCUI A7040 HBT D1F=Prosthetic/Orthotic devices ONE WAY CHEST DRAIN VALVE
C1508836 A7185329 L5316604 S6057909 SCUI A7527 HBT D1A=Medical/surgical supplies TRACHEOSTOMY/LARYNGECTOMY TUBE PLUG/STOP, EACH
C1144998 A9063435 L2341710 S2776733 SCUI A9513 HBT I1E=Standard imaging - nuclear medicine SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M MEBROFENIN, PER MCI
C0520086 A7185642 L5315943 S6058367 SCUI B4150 HBT O1C=Enteral and parenteral ENTERAL FORMULA, NUTRITIONALLY COMPLETE WITH INTACT NUTRIENTS, INCLUDES PROTEINS, FATS, CARBOHYDRATES, VITAMINS AND MINERALS, MAY INCLUDE FIBER, ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
C0497998 A1037042 L0680215 S0978583 SCUI B4216 HBT O1C=Enteral and parenteral PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN, ELECTROLYTES) HOMEMIX PER DAY

HMP

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C1314216 A11003595 L6140130 S7050468 SCUI A4216 HMP A=Not applicable as HCPCS priced under one methodology STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML
C0497813 A0964581 L0692842 S0907683 SCUI A4312 HMP A=Not applicable as HCPCS priced under one methodology INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE
C0497826 A1037915 L0681047 S0979658 SCUI A4330 HMP A=Not applicable as HCPCS priced under one methodology PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH
C0497829 A0963925 L0774396 S0906874 SCUI A4340 HMP A=Not applicable as HCPCS priced under one methodology INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH
C0497841 A11002442 L0739425 S1052344 SCUI A4359 HMP A=Not applicable as HCPCS priced under one methodology URINARY SUSPENSORY WITHOUT LEG BAG, EACH
C0812608 A1752676 L1506335 S1801068 SCUI A4380 HMP A=Not applicable as HCPCS priced under one methodology OSTOMY POUCH, URINARY, WITH FACEPLATE ATTACHED, RUBBER, EACH
C1314232 A3861307 L2341434 S2776259 SCUI A4430 HMP A=Not applicable as HCPCS priced under one methodology OSTOMY POUCH, URINARY, WITH EXTENDED WEAR BARRIER ATTACHED, WITH BUILT-IN CONVEXITY, WITH FAUCET-TYPE TAP WITH VALVE (1 PIECE), EACH
C0497874 A0873402 L0741515 S0813564 SCUI A4611 HMP A=Not applicable as HCPCS priced under one methodology BATTERY, HEAVY DUTY; REPLACEMENT FOR PATIENT OWNED VENTILATOR
C0497896 A1077600 L0871622 S1020602 SCUI A4649 HMP A=Not applicable as HCPCS priced under one methodology SURGICAL SUPPLY; MISCELLANEOUS

HMR

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0812594 A1752452 L1506316 S1800845 SCUI G7 HMR 2005.1 PREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS LIFE THREATENING
C0497807 A2232134 L2046068 S2384376 SCUI A4300 HMR 2130 IMPLANTABLE ACCESS CATHETER, (E,G., VENOUS, ARTERIAL, EPIDURAL SUBARACHNOID, OR PERITONEAL, ETC.) EXTERNAL ACCESS
C0918307 A7185062 L5316603 S6057430 SCUI A4332 HMR 2130 LUBRICANT, INDIVIDUAL STERILE PACKET, EACH
C0812610 A1753305 L1506589 S1801635 SCUI A4382 HMR 2130 OSTOMY POUCH, URINARY, FOR USE ON FACEPLATE, HEAVY PLASTIC, EACH
C1620968 A9064058 L5670693 S6502755 SCUI A4412 HMR 2130 OSTOMY POUCH, DRAINABLE, HIGH OUTPUT, FOR USE ON A BARRIER WITH FLANGE (2 PIECE SYSTEM), WITHOUT FILTER, EACH
C0520174 A1099518 L0771653 S1042112 SCUI A4629 HMR 2130 TRACHEOSTOMY CARE KIT FOR ESTABLISHED TRACHEOSTOMY
C1314447 A3862528 L3155271 S3678471 SCUI A4674 HMR 4270 CHEMICALS/ANTISEPTICS SOLUTION USED TO CLEAN/STERILIZE DIALYSIS EQUIPMENT, PER 8 OZ
C0993690 A2410754 L2341522 S2775349 SCUI A4721 HMR 4270 DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 999CC BUT LESS THAN OR EQUAL TO 1999CC, FOR PERITONEAL DIALYSIS
C0497909 A2231126 L2046423 S2383312 SCUI A4750 HMR 4270 BLOOD TUBING, ARTERIAL OR VENOUS, FOR HEMODIALYSIS, EACH

HTD

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0497895 A9063197 L0797550 S1020523 SCUI A4647 HTD 20051231 SUPPLY OF PARAMAGNETIC CONTRAST MATERIAL, EG., GADOLINIUM
C0993708 A9063356 L2046868 S2383976 SCUI A5509 HTD 20051231 FOR DIABETICS ONLY, DIRECT FORMED, MOLDED TO FOOT WITH EXTERNAL HEAT SOURCE (I.E. HEAT GUN) MULTIPLE DENSITY INSERT (S), PREFABRICATED, PER SHOE
C1145004 A9063438 L2341708 S2776737 SCUI A9520 HTD 20051231 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC-99M SULFUR COLLOID, PER MCI
C0918406 A9063376 L2045662 S2385297 SCUI C1091 HTD 20051231 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 OXYQUINOLINE, PER 0.5 MILLICURIE
C1145022 A11003598 L2341486 S2775067 SCUI C2632 HTD 20061231 BRACHYTHERAPY SOLUTION, IODINE-125, PER MCI
C0918961 A9063298 L1776007 S2071684 SCUI C9008 HTD 20051231 BACLOFEN INTRATHECAL REFILL KIT, PER 500 MCG
C0918595 A9063658 L5670706 S6502162 SCUI C9123 HTD 20051231 HUMAN FIBROBLAST DERIVED TEMPORARY SKIN SUBSTITUTE, PER 247 SQUARE CENTIMETERS
C1618340 A9063710 L5670538 S6502240 SCUI C9129 HTD 20051231 INJECTION, CLOFARABINE, PER 1 MG
C1314287 A3861599 L3155254 S3677581 SCUI C9205 HTD 20051231 INJECTION, OXALIPLATIN, PER 5 MG

HPN

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0694916 A1413737 L1219003 S1460685 SCUI KS HPN 0074=PER BBA 1997, SECTION 44105, EXPANDED COVERAGE OF SUPPLIES FOR DIABETIC BENEFICIARIES. GLUCOSE MONITOR SUPPLY FOR DIABETIC BENEFICIARY NOT TREATED WITH INSULIN
C1314214 A3862161 L3155894 S3678114 SCUI US HPN 0114=FOR MEDICARE PURPOSES, MODIFIERS UN-US WOULD BE REPORTED WITH R0075. SIX OR MORE PATIENTS SERVED
C0497787 A1061229 L0856238 S1003168 SCUI A4220 HPN 0050=THIS CODE MUST INCLUDE NON-CORING NEEDLES, PRESSURE MONITOR WITH STOPCOCK AND TEMPLATES. CARRIERS SHOULD NOT ALLOW SEPARATE PAYMENT FOR THIS CODE AND FOR A4212. REFILL KIT FOR IMPLANTABLE INFUSION PUMP
C1616291 A9064057 L5671194 S6502754 SCUI A4363 HPN 0124=PUBLICATION 100.2, CHAPTER 15, SS 120. OSTOMY CLAMP, ANY TYPE, REPLACEMENT ONLY, EACH
C0497899 A1076687 L0712784 S1019363 SCUI A4660 HPN 0017=SEE INTERMEDIARY MANUAL SECTION 3170.5 FOR COVERAGE INSTRUCTIONS PERTAINING TO E1510-E1600, E1620, E1630-E1699, A4650-A4663, A4690, A4712, A4730-A4870, A4890-A4927. SPHYGMOMANOMETER/BLOOD PRESSURE APPARATUS WITH CUFF AND STETHOSCOPE
C0993681 A0874104 L0750112 S0814440 SCUI A4663 HPN 0017=SEE INTERMEDIARY MANUAL SECTION 3170.5 FOR COVERAGE INSTRUCTIONS PERTAINING TO E1510-E1600, E1620, E1630-E1699, A4650-A4663, A4690, A4712, A4730-A4870, A4890-A4927. BLOOD PRESSURE CUFF ONLY
C0993685 A2230929 L2046094 S2383102 SCUI A4709 HPN 0017=SEE INTERMEDIARY MANUAL SECTION 3170.5 FOR COVERAGE INSTRUCTIONS PERTAINING TO E1510-E1600, E1620, E1630-E1699, A4650-A4663, A4690, A4712, A4730-A4870, A4890-A4927. ACID CONCENTRATE, SOLUTION, FOR HEMODIALYSIS, PER GALLON
C0993690 A2410754 L2341522 S2775349 SCUI A4721 HPN 0017=SEE INTERMEDIARY MANUAL SECTION 3170.5 FOR COVERAGE INSTRUCTIONS PERTAINING TO E1510-E1600, E1620, E1630-E1699, A4650-A4663, A4690, A4712, A4730-A4870, A4890-A4927. DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 999CC BUT LESS THAN OR EQUAL TO 1999CC, FOR PERITONEAL DIALYSIS
C0993693 A2410752 L2341615 S2775347 SCUI A4724 HPN 0017=SEE INTERMEDIARY MANUAL SECTION 3170.5 FOR COVERAGE INSTRUCTIONS PERTAINING TO E1510-E1600, E1620, E1630-E1699, A4650-A4663, A4690, A4712, A4730-A4870, A4890-A4927. DIALYSATE SOLUTION, ANY CONCENTRATION OF DEXTROSE, FLUID VOLUME GREATER THAN 3999CC BUT LESS THAN OR EQUAL TO 4999CC, FOR PERITONEAL DIALYSIS

HIR

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0812594 A1752452 L1506316 S1800845 SCUI G7 HIR 35-99 PREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS LIFE THREATENING
C0497677 A0992772 L0699526 S0936870 SCUI QS HIR 15018I MONITORED ANESTHESIA CARE SERVICE
C0497791 A0964086 L0831995 S0907112 SCUI A4231 HIR 60-14 INFUSION SET FOR EXTERNAL INSULIN PUMP, NEEDLE TYPE
C0497798 A0874096 L0644234 S0814430 SCUI A4253 HIR 60-11 BLOOD GLUCOSE TEST OR REAGENT STRIPS FOR HOME BLOOD GLUCOSE MONITOR, PER 50 STRIPS
C0520187 A9063178 L0711416 S1003724 SCUI A4254 HIR 60-11 REPLACEMENT BATTERY, ANY TYPE, FOR USE WITH MEDICALLY NECESSARY HOME BLOOD GLUCOSE MONITOR OWNED BY PATIENT, EACH
C0497865 A9064564 L5671101 S6503762 SCUI A4554 HIR 60-9 DISPOSABLE UNDERPADS, ALL SIZES
C0497868 A1099388 L0780258 S1041954 SCUI A4575 HIR 35-10 TOPICAL HYPERBARIC OXYGEN CHAMBER, DISPOSABLE
C0497891 A1061786 L0770575 S1003757 SCUI A4637 HIR 60-9 REPLACEMENT, TIP, CANE, CRUTCH, WALKER, EACH.
C0694982 A9063229 L1218355 S1459949 SCUI A6540 HIR 60-9 GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, EACH

HSN

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0497802 A9063128 L0797261 S0924850 SCUI A4260 HSN 1862a1A LEVONORGESTREL (CONTRACEPTIVE) IMPLANTS SYSTEM, INCLUDING IMPLANTS AND SUPPLIES
C1616801 A9064360 L5671202 S6503424 SCUI A9282 HSN 1861SSA WIG, ANY TYPE, EACH
C0918496 A1947890 L1775853 S2072614 SCUI C1300 HSN 1833(T) HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL
C0993732 A7184662 L2046632 S2383377 SCUI C1721 HSN 1833(T) CARDIOVERTER-DEFIBRILLATOR, DUAL CHAMBER (IMPLANTABLE)
C0993733 A7184664 L2046634 S2383379 SCUI C1722 HSN 1833(T) CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE)
C0879005 A7184668 L1720514 S2383447 SCUI C1729 HSN 1833(T) CATHETER, DRAINAGE
C0993743 A7184673 L2045928 S2383456 SCUI C1733 HSN 1833(T) CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR MAPPING, OTHER THAN COOL-TIP
C0993744 A11003027 L6140041 S7050762 SCUI C1750 HSN 1833(T) CATHETER, HEMODIALYSIS/PERITONEAL, LONG-TERM
C0993746 A11002620 L6139828 S7050763 SCUI C1752 HSN 1833(T) CATHETER, HEMODIALYSIS/PERITONEAL, SHORT-TERM

HPD

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C1740511 A11002238 L6139979 S7049746 SCUI A9527 HPD 20080101 IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE
C0993730 A13297335 L6881919 S8013265 SCUI C1719 HPD 20080101 BRACHYTHERAPY SOURCE, NON-STRANDED, NON-HIGH DOSE RATE IRIDIUM-192, PER SOURCE
C1616805 A13297352 L6882450 S8013258 SCUI C2636 HPD 20080101 BRACHYTHERAPY LINEAR SOURCE, NON-STRANDED, PALADIUM-103, PER 1 MM
C1971549 A13300145 L6881409 S8013264 SCUI C2639 HPD 20080101 BRACHYTHERAPY SOURCE, NON-STRANDED, IODINE-125, PER SOURCE
C1971550 A13296675 L6881410 S8013273 SCUI C2640 HPD 20080101 BRACHYTHERAPY SOURCE, STRANDED, PALLADIUM-103, PER SOURCE
C0993819 A2232374 L2046034 S2384623 SCUI C8900 HPD 20080101 MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, ABDOMEN
C0993823 A2232390 L2046603 S2384639 SCUI C8904 HPD 20080101 MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL
C0993824 A2232388 L2046601 S2384637 SCUI C8905 HPD 20080101 MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; UNILATERAL
C0993826 A2232389 L2046530 S2384638 SCUI C8907 HPD 20080101 MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; BILATERAL

HPG

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C1145135 A7184966 L5316312 S6057262 SCUI G0260 HPG YY INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY
C1617314 A13298741 L6881746 S8013262 SCUI C2635 HPG YY BRACHYTHERAPY SOURCE, NON-STRANDED, HIGH ACTIVITY, PALADIUM-103, GREATER THAN 2.2 MCI (NIST), PER SOURCE
C1971549 A13300145 L6881409 S8013264 SCUI C2639 HPG YY BRACHYTHERAPY SOURCE, NON-STRANDED, IODINE-125, PER SOURCE
C1971550 A13296675 L6881410 S8013273 SCUI C2640 HPG YY BRACHYTHERAPY SOURCE, STRANDED, PALLADIUM-103, PER SOURCE
C1971553 A13295918 L6881918 S8013259 SCUI C2643 HPG YY BRACHYTHERAPY SOURCE, NON-STRANDED, CESIUM-131, PER SOURCE
C0993823 A2232390 L2046603 S2384639 SCUI C8904 HPG YY MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST, BREAST; UNILATERAL
C0993824 A2232388 L2046601 S2384637 SCUI C8905 HPG YY MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; UNILATERAL
C0993828 A2232375 L2046352 S2384624 SCUI C8909 HPG YY MAGNETIC RESONANCE ANGIOGRAPHY WITH CONTRAST, CHEST (EXCLUDING MYOCARDIUM)
C0993829 A2232381 L2046353 S2384630 SCUI C8910 HPG YY MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT CONTRAST, CHEST (EXCLUDING MYOCARDIUM)

HXR

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0497707 A0848901 L0694459 S0789356 SCUI A0021 HXR A0030 AMBULANCE SERVICE, OUTSIDE STATE PER MILE, TRANSPORT (MEDICAID ONLY)
C1508851 A9063562 L5316025 S6057865 SCUI C1081 HXR A9545 SUPPLY OF RADIOPHARMACEUTICAL THERAPEUTIC IMAGING AGENT, I-131 TOSITUMOMAB, PER DOSE
C1508852 A9063558 L5316004 S6057861 SCUI C1082 HXR A9542 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM-111 IBRITUMOMAB TIUXETAN, PER DOSE
C0993719 A9063377 L2045663 S2385298 SCUI C1092 HXR A9548 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM 111 PENTETATE, PER 0.5 MILLICURIE
C1616863 A9064269 L5670552 S6503217 SCUI C1093 HXR A9566 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M FANOLESOMAB, PER DOSE (10 - 20 MCI)
C0918482 A11002445 L2341678 S2775782 SCUI C1178 HXR J0594 INJECTION, BUSULFAN, PER 6 MG
C0918960 A9063299 L1775431 S2071685 SCUI C9007 HXR J0476 BACLOFEN INTRATHECAL SCREENING KIT (1 AMP)
C0918961 A9063298 L1776007 S2071684 SCUI C9008 HXR J0475 BACLOFEN INTRATHECAL REFILL KIT, PER 500 MCG
C0918962 A9063474 L3155150 S3678401 SCUI C9009 HXR J0475 BACLOFEN INTRATHECAL REFILL KIT, PER 2000 MCG

HLC

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CUI METAUI LUI SUI STYPE CODE ATN ATV STR
C0498693 A3860551 L0697976 S1017968 SCUI G0027 HLC 400=Hematology SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER
C0812710 A11002460 L6139904 S7050251 SCUI G0103 HLC 310=Routine chemistry PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)
C0694932 A1413578 L1218852 S1460516 SCUI G0123 HLC 630=Cytology SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION
C0694933 A1413579 L1218853 S1460517 SCUI G0124 HLC 630=Cytology SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, REQUIRING INTERPRETATION BY PHYSICIAN
C0694942 A1413705 L1218967 S1460647 SCUI G0141 HLC 630=Cytology SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED SYSTEM, WITH MANUAL RESCREENING, REQUIRING INTERPRETATION BY PHYSICIAN
C0694943 A1413577 L1218851 S1460515 SCUI G0143 HLC 630=Cytology SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH MANUAL SCREENING AND RESCREENING BY CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION
C0694944 A2412197 L2342004 S2776680 SCUI G0144 HLC 630=Cytology SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH SCREENING BY AUTOMATED SYSTEM, UNDER PHYSICIAN SUPERVISION
C0694945 A2412196 L2342003 S2776679 SCUI G0145 HLC 630=Cytology SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH SCREENING BY AUTOMATED SYSTEM AND MANUAL RESCREENING UNDER PHYSICIAN SUPERVISION
C0694946 A1413707 L1218970 S1460650 SCUI G0147 HLC 630=Cytology SCREENING CYTOPATHOLOGY SMEARS, CERVICAL OR VAGINAL, PERFORMED BY AUTOMATED SYSTEM UNDER PHYSICIAN SUPERVISION

Last reviewed: 10 June 2009
Last updated: 10 June 2009
First published: 10 June 2009
Metadata| Permanence level: Permanence Not Guaranteed