Variable: REV_CNTR_APC_HIPPS_CD
Revenue Center APC or HIPPS Code
Description
This field contains one of two potential pieces of data; the Ambulatory Payment Classification (APC) code or the Health Insurance Prospective Payment System (HIPPS) code, which corresponds with the revenue center line for the claim. The APC codes are used as the basis for payment for outpatient prospective payment (OPPS) service (e.g., Part B institutional). Some Part A claim types (e.g., home health and SNF) use resource groupings, which are similar to case-mix groups, as the basis for payment (e.g., HHRG, SNF RUGs). For home health (HH) claims, when the revenue center code (variable called REV_CNTR) is 0023, the HHRG is located in this field and is a HIPPS code. This field is only meaningful for a HH claim when CMS determines the claim should be paid using a different HIPPS code than the one submitted by the provider. When this happens, the revised HIPPS code (the one actually used for payment purposes) appears in this field and the original HIPPS code submitted by the provider remains in the HCPCS_CD field. Otherwise, this variable will always be null or have a value of “00000” for HH revenue center records. The resource utilization group for the particular revenue center is located in the data field called the APC or HIPPS code variable. The APC is a four byte field. The HIPPS code is a five byte field (such as 1AFKS).
Comment
The APC field is populated for those claims that are required to process through Outpatient PPS Pricer. The type of bills (TOB) required to process through are: 12X, 13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals (CAH)); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code '07' and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field.
Values
This variable is coded, and will contain one of the following values.
| Value | Description |
|---|---|
| 0000 | Code used when Payment Method Indicator equals 'N9' |
| 0001 | Photochemotherapy |
| 0002 | Fine needle Biopsy/Aspiration |
| 0003 | Bone Marrow Biopsy/Aspiration |
| 0004 | Level I Needle Biopsy/ Aspiration Except Bone Marrow |
| 0005 | Level II Needle Biopsy /Aspiration Except Bone Marrow |
| 0006 | Level I Incision & Drainage |
| 0007 | Level II Incision & Drainage |
| 0008 | Level III Incision & Drainage |
| 0009 | Nail Procedures |
| 0010 | Level I Destruction of Lesion |
| 0011 | Level II Destruction of Lesion |
| 0012 | Level I Debridement & Destruction |
| 0013 | Level II Debridement & Destruction |
| 0014 | Level III Debridement & Destruction |
| 0015 | Level IV Debridement & Destruction |
| 0016 | Level V Debridement & Destruction |
| 0017 | Level VI Debridement & Destruction |
| 0018 | Biopsy Skin, Subcutaneous Tissue or Mucous Membrane |
| 0019 | Level I Excision/ Biopsy |
| 0020 | Level II Excision/ Biopsy |
| 0021 | Level III Excision/ Biopsy |
| 0022 | Level IV Excision/ Biopsy |
| 0023 | Exploration Penetrating Wound |
| 0024 | Level I Skin Repair |
| 0025 | Level II Skin Repair |
| 0026 | Level III Skin Repair |
| 0027 | Level IV Skin Repair |
| 0028 | Level I Incision/Excision Breast |
| 0029 | Incision/Excision Breast (obsolete 12/00); Level II Incision/Excision Breast Effective 1/01) |
| 0030 | Breast Reconstruction/Mastectomy |
| 0031 | Hyperbaric Oxygen (obsolete 1/01) |
| 0032 | Placement Transvenous Catheters/Arterial Cutdown |
| 0033 | Partial Hospitalization |
| 0040 | Arthrocentesis & Ligament/Tendon Injection |
| 0041 | Arthroscopy |
| 0042 | Arthroscopically-Aided Procedures |
| 0043 | Closed Treatment Fracture Finger/Toe/Trunk |
| 0044 | Closed Treatment Fracture/Dislocation Except Finger/Toe/Trunk |
| 0045 | Bone/Joint Manipulation Under Anesthesia |
| 0046 | Open/Percutaneous Treatment Fracture or Dislocation |
| 0047 | Arthroplasty without Prosthesis |
| 0048 | Arthroplasty with Prosthesis |
| 0049 | Level I Musculoskeletal Procedures Except Hand and Foot |
| 0050 | Level II Musculoskeletal Procedures Except Hand and Foot |
| 0051 | Level III Musculoskeletal Procedures Except Hand and Foot |
| 0052 | Level IV Musculoskeletal Procedures Except Hand and Foot |
| 0053 | Level I Hand Musculoskeletal Procedures |
| 0054 | Level II Hand Musculoskeletal Procedures |
| 0055 | Level I Foot Musculoskeletal Procedures |
| 0056 | Level II Foot Musculoskeletal Procedures |
| 0057 | Bunion Procedures |
| 0058 | Level I Strapping and Cast Application |
| 0059 | Level II Strapping and Cast Application |
| 0060 | Manipulation Therapy |
| 0070 | Thoracentesis/Lavage Procedures |
| 0071 | Level I Endoscopy Upper Airway |
| 0072 | Level II Endoscopy Upper Airway |
| 0073 | Level III Endoscopy Upper Airway |
| 0074 | Level IV Endoscopy Upper Airway |
| 0075 | Level V Endoscopy Upper Airway |
| 0076 | Endoscopy Lower Airway |
| 0077 | Level I Pulmonary Treatment |
| 0078 | Level II Pulmonary Treatment |
| 0079 | Ventilation Initiation and Management |
| 0080 | Diagnostic Cardiac Catheterization |
| 0081 | Non-Coronary Angioplasty or Atherectomy |
| 0082 | Coronary Atherectomy |
| 0083 | Coronary Angiosplasty |
| 0084 | Level I Electrophysiologic Evaluation |
| 0085 | Level II Electrophysiologic Evaluation |
| 0086 | Ablate Heart Dysrhythm Focus |
| 0087 | Cardiac Electrophysiologic Recording/Mapping |
| 0088 | Thrombectomy |
| 0089 | Level I Implantation/Removal/Revision of Pacemaker, AICD Vascular Device (obsolete 12/00); Insertion/Replacement of Permanent Pacemaker and Electrodes (eff. 1/01) |
| 0090 | Level II Implantation/Removal/Revision of Pacemaker AICD Vascular Device (obsolete 12/00); Insertion/Replacement of Permanent Pacemaker and Pulse Generator |
| 0091 | Level I Vascular Ligation |
| 0092 | Level II Vascular Ligation |
| 0093 | Vascular Repair/Fistula Construction |
| 0094 | Resuscitation and Cardioversion |
| 0095 | Cardiac Rehabilitation |
| 0096 | Non-Invasive Vascular Studies |
| 0097 | Cardiovascular Stress Test (obsolete 12/00); Cardiac Monitoring for 30 days (eff. 1/01) |
| 0098 | Injection of Sclerosing Solution |
| 0099 | Continuous Cardiac Monitoring (obsolete 12/00); Electrocardiograms (eff. 1/01) |
| 0100 | Stress test and continuous ECG |
| 0101 | Tilt Table Evaluation |
| 0102 | Electronic Analysis of Pacemakers/other Devices |
| 0103 | Miscellaneous Vascular Procedures (eff. 1/01) |
| 0104 | Transcatheter Placement of Intracoronary Stents (eff. 1/01) |
| 0105 | Revision/Removal of Pacemakers, AICD or Vascular (eff. 1/01) |
| 0106 | Insertion/Replacement/Repair of Pacemaker Electrode (eff. 1/01) |
| 0107 | Insertion of Cardioverter-Defibrillator (eff. 1/01) |
| 0108 | Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads (eff. 1/01) |
| 0109 | Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant (obsolete 12/00); Removal of Implanted Devices (eff. 1/01) |
| 0110 | Transfusion |
| 0111 | Blood PRODuct Exchange |
| 0112 | Extracorporeal Photopheresis |
| 0113 | Excision Lymphatic System |
| 0114 | Thyroid/Lymphadenectomy Procedures |
| 0115 | Cannula/Access Device Procedures (eff. 1/01) |
| 0116 | Chemotherapy Administration by Other Technique Except Infusion |
| 0117 | Chemotherapy Administration by Infusion Only |
| 0118 | Chemotherapy Administration by Both Infusion and Other Technique |
| 0119 | Implantation of Devices (eff. 1/01) |
| 0120 | Infusion Therapy Except Chemotherapy |
| 0121 | Level I Tube changes and Repositioning |
| 0122 | Level II Tube changes and Repositioning |
| 0123 | Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant |
| 0124 | Revision of Implanted Infusion Pump (eff. 1/01) |
| 0130 | Level I Laparoscopy |
| 0131 | Level II Laparoscopy |
| 0132 | Level III Laparoscopy |
| 0140 | Esophageal Dilation without Endoscopy |
| 0141 | Upper GI Procedures |
| 0142 | Small Intestine Endoscopy |
| 0143 | Lower GI Endoscopy |
| 0144 | Diagnostic Anoscopy |
| 0145 | Therapeutic Anoscopy |
| 0146 | Level I Sigmoidoscopy |
| 0147 | Level II Sigmoidoscopy |
| 0148 | Level I Anal/Rectal Procedure |
| 0149 | Level II Anal/Rectal Procedure |
| 0150 | Level III Anal/Rectal Procedure |
| 0151 | Endoscopic Retrograde Cholangio-Pancreatography (ERCP) |
| 0152 | Percutaneous Biliary Endoscopic Procedures |
| 0153 | Peritoneal and Abdominal Procedures |
| 0154 | Hernia/Hydrocele Procedures |
| 0157 | Colorectal Cancer Screening: Barium Enema (Not subject to National coinsurance) |
| 0158 | Colorectal Cancer Screening: Colonoscopy Not subject to National coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. Payment rate is lower of the HOPD payment rate or the Ambulatory Surgical Center payment. |
| 0159 | Colorectal Cancer Screening: Flexible Sigmoidoscopy Not subject to National coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. Payment rate is lower of the HOPD payment rate or the Ambulatory Surgical Center payment. |
| 0160 | Level I Cystourethroscopy and other Genitourinary Procedures |
| 0161 | Level II Cystourethroscopy and other Genitourinary Procedures |
| 0162 | Level III Cystourethroscopy and other Genitourinary Procedures |
| 0163 | Level IV Cystourethroscopy and other Genitourinary Procedures |
| 0164 | Level I Urinary and Anal Procedures |
| 0165 | Level II Urinary and Anal Procedures |
| 0166 | Level I Urethral Procedures |
| 0167 | Level II Urethral Procedures |
| 0168 | Level III Urethral Procedures |
| 0169 | Lithotripsy |
| 0170 | Dialysis for Other Than ESRD Patients |
| 0180 | Circumcision |
| 0181 | Penile Procedures |
| 0182 | Insertion of Penile Prosthesis |
| 0183 | Testes/Epididymis Procedures |
| 0184 | Prostate Biopsy |
| 0190 | Surgical Hysteroscopy |
| 0191 | Level I Female RePRODuctive Procedures |
| 0192 | Level II Female RePRODuctive Procedures |
| 0193 | Level III Female RePRODuctive Procedures |
| 0194 | Level IV Female RePRODuctive Procedures |
| 0195 | Level V Female RePRODuctive Procedures |
| 0196 | Dilatation & Curettage |
| 0197 | Infertility Procedures |
| 0198 | Pregnancy and Neonatal Care Procedures |
| 0199 | Vaginal Delivery |
| 0200 | Therapeutic Abortion |
| 0201 | Spontaneous Abortion |
| 0210 | Spinal Tap |
| 0211 | Level I Nervous System Injections |
| 0212 | Level II Nervous System Injections |
| 0213 | Extended EEG Studies and Sleep Studies |
| 0214 | Electroencephalogram |
| 0215 | Level I Nerve and Muscle Tests |
| 0216 | Level II Nerve and Muscle Tests |
| 0217 | Level III Nerve and Muscle Tests |
| 0220 | Level I Nerve Procedures |
| 0221 | Level II Nerve Procedures |
| 0222 | Implantation of Neurological Device |
| 0223 | Level I Revision/Removal Neurological Device (obsolete 12/00); Implantation of Pain Management Device (eff. 1/01) |
| 0224 | Level II Revision/Removal Neurological Device (obsolete 12/00); Implantation of Reservoir/Pump/Shunt (eff. 1/01) |
| 0225 | Implantation of Neurostimulator Electrodes |
| 0226 | Implantation of Drug Infusion Reservior (eff. 1/01) |
| 0227 | Implantation of Drug Infusion Device (eff. 1/01) |
| 0228 | Creation of Lumbar Subarachnoid Shunt (eff. 1/01) |
| 0229 | Transcatherter Placement of Intravascular Shunts (eff. 1/01) |
| 0230 | Level I Eye Tests |
| 0231 | Level II Eye Tests |
| 0232 | Level I Anterior Segment Eye |
| 0233 | Level II Anterior Segment Eye |
| 0234 | Level III Anterior Segment Eye Procedures |
| 0235 | Level I Posterior Segment Eye Procedures |
| 0236 | Level II Posterior Segment Eye Procedures |
| 0237 | Level III Posterior Segment Eye Procedures |
| 0238 | Level I Repair and Plastic Eye Procedures |
| 0239 | Level II Repair and Plastic Eye Procedures |
| 0240 | Level III Repair and Plastic Eye Procedures |
| 0241 | Level IV Repair and Plastic Eye Procedures |
| 0242 | Level V Repair and Plastic Eye Procedures |
| 0243 | Strabismus/Muscle Procedures |
| 0244 | Corneal Transplant |
| 0245 | Cataract Procedures without IOL Insert |
| 0246 | Cataract Procedures with IOL Insert |
| 0247 | Laser Eye Procedures Except Retinal |
| 0248 | Laser Retinal Procedures |
| 0250 | Nasal Cauterization/Packing |
| 0251 | Level I ENT Procedures |
| 0252 | Level II ENT Procedures |
| 0253 | Level III ENT Procedures |
| 0254 | Level IV ENT Procedures |
| 0256 | Level V ENT Procedures |
| 0257 | Implantation of Cochlear Device (obsolete 1/01) |
| 0258 | Tonsil and Adenoid Procedures |
| 0260 | Level I Plain Film Except Teeth |
| 0261 | Level II Plain Film Except Teeth Including Bone Density Measurement |
| 0262 | Plain Film of Teeth |
| 0263 | Level I Miscellaneous Radiology Procedures |
| 0264 | Level II Miscellaneous Radiology Procedures |
| 0265 | Level I Diagnostic Ultrasound Except Vascular |
| 0266 | Level II Diagnostic Ultrasound Except Vascular |
| 0267 | Vascular Ultrasound |
| 0268 | Guidance Under Ultrasound |
| 0269 | Echocardiogram Except Transesophageal |
| 0270 | Transesophageal Echocardiogram |
| 0271 | Mammography |
| 0272 | Level I Fluoroscopy |
| 0273 | Level II Fluoroscopy |
| 0274 | Myelography |
| 0275 | Arthrography |
| 0276 | Level I Digestive Radiology |
| 0277 | Level II Digestive Radiology |
| 0278 | Diagnostic Urography |
| 0279 | Level I Diagnostic Angiography and Venography Except Extremity |
| 0280 | Level II Diagnostic Angiography and Venography Except Extremity |
| 0281 | Venography of Extremity |
| 0282 | Level I Computerized Axial Tomography |
| 0283 | Level II Computerized Axial Tomography |
| 0284 | Magnetic Resonance Imaging |
| 0285 | Positron Emission Tomography (PET) |
| 0286 | Myocardial Scans |
| 0290 | Standard Non-Imaging Nuclear Medicine |
| 0291 | Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans |
| 0292 | Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans |
| 0294 | Level I Therapeutic Nuclear Medicine |
| 0295 | Level II Therapeutic Nuclear Medicine |
| 0296 | Level I Therapeutic Radiologic Procedures |
| 0297 | Level II Therapeutic Radiologic Procedures |
| 0300 | Level I Radiation Therapy |
| 0301 | Level II Radiation Therapy |
| 0302 | Level III Radiation Therapy |
| 0303 | Treatment Device Construction |
| 0304 | Level I Therapeutic Radiation Treatment Preparation |
| 0305 | Level II Therapeutic Radiation Treatment Preparation |
| 0310 | Level III Therapeutic Radiation Treatment Preparation |
| 0311 | Radiation Physics Services |
| 0312 | Radioelement Applications |
| 0313 | Brachytherapy |
| 0314 | Hyperthermic Therapies |
| 0320 | Electroconvulsive Therapy |
| 0321 | Biofeedback and Other Training |
| 0322 | Brief Individual Psychotherapy |
| 0323 | Extended Individual Psychotherapy |
| 0324 | Family Psychotherapy |
| 0325 | Group Psychotherapy |
| 0330 | Dental Procedures |
| 0340 | Minor Ancillary Procedures |
| 0341 | Immunology Tests |
| 0342 | Level I Pathology |
| 0343 | Level II Pathology |
| 0344 | Level III Pathology |
| 0345 | Transfusion Laboratory Procedures Level I (eff. 1/01) |
| 0346 | Transfusion Laboratory Procedures Level II (eff. 1/01) |
| 0347 | Transfusion Laboratory Procedures Level III (eff. 1/01) |
| 0348 | Fertility Laboratory Procedures (eff. 1/01) |
| 0349 | Miscellaneous Laboratory Procedures (eff. 1/01) |
| 0354 | Administration of Influenza Vaccine (Not subject to national coinsurance) |
| 0355 | Level I Immunizations |
| 0356 | Level II Immunizations |
| 0357 | Level III Immunizations (obsolete 1/01) |
| 0358 | Level IV Immunizations (obsolete 1/01) |
| 0359 | Injections |
| 0360 | Level I Alimentary Tests |
| 0361 | Level II Alimentary Tests |
| 0362 | Fitting of Vision Aids |
| 0363 | Otorhinolaryngologic Function Tests |
| 0364 | Level I Audiometry |
| 0365 | Level II Audiometry |
| 0366 | Electrocardiogram (ECG) (obsolete 1/01) |
| 0367 | Level I Pulmonary Test |
| 0368 | Level II Pulmonary Test |
| 0369 | Level III Pulmonary Test |
| 0370 | Allergy Tests |
| 0371 | Allergy Injections |
| 0372 | Therapeutic Phlebotomy |
| 0373 | Neuropsychological Testing |
| 0374 | Monitoring Psychiatric Drugs |
| 0600 | Low Level Clinic Visits |
| 0601 | Mid Level Clinic Visits |
| 0602 | High Level Clinic Visits |
| 0603 | Interdisciplinary Team Conference (obsolete 1/01) |
| 0610 | Low Level Emergency Visits |
| 0611 | Mid Level Emergency Visits |
| 0612 | High Level Emergency Visits |
| 0620 | Critical Care |
| 0701 | Strontium (eligible for pass-through payments) (obsolete 12/00); SR 89 chloride, per mCi (eff. 1/01) |
| 0702 | Samariam (eligible for pass-through payments) (obsolete 12/00); SM 153 lexidronam, 50 mCi (eff. 1/01) |
| 0704 | IN 111 Satumomab Pendetide (eligible for pass-through payments) |
| 0705 | Tc99 Tetrofosmin (eligible for pass-through payments) |
| 0725 | Leucovorin Calcium (eligible for pass-through payments) |
| 0726 | Dexrazoxane Hydrochloride (eligible for pass-through payments) |
| 0727 | Injection, Etidronate Disodium (eligible for pass-through payments) |
| 0728 | Filgrastim (G-CSF) (eligible for pass-through payments) |
| 0730 | Pamidronate Disodium (eligible for pass-through payments) |
| 0731 | Sargramostim (GM-CSF) (eligible for pass-through payments) |
| 0732 | Mesna (eligible for pass-through payments) |
| 0733 | Non-ESRD Epoetin Alpha (eligible for pass-through payments) |
| 0750 | Dolasetron Mesylate 10 mg (eligible for pass-through payments) |
| 0754 | Metoclopramide HCL (eligible for pass-through payments) |
| 0755 | Thiethylperazine Maleate (eligible for pass-through payments) |
| 0761 | Oral Substitute for IV Antiemtic (eligible for pass-through payments) |
| 0762 | Dronabinol (elibible for pass-through payments) |
| 0763 | Dolasetron Mesylate 100 mg Oral (eligible for pass-through payments) |
| 0764 | Granisetron HCL, 100 mcg (eligible for pass-through payments) |
| 0765 | Granisetron HCL, 1mg Oral (eligible for pass-through payments) |
| 0768 | Ondansetron Hydrochloride per 1 mg Injection (eligible for pass-through payments) |
| 0769 | Ondansetron Hydrochloride 8 mg oral (eligible for pass-through payments) |
| 0800 | Leuprolide Acetate per 3.75 mg (eligible for pass-through payments) |
| 0801 | Cyclophosphamide (eligible for pass-through payments) |
| 0802 | Etoposide (eligible for pass-through payments) |
| 0803 | Melphalan (eligible for pass-through payments) |
| 0807 | Aldesleukin single use vial (eligible for pass-through payments) |
| 0809 | BCG (Intravesical) one vial (eligible for pass-through payments) |
| 0810 | Goserelin Acetate Implant, per 3.6 mg (eligible for pass-through payments) |
| 0811 | Carboplatin 50 mg (eligible for pass-through payments) |
| 0812 | Carmustine 100 mg (eligible for pass-through payments) |
| 0813 | Cisplatin 10 mg (eligible for pass-through payments) |
| 0814 | Asparaginase, 10,000 units (eligible for pass-through payments) |
| 0815 | Cyclophosphamide 100 mg (eligible for pass-through payments) |
| 0816 | Cyclophosphamide, Lyophilized 100 mg (eligible for pass-through payments) |
| 0817 | Cytrabine 100 mg (eligible for pass-through payments) |
| 0818 | Dactinomycin 0.5 mg (eligible for pass-through payments) |
| 0819 | Dacarbazine 100 mg (eligible for pass-through payments) |
| 0820 | Daunorubicin HCI 10 mg (eligible for pass-through payments) |
| 0821 | Daunorubicin Citrate, Liposomal Formulation, 10 mg (eligible for pass-through payments) |
| 0822 | Diethylstibestrol Diphosphate 250 mg (eligible for pass-through payments) |
| 0823 | Docetaxel 20 mg (eligible for pass-through payments) |
| 0824 | Etoposide 10 mg (eligible for pass-through payments) |
| 0826 | Methotrexate Oral 2.5 mg (eligible for pass-through payments) |
| 0827 | Floxuridine injection 500mg |
| 0828 | Gemcitabine HCL 200 mg (eligible for pass-through payments) |
| 0830 | Irinotecan 20 mg (eligible for pass-through payments) |
| 0831 | Ifosfamide injection 1 gm (eligible for pass-through payments) |
| 0832 | Idarubicin HCL injection 5 mg (eligible for pass-through payments) |
| 0833 | Interferon Alfacon-1, 1 mcg (eligible for pass-through payments) |
| 0834 | Interferon, Alfa-2A, Recombinant 3 million units (eligible for pass-through payments) |
| 0836 | Interferon, Alfa-2B, Recombinant, 1 million units (eligible for pass-through payments) |
| 0838 | Interferon, Gamma 1-B injection, 3 million units (eligible for pass-through payments) |
| 0839 | Mechlorethamine HCL injection 10 mg (eligible for pass-through payments) |
| 0840 | Melphalan HCL 50 mg (eligible for pass-through payments) |
| 0841 | Methotrexate sodium injection 5 mg (eligible for pass-through payments) |
| 0842 | Fludarabine Phosphate injection 50 mg (eligible for pass-through payments) |
| 0843 | Pegaspargase, single dose vial (eligible for pass-through payments) |
| 0844 | Pentostatin injection, 10 mg (eligible for pass-through payments) |
| 0847 | Doxorubicin HCL 10 mg (eligible for pass-through payments) |
| 0849 | Rituximab, 100 mg (eligible for pass-through payments) |
| 0850 | Streptozocin injection, 1 gm (eligible for pass-through payments) |
| 0851 | Thiotepa injection, 15 mg (eligible for pass-through payments) |
| 0852 | Topotecan 4 mg (eligible for pass-through payments) |
| 0853 | Vinblastine Sulfate injection, 1 mg (eligible for pass-through payments) |
| 0854 | Vincristine Sulfate 1 mg (eligible for pass-through payments) |
| 0855 | Vinorelbine Tartrate per 10 mg (eligible for pass-through payments) |
| 0856 | Porfimer Sodium 75 mg (eligible for pass-through payments) |
| 0857 | Bleomycin Sulfate injection 15 units (eligible for pass-through payments) |
| 0858 | Cladribine, 1mg (eligible for pass-through payments) |
| 0859 | Fluorouracil injection 500 mg |
| 0860 | Plicamycin (mithramycin) injection, 2.5 mg |
| 0861 | Leuprolide Acetate 1 mg (eligible for pass-through payments) |
| 0862 | Mitomycin, 5mg (eligible for pass-through payments) |
| 0863 | Paclitaxel, 30mg (eligible for pass-through payments) |
| 0864 | Mitoxantrone HCl, per 5mg (eligible for pass-through payments) |
| 0865 | Interferon alfa-N3, 250,000 IU (eligible for pass-through payments) |
| 0884 | Rho (D) Immune Globulin, Human one dose pack (eligible for pass-through payments) |
| 0886 | Azathioprine, 50 mg oral (Not subject to national coinsurance) |
| 0887 | Azathioprine, Parenteral 100 mg, 20 ml each injection (Not subject to national coinsurance) |
| 0888 | Cyclosporine, Oral 100 mg (Not subject to national coinsurance) |
| 0889 | Cyclosporine, Parenteral (Not subject to national coinsurance) |
| 0890 | Lymphocyte Immune Globulin 250 mg (Not subject to national coinsurance) |
| 0891 | Tacrolimus per 1 mg oral (Not subject to national coinsurance) |
| 0892 | Daclizumab, Parenteral, 25 mg (obsolete 1/01) (eligible for pass-through payments) |
| 0900 | Injection, Alglucerase per 10 units (eligible for pass-through payments) |
| 0901 | Alpha I, Proteinase Inhibitor, Human per 10mg (eligible for pass-through payments) |
| 0902 | Botulinum Toxin, Type A per unit (eligible for pass-through payments) |
| 0903 | CMV Immune Globulin (obsolete 12/00); Cytomegalovirus imm IV, vial (eligible for pass-through payments) (eff. 1/01) |
| 0905 | Immune Globulin per 500 mg (eligible for pass-through payments) |
| 0906 | RSV-ivig 50 mg (eligible for pass-through payments) |
| 0907 | Ganciclovir Sodium 500 mg injection (Not subject to national coinsurance) |
| 0908 | Tetanus Immune Globulin, injection up to 250 units (Not subject to national coinsurance) |
| 0909 | Interferon Beta - 1a 33 mcg (eligible for pass-through payments) |
| 0910 | Interferon Beta - 1b 0.25 mg (eligible for pass-through payments) |
| 0911 | Streptokinase per 250,000 iu (Not subject to national coinsurance) |
| 0913 | Ganciclovir long act implant 4.5 mg (eligible for pass-through payments) |
| 0914 | Reteplase, 37.6 mg (Not subject to national coinsurance) |
| 0915 | Alteplase injection,recombinant, 10mg (Not subject to national coinsurance) |
| 0916 | Imiglucerase per unit (eligible for pass-through payments) |
| 0917 | Dipyridamole, 10mg / Adenosine 6MG (Not subject to national coinsurance) (obsolete 1/01) Pharmalogic stresses (eff. 1/01) |
| 0918 | Brachytherapy Seeds, Any type, Each (eligible for pass-through payments) (obsolete 4/01) |
| 0925 | Factor VIII (Antihemophilic Factor, Human) per iu (eligible for pass-through payments) |
| 0926 | Factor VIII (Antihemophilic Factor, Porcine) per iu (eligible for pass-through payments) |
| 0927 | Factor VIII (Antihemophilic Factor, Recombinant) per iu (eligible for pass-through payments) |
| 0928 | Factor IX, Complex (eligible for pass-through payments) |
| 0929 | Other Hemophilia Clotting Factors per iu (eligible for pass-through payments) (obsolete 1/01) Anti-inhibitor per iu (eff. 1/01) |
| 0930 | Antithrombin III (Human) per iu (eligible for pass-through payments) |
| 0931 | Factor IX (Antihemophilic Factor, Purified, Non-Recombinant) (eligible for pass-through payments) |
| 0932 | Factor IX (Antihemophilic Factor, Recombinant) (eligible for pass-through payments) |
| 0949 | Plasma, Pooled Multiple Donor, Solvent/Detergent Treated, Frozen (not subject to national coinsurance) |
| 0950 | Blood (Whole) For Transfusion (not subject to national coinsurance) |
| 0952 | Cryoprecipitate (not subject to national coinsurance) |
| 0953 | Fibrinogen Unit (not subject to national coinsurance) |
| 0954 | Leukocyte Poor Blood (not subject to national coinsurance) |
| 0955 | Plasma, Fresh Frozen (not subject to national coinsurance) |
| 0956 | Plasma Protein Fraction (not subject to national coinsurance) |
| 0957 | Platelet Concentrate (not subject to national coinsurance) |
| 0958 | Platelet Rich Plasma (not subject to national coinsurance) |
| 0959 | Red Blood Cells (not subject to national coinsurance) |
| 0960 | Washed Red Blood Cells (not subject to national coinsurance) |
| 0961 | Infusion, Albumin (Human) 5%, 500 ml (not subject to national coinsurance) |
| 0962 | Infusion, Albumin (Human) 25%, 50 ml (not subject to national coinsurance) |
| 0970 | New Technology - Level I ($0 - $50) (not subject to national coinsurance) |
| 0971 | New Technology - Level II ($50 - $100) (not subject to national coinsurance) |
| 0972 | New Technology - Level III ($100 - $200) (not subject to national coinsurance) |
| 0973 | New Technology - Level IV ($200 - $300) (not subject to national coinsurance) |
| 0974 | New Technology - Level V ($300 - $500) (not subject to national coinsurance) |
| 0975 | New Technology - Level VI ($500 - $750) (not subject to national coinsurance) |
| 0976 | New Technology - Level VII ($750 - $1000) (not subject to national coinsurance) |
| 0977 | New Technology - Level VIII ($1000 - $1250) (not subject to national coinsurance) |
| 0978 | New Technology - Level IX ($1250 - $1500) (not subject to national coinsurance) |
| 0979 | New Technology - Level X ($1500 - $1750) (not subject to national coinsurance) |
| 0980 | New Technology - Level XI ($1750 - $2000) (not subject to national coinsurance) |
| 0981 | New Technology - Level XII ($2000 - $2500) (not subject to national coinsurance) |
| 0982 | New Technology - Level XIII ($2500 - $3500) (not subject to national coinsurance) |
| 0983 | New Technology - Level XIV ($3500 - $5000) (not subject to national coinsurance) |
| 0984 | New Technology - Level XV ($5000 - $6000) (not subject to national coinsurance) |
| 0987 | New Device Technology - Level I ($0 - $250) (eff. 1/01) |
| 0988 | New Device Technology - Level II ($250 - $500) (eff. 1/01) |
| 0989 | New Device Technology - Level III ($500 - $750) (eff. 1/01) |
| 0990 | New Device Technology - Level IV ($750 - $1000) (eff. 1/01) |
| 0991 | New Device Technology - Level V ($1000 - $1500) (eff. 1/01) |
| 0992 | New Device Technology - Level VI ($1500 - $2000) (eff. 1/01) |
| 0993 | New Device Technology - Level VII ($2000 - $3000) (eff. 1/01) |
| 0994 | New Device Technology - Level VIII ($3000 - $4000) (eff. 1/01) |
| 0995 | New Device Technology - Level IX ($4000 - $5000) (eff. 1/01) |
| 0996 | New Device Technology - Level X ($5000 - $7000) (eff. 1/01) |
| 0997 | New Device Technology - Level XI ($7000 - $9000) (eff. 1/01) |
| 1000 | Perclose Closer Prostar Arterial Vascular Closure (eff. 1/01) |
| 1001 | AcuNav-diagnostic ultrasound ca (eff. 1/01) |
| 1002 | Cochlear Implant System (eff. 1/01) |
| 1003 | Cath, ablation, livewire TC (eff. 1/01) |
| 1004 | Fast-Cath, Swartz, SAFL, CSTA (eff. 1/01) |
| 1006 | ARRAY post chamb IOL (eff. 1/01) 1007 = Ams 700 penile prosthesis (eff. 1/01) |
| 1008 | Urolume-implant urethral stent (eff. 1/01) |
| 1009 | Plasma, cryoprecipitate-reduced, unit (eff. 1/01) |
| 1010 | Blood, L/R CMV-neg (eff. 1/01) |
| 1011 | Platelets, L/R, CMV-neg (eff. 1/01) |
| 1012 | Platelet concentrate, L/R, irradiated, unit (eff. 1/01) |
| 1013 | Platelet concentrate, L/R, unit (eff. 1/01) |
| 1014 | Platelets, aph/pher, L/R, unit (eff. 1/01) |
| 1016 | Blood, L/R, froz/deglycerol/washed (eff. 1/01) |
| 1017 | Platelets, aph/pher, L/R CMV-neg, unit (eff. 1/01) |
| 1018 | Blood, L/R, irradiated (eff. 1/01) |
| 1019 | Platelets, aph/pher, L/R, irradiated, unit (eff. 1/01) |
| 1024 | Quinupristin 150 mg/dalfopriston 350 mg (eff. 1/01) |
| 1025 | Marinr CS catheter (eff. 1/01) |
| 1026 | RF Perfrmr cath 5F RF Marinr (eff. 1/01) |
| 1027 | Magic x/short, radius 14m (eff. 1/01) |
| 1028 | Prcis Twst trnsvg anch sys (eff. 1/01) |
| 1029 | CRE guided balloon dil cath (eff. 1/01) |
| 1030 | Cthtr:Mrshal, Blu Max Utr Dmnd (eff. 1/01) |
| 1033 | Sonicath mdl 37-410 (eff. 1/01) |
| 1034 | SURPASS, Long30 SURPASS-cath (eff. 1/01) |
| 1035 | Cath, Ultra ICE (eff. 1/01) |
| 1036 | R port/reservior impl dev (eff. 1/01) |
| 1037 | Vaxcelchronic dialysis cath (eff. 1/01) |
| 1038 | UltraCross Imaging Cath (eff. 1/01) |
| 1039 | Wallstent/RP:Trach (eff. 1/01) |
| 1040 | Wallstent/RP TIPS -- 20/40/60 (eff. 1/01) |
| 1042 | Wallstent, UltraFlex: Bil (eff. 1/01) |
| 1045 | I-131 MIBG (ioben-sulfate) 0.5 mCi (eff. 1/01) |
| 1047 | Navi-Star, Noga-Star cath (eff. 1/01) |
| 1048 | NeuroCyberneticPros: gen (eff. 1/01) |
| 1051 | Oasis Thrombectomy Cath (eff. 1/01) |
| 1053 | EnSite 3000 catheter (eff. 1/01) |
| 1054 | Hydrolyser Thromb Cath 6/7F (eff. 1/01) |
| 1055 | Transesoph 210, 210-S Cath (eff. 1/01) |
| 1056 | Thermachoice II Cath (eff. 1/01) |
| 1057 | Micromark Tissue Marker (eff. 1/01) |
| 1059 | Carticel, auto cult-chndr cyte (eff. 1/01) |
| 1060 | ACS multi-link tristor stent (eff. 1/01) |
| 1061 | ACS Viking Guiding cath (eff. 1/01) |
| 1063 | EndoTak Endurance EZ, RX leads (eff. 1/01) |
| 1067 | Megalink biliary stent (eff. 1/01) |
| 1068 | Pulsar DDD pmkr (eff. 1/01) |
| 1069 | Discovery DR, pmaker |
| 1071 | Pulsar Max, Pulsar SR pmkr (eff. 1/01) |
| 1072 | Guidant: blln dil cath (eff. 1/01) |
| 1073 | Gynecare Morcellator (eff. 1/01) |
| 1074 | RX/OTW Viatrac-peri dil cath (eff. 1/01) |
| 1075 | Guidant: lead (eff. 1/01) |
| 1076 | Ventak minisc defib (eff. 1/01) |
| 1077 | Ventak VR Prizm VR, sc defib (eff. 1/01) |
| 1078 | Ventak: Prizm, AVIIIDR defib |
| 1079 | CO 57/58 0.5 mCi (eff. 1/01) |
| 1084 | Denileukin diftitox, 300 mcg (eff. 1/01) |
| 1086 | Temozolomide, 5 mg (eff. 1/01) |
| 1087 | I-123 per uCi capsule (eff. 1/01) |
| 1089 | CO 57, 0.5 mCi (eff. 1/01) |
| 1090 | IN 111 Chloride, per mCi (eff. 1/01) |
| 1091 | IN 111 Oxyquinoline, per 5 mCi (eff. 1/01) |
| 1092 | IN 111 Pentetate, per 1.5 mCi (eff. 1/01) |
| 1094 | TC 99M Albumin aggr, per vial |
| 1095 | TC 99M Depreotide, per vial (eff. 1/01) |
| 1096 | TC 99M Exametazime, per dose (eff. 1/01) |
| 1097 | TC 99M Mebrofenin, per vial (eff. 1/01) |
| 1098 | TC 99M Pentetate, per vial (eff. 1/01) |
| 1099 | TC 99M Pyrophosphate, per vial (eff. 1/01) |
| 1100 | Medtronic AVE GT1 guidewire (eff. 1/01) |
| 1101 | Medtronic AVE, AVE Z2 cath (eff. 1/01) |
| 1102 | Synergy Neurostim Genrtr (eff. 1/01) |
| 1103 | Micro Jewell Defibrillator (eff. 1/01) |
| 1104 | RF ConductorAblative Cath (eff. 1/01) |
| 1105 | Sigman 300VDD pacmkr (eff. 1/01) |
| 1106 | SynergyEZ Pt Progmr (eff. 1/01) |
| 1107 | Torqr, Solist cath (eff. 1/01) |
| 1108 | Reveal Cardiac Recorder (eff. 1/01) |
| 1109 | Implantable anchor: Ethicon (eff. 1/01) |
| 1110 | Stable Mapper, cath electrd (eff. 1/01) |
| 1111 | AneuRxAort-Uni-llicstnt & cath (eff. 1/01) |
| 1112 | AneuRx Stent graft/del cath (eff. 1/01) |
| 1113 | Tlnt Endo Sprng Stnt Grft Sys (eff. 1/01) |
| 1114 | TalntSprgStnt + Graf endo pros (eff. 1/01) |
| 1115 | 5038S, 5038, 5038L pace lead (eff. 1/01) |
| 1116 | CapSureSP pacing lead (eff. 1/01) |
| 1117 | Ancure Endograft Del Sys (eff. 1/01) |
| 1118 | Sigma300DR LegIIDR, pacemkr (eff. 1/01) |
| 1119 | Sprint6932, 6943 defib lead (eff. 1/01) |
| 1120 | Sprint6942, 6945 defi lead (eff. 1/01) |
| 1121 | Gem defibrillator (eff. 1/01) |
| 1122 | TC 99M arcitumomab per dose (eff. 1/01) |
| 1123 | Gem II VR defibrillator (eff. 1/01) |
| 1124 | InterStim Test Stim Kit (eff. 1/01) |
| 1125 | Kappa 400SR, Ttopaz II SR pmkr (eff. 1/01) |
| 1126 | Kappa 700 DR pacemkr (eff. 1/01) |
| 1127 | Kappa 700SR, pmkr sgl chamber (eff. 1/01) |
| 1128 | Kappa 700D, Ruby IID pmkr (eff. 1/01) |
| 1129 | Kappa 700VDD, pacmkr (eff. 1/01) |
| 1130 | Sigma 200D, LGCY IID sc pmkr (eff. 1/01) |
| 1131 | Sigma 200DR pmker (eff. 1/01) |
| 1132 | Sigma 200SR Leg II:sc pac (eff. 1/01) |
| 1133 | Sigma SR, Vita SR, pmaker (eff. 1/01) |
| 1134 | Sigma 300D pmker (eff. 1/01) |
| 1135 | Entity DR 5326L/R, DC, pmkr (eff. 1/01) |
| 1136 | Affinity DR 5330L/R, DC, pmkr (eff. 1/01) |
| 1137 | CardioSEAL implant syst (eff. 1/01) |
| 1143 | AddVent mod 2060BL, VDD (eff. 1/01) |
| 1144 | Afnty SP 5130, Integrity SR, pmkr (eff. 1/01) |
| 1145 | Angio-Seal 6fr, 8fr (eff. 1/01) |
| 1147 | AV Plus DX 1368: lead (eff. 1/01) |
| 1148 | Contour MD sc defib (eff. 1/01) |
| 1149 | Entity DC 5226R-pmker (eff. 1/01) |
| 1151 | Passiveplus DXlead, 10mdls (eff. 1/01) |
| 1152 | LifeSite Access System (eff. 1/01) |
| 1153 | Regency SC+ 2402L pmkr (eff. 1/01) |
| 1154 | SPL:SPOI, 0204- defib lead (eff. 1/01) |
| 1155 | Repliform 8 sq cm (eff. 1/01) |
| 1156 | Tr 1102TrSR+ 2260L, 2264L, 5131 (eff. 1/01) |
| 1157 | Trilogy DCT 23/8L pmkr (eff. 1/01) |
| 1158 | TVL lead SV01, SV02, SV04 (eff. 1/01) |
| 1159 | TVL RV02, RV06, RV07: lead (eff. 1/01) |
| 1160 | TVL-ADX 1559: lead (eff. 1/01) |
| 1161 | Tendril DX, 1338 pacing lead (eff. 1/01) |
| 1162 | TempoDr, TrilogyDR+ DC pmkr (eff. 1/01) |
| 1163 | Tendril SDX, 1488T pacing lead (eff. 1/01) |
| 1164 | Iodine-125 brachytx seed (eff. 1/01) |
| 1166 | Cytarabine liposomal, 10 mg (eff. 1/01) |
| 1167 | Epirubicin hcl, 2 mg (eff. 1/01) |
| 1171 | Autosuture site marker stple (eff. 1/01) |
| 1172 | Spacemaker dissect ballon (eff. 1/01) |
| 1173 | Cor stntS540, S670, o-wire stn (eff. 1/01) |
| 1174 | Bard brachytx needle (eff. 1/01) |
| 1178 | Busulfan IV, 6 mg (eff. 1/01) |
| 1180 | Vigor SR, SC, pmkr (eff. 1/01) |
| 1181 | Meridian SSI, SC pmkr (eff. 1/01) |
| 1182 | Pulsar SSI, SC, pmkr (eff. 1/01) |
| 1183 | Jade IIS, Sigma 300S, SC, pmkr (eff. 1/01) |
| 1184 | Sigma 200S, SC, pmkr (eff. 1/01) |
| 1188 | I 131, per mCi (eff. 1/01) |
| 1200 | TC 99M Sodium Clucoheptonate, per vial (eff. 1/01) |
| 1201 | TC 99M succimer, per vial (eff. 1/01) |
| 1202 | TC 99M Sulfur Colloid, per dose (eff. 1/01) |
| 1203 | Verteporfin for Injection (eff. 1/01) |
| 1205 | TC 99M Disofenin, per vial (eff. 1/01) |
| 1207 | Octreotide acetate depot 1 mg (eff. 1/01) |
| 1302 | SQ01:lead (eff. 1/01) |
| 1303 | CapSure Fix 6940/4068-110, lead (eff. 1/01) |
| 1304 | Sonicath mdl 37-416,-418 (eff. 1/01) |
| 1305 | Apligraf (eff. 1/01) |
| 1306 | NeuroCyberneticsPros: lead (eff. 1/01) |
| 1311 | Trilogy DR + DAO pmkr (eff. 1/01) |
| 1312 | Magic WALLSTENT stent-mini (eff. 1/01) |
| 1313 | Magic medium, radius 31mm (eff. 1/01) |
| 1314 | Magic WALLSTENT stent-Long (eff. 1/01) |
| 1315 | Vigor DR, Meridian DR pmkr (eff. 1/01) |
| 1316 | Meridian DDD pmkr (eff. 1/01) |
| 1317 | Discovery SR, pmkr (eff. 1/01) |
| 1318 | Meridian SR pmkr (eff. 1/01) |
| 1319 | Wallstent/RP Enteral--60mm (eff. 1/01) |
| 1320 | Wallstent/RP lliac Del Sys (eff. 1/01) |
| 1325 | Pallidium - 103 seed (eff. 1/01) |
| 1326 | Angio-jet rheolytic thromb cath (eff. 1/01) |
| 1328 | ANS Renew NS trnsmtr (eff. 1/01) |
| 1333 | PALMZA Corinthian bill stent (eff. 1/01) |
| 1334 | Crown, Mini-crown,CrossLC (eff. 1/01) |
| 1335 | Mesh, Prolene (eff. 1/01) |
| 1336 | Constant Flow Imp Pump (eff. 1/01) |
| 1337 | IsoMed 8472-20/35/60 (eff. 1/01) |
| 1348 | I 131 per mCi solution (eff. 1/01) |
| 1350 | Prosta/OncoSeed, RAPID strand, I-125 (eff. 1/01) |
| 1351 | CapSure (Fix) pacing lead (eff. 1/01) |
| 1352 | Gem II defib (eff. 1/01) |
| 1353 | Itrel Interstm neurostim + ext (eff. 1/01) |
| 1354 | Kappa 400DR, Diamond II 820 DR (eff. 1/01) |
| 1355 | Kappa 600 DR, Vita DR (eff. 1/01) |
| 1356 | Profile MD V-186HV3 sc defib (eff. 1/01) |
| 1357 | Angstrom MD V-190HV3 sc defib (eff. 1/01) |
| 1358 | Affinity DC 5230R-Pacemaker (eff. 1/01) |
| 1359 | Pulsar, Pulsar Max DR, pmkr (eff. 1/01) |
| 1363 | Gem DR, DC, defib (eff. 1/01) |
| 1364 | Photon DR V-230HV3 DC defib (eff. 1/01) |
| 1365 | Guidewire, Hi-Torque 14/18/35 (eff. 1/01) |
| 1366 | Guidewire, PTCA, Hi-Torque (eff. 1/01) |
| 1367 | Guidewire, Hi-Torque Crosslt (eff. 1/01) |
| 1369 | ANS Renew Stim Sys recvr (eff. 1/01) |
| 1370 | Tension-Free Vaginal Tape (eff. 1/01) |
| 1371 | Symp Nitinol Transhep Bil Sys (eff. 1/01) |
| 1372 | Cordis Nitinol bil Stent (eff. 1/01) |
| 1375 | Stent, corornary, NIR (eff. 1/01) |
| 1376 | ANS Renew Stim Sys lead (eff. 1/01) |
| 1377 | Specify 3988 neuro lead (eff. 1/01) |
| 1378 | InterStim Tx 3080/3886 lead (eff. 1/01) |
| 1379 | Pisces-Quad 3887 lead (eff. 1/01) |
| 1400 | Diphenhydramine hcl 50 mg (eff. 1/01) |
| 1401 | Prochlorperazine maleate 5 mg (eff. 1/01) |
| 1402 | Promethazine hcl 12.5 mg oral (eff. 1/01) |
| 1403 | Chlorpromazine hcl 10mg oral (eff. 1/01) |
| 1404 | Trimethobenzamide hcl 250mg (eff. 1/01) |
| 1405 | Thiethylperazine maleate 10 mg (eff. 1/01) |
| 1406 | Perphenazine 4 mg oral (eff. 1/01) |
| 1407 | Hydroxyzine pamoate 25 mg (eff. 1/01) |
| 1409 | Factor via recombinant, per 1.2 mg (eff. 1/01) |
| 1410 | Prosorba column (eff. 1/01) |
| 1411 | Herculink, OTW SDS bil stent (eff. 1/01) |
| 1420 | StapleTac2 Bone w/Dermis (eff. 1/01) |
| 1421 | StapleTac2 Bone w/o Dermis (eff. 1/01) |
| 1450 | Orthosphere Arthroplasty (eff. 1/01) |
| 1451 | Orthosphere Arthroplasty Kity (eff. 1/01) |
| 1500 | Atherectomy sys, peripheral (eff. 1/01) |
| 1600 | TC 99M sestamibi, per syringe (eff. 1/01) |
| 1601 | TC 99M medronate, per dose (eff. 1/01) |
| 1602 | TC 99M apcitide, per vial (eff. 1/01) |
| 1603 | TL 201, mCi (eff. 1/01) |
| 1604 | IN 111 capromab pendetide, per dose (eff. 1/01) |
| 1605 | Abciximab injection, 10 mg (eff. 1/01) |
| 1606 | Anistreplase, 30 u (eff. 1/01) |
| 1607 | Eptifibatide injection, 5 mg (eff. 1/01) |
| 1608 | Etanercept injection, 25 mg (eff. 1/01) |
| 1609 | Rho(D) Immune globulin h, sd 100 iu (eff. 1/01) |
| 1611 | Hylan G-F 20 injection, 16 mg (eff. 1/01) |
| 1612 | Daclizumab, parenteral, 25 mg (eff. 1/01) |
| 1613 | Trastuzumab, 10 mg (eff. 1/01) |
| 1614 | Valrubicin, 200 mg (eff. 1/01) |
| 1615 | Basiliximab, 20 mg (eff. 1/01) |
| 1616 | Histrelin Acetate, 0.5 mg (eff. 1/01) |
| 1617 | Lepirdin, 50 mg (eff. 1/01) |
| 1618 | Von Willebrand factor, per iu (eff. 1/01) |
| 1619 | Ga 67, per mCi (eff. 1/01) |
| 1620 | TC 99M Bicisate, per vial (eff. 1/01) |
| 1621 | Xe 133, per mCi (eff. 1/01) |
| 1622 | TC 99M Mertiatide, per vial (eff. 1/01) |
| 1623 | TC 99M Gluceptate (eff. 1/01) |
| 1624 | P32 sodium, per mCi (eff. 1/01) |
| 1625 | IN 111 Pentetreotide, per mCi (eff. 1/01) |
| 1626 | TC 99M Oxidronate, per vial (eff. 1/01) |
| 1627 | TC-99 labeled red blood cell, per test (eff. 1/01) |
| 1628 | P32 phosphate chromic,per mCi (eff. 1/01) |
| 1700 | Authen Mick TP brachy needle (eff. 1/01) (obsolete 4/01) |
| 1701 | Medtec MT-BT-5201-25 ndl (eff. 1/01) (obsolete 4/01) |
| 1702 | WWMT brachytx needle (eff. 1/01) (obsolete 4/01) |
| 1703 | Mentor Prostate Brachy (eff. 1/01) (obsolete 4/01) |
| 1704 | MT-BT-5001-25/5051-25 (eff. 1/01) (obsolete 4/01) |
| 1705 | Best Flexi Brachy Needle (eff. 1/01) (obsolete 4/01) |
| 1706 | Indigo Prostate Seeding Ndl (eff. 1/01) (obsolete 4/01) |
| 1707 | Varisource Implt Ndl (eff. 1/01) (obsolete 4/01) |
| 1708 | UroMed Prostate Seed Ndl (eff. 1/01) (obsolete 4/01) |
| 1709 | Remington Brachytx Needle (eff. 1/01) (obsolete 4/01) |
| 1710 | US Biopsy Prostate Needle (eff. 1/01) (obsolete 4/01) |
| 1711 | MD Tech brachytx needle (eff. 1/01) (obsolete 4/01) |
| 1712 | Imagyn brachytx needle (eff. 1/01) (obsolete 4/01) |
| 1713 | Anchor/screw bn/bn,tis/bn (eff. 4/01) |
| 1714 | Cath, trans atherectomy, dir (eff. 4/01) |
| 1715 | Brachytherapy needle (eff. 4/01) |
| 1716 | Brachytx seed, Gold 198 (eff. 4/01) |
| 1717 | Brachytx seed, HDR Ir-192 (eff. 4/01) |
| 1718 | Brachytx seed, Iodine 125 (eff. 4/01) |
| 1719 | Brachytx seed, Non-HDR Ir-192 (eff. 4/01) |
| 1720 | Brachytx, Palladium 103 (eff. 4/01) |
| 1721 | AICD, dual chamber (eff. 4/01) |
| 1722 | AICD, single chamber (eff. 4/01) |
| 1723 | Cath, ablation, non-cardiac (eff. 4/01) |
| 1724 | Cath, trans atherec, rotation (eff. 4/01) |
| 1725 | Cath, translumin non-laser (eff. 4/01) |
| 1726 | Cath, bal dil, non-vascular (eff. 4/01) |
| 1727 | Cath, bal tis, dis, nonvas (eff. 4/01) |
| 1728 | Cath, brachytx seed adm (eff. 4/01) |
| 1729 | Cath, drainage, biliary (eff. 4/01) |
| 1730 | Cath, EP, 19 or fewer elect (eff. 4/01) |
| 1731 | Cath, EP, 20 or more elect (eff. 4/01) |
| 1732 | Cath, EP, diag/abl, 3D/vect (eff. 4/01) |
| 1733 | Cath, EP, other than temp (eff. 4/01) |
| 1750 | Cath, hemodialysis, long-term (eff. 4/01) |
| 1751 | Cath, inf pr/cent/midline (eff. 4/01) |
| 1752 | Cath, hemodialysis, short-term (eff. 4/01) |
| 1753 | Cath, intravas ultrasound (eff. 4/01) |
| 1754 | Catheter, intradiscal (eff. 4/01) |
| 1755 | Catheter, intraspinal (eff. 4/01) |
| 1756 | Cath, pacing, transesoph (eff. 4/01) |
| 1757 | Cath, thrombectomy/embolect (eff. 4/01) |
| 1758 | Cath, ureteral (eff. 4/01) |
| 1759 | Cath, intra echocardiography (eff. 4/01) |
| 1760 | Closure dev, vasc, imp/insert (eff. 4/01) |
| 1762 | Conn tiss, human (inc fascia) (eff. 4/01) |
| 1763 | Conn tiss, non-human (eff. 4/01) |
| 1764 | Event recorder, cardiac (eff. 4/01) |
| 1767 | Generator, neurostim, imp (eff. 4/01) |
| 1768 | Graft, vascular (eff. 4/01) |
| 1769 | Guide wire (eff. 4/01) |
| 1770 | Imaging coil, MR insertable (eff. 4/01) |
| 1771 | Rep dev, urinary, w/sling (eff. 4/01) |
| 1772 | Infusion pump, programmable (eff. 4/01) |
| 1773 | Retrieval dev, insert (eff. 4/01) |
| 1776 | Joint device (implantable) (eff. 4/01) |
| 1777 | Lead, AICD, endo single coil (eff. 4/01) |
| 1778 | Lead, neurostimulator (eff. 4/01) |
| 1779 | Lead, pmkr, transvenous VDD (eff. 4/01) |
| 1780 | Lens, intraocular (eff. 4/01) |
| 1781 | Mesh (implantable) (eff. 4/01) |
| 1782 | Morcellator (eff. 4/01) |
| 1784 | Ocular dev, intraop, det ret (eff. 4/01) |
| 1785 | Pmkr, dual, rate-resp (eff. 4/01) |
| 1786 | Pmkr, single, rate-resp (eff. 4/01) |
| 1787 | Patient progr, neurostim (eff. 4/01) |
| 1788 | Port, indwelling, imp (eff. 4/01) |
| 1789 | Prosthesis, breast, imp. (eff. 4/01) |
| 1790 | Iridium 192 HDR (eff. 1/01) (obsolete 4/01) |
| 1791 | OncoSeed, Rapid Strand I-125 (eff. 1/01) (obsolete 4/01) |
| 1792 | UroMed I-125 Brachy seed (eff. 1/01) (obsolete 4/01) |
| 1793 | Bard InterSource P-103 seed (eff. 1/01) (obsolete 4/01) |
| 1794 | Bard IsoSeed P-103 seed (eff. 1/01) (obsolete 4/01) |
| 1795 | Bard BrachySource I-125 (eff. 1/01) (obsolete 4/01) |
| 1796 | Source Tech Med I-125 (eff. 1/01) (obsolete 4/01) |
| 1797 | Draximage I-125 seed (eff. 1/01) (obsolete 4/01) |
| 1798 | Syncor I-125 PharmaSeed (eff. 1/01) (obsolete 4/01) |
| 1799 | I-Plant I-125 Brachytx seed (eff. 1/01) (obsolete 4/01) |
| 1800 | Pd-103 brachytx seed (eff. 1/01) (obsolete 4/01) |
| 1801 | IoGold I-125 brachytx seed (eff. 1/01) (obsolete 4/01) |
| 1802 | Iridium 192 brachytx seed (eff. 1/01) (obsolete 4/01) |
| 1803 | Best Iodine 125 brachytx seeds (eff. 1/01) (obsolete 4/01) |
| 1804 | Best Palladium 103 seeds (eff. 1/01) (obsolete 4/01) |
| 1805 | IsoStar Iodine-125 seeds (eff. 1/01) (obsolete 4/01) |
| 1806 | Gold 198 (eff. 1/01) (obsolete 4/01) |
| 1810 | D114S Dilatation Cath (eff. 1/01) (obsolete 4/01) |
| 1811 | Surgical Dynamics Anchors (eff. 1/01) (obsolete 4/01) |
| 1812 | OBL Anchors (eff. 1/01) (obsolete 4/01) |
| 1813 | Prosthesis, penile, inflatab (eff. 4/01) |
| 1815 | Pros, urinary sph, imp (eff. 4/01) |
| 1816 | Receiver/transmitter, neuro (eff. 4/01) |
| 1817 | Septal defect imp sys (eff. 4/01) |
| 1850 | Repliform 14/21 sq cm (eff. 1/01) (obsolete 4/01) |
| 1851 | Repliform 24/28 sq cm (eff. 1/01) (obsolete 4/01) |
| 1852 | TransCyte, per 247 sq cm (eff. 1/01) (obsolete 4/01) |
| 1853 | Suspend, per 8/14 sq cm (eff. 1/01) (obsolete 4/01) |
| 1854 | Suspend, per 24/28 sq cm (eff. 1/01) (obsolete 4/01) |
| 1855 | Suspend, per 36 sq cm (eff. 1/01) (obsolete 4/01) |
| 1856 | Suspend, per 48 sq cm (eff. 1/01) (obsolete 4/01) |
| 1857 | Suspend, per 84 sq cm (eff. 1/01) (obsolete 4/01) |
| 1858 | DuraDerm, per 8/14 sq cm (eff. 1/01) (obsolete 4/01) |
| 1859 | DuraDerm, per 21/24 sq cm (eff. 1/01) (obsolete 4/01) |
| 1860 | DuraDerm, per 48 sq cm (eff. 1/01) (obsolete 4/01) |
| 1861 | DuraDerm, per 36 sq cm (eff. 1/01) (obsolete 4/01) |
| 1862 | DuraDerm, per 72 sq cm (eff. 1/01) (obsolete 4/01) |
| 1863 | DuraDerm, per 84 sq cm (eff. 1/01) (obsolete 4/01) |
| 1864 | SpermaTex, per 13/44 sq cm (eff. 1/01) (obsolete 4/01) |
| 1865 | FasLata, per 8/14 sq cm (eff. 1/01) (obsolete 4/01) |
| 1866 | FasLata, per 24/28 sq cm (eff. 1/01) (obsolete 4/01) |
| 1867 | FasLata, per 36/48 sq cm (eff. 1/01) (obsolete 4/01) |
| 1868 | FasLata, per 96 sq cm (eff. 1/01) (obsolete 4/01) |
| 1869 | Gore Thyroplasty Dev (eff. 1/01) (obsolete 4/01) |
| 1870 | DermMatrix, per 16 sq cm (eff. 1/01) (obsolete 4/01) |
| 1871 | DermMatrix, 32 or 64 sq cm (eff. 1/01) (obsolete 4/01) |
| 1872 | Dermagraft, per 37.5 sq cm (eff. 1/01) (obsolete 4/01) |
| 1873 | Bard 3DMax Mesh (eff. 1/01) (obsolete 4/01) |
| 1874 | Stent, coated/cov w/del sys (eff. 4/01) |
| 1875 | Stent, coated/cov w/o del sys (eff. 4/01) |
| 1876 | Stent, non-coated/no-cov w/del (eff. 4/01) |
| 1877 | Stent, non-coated/cov w/o del (eff. 4/01) |
| 1878 | Martl for vocal cord (eff. 4/01) |
| 1879 | Tissue marker, imp (eff. 4/01) |
| 1880 | Vena cava filter (eff. 4/01) |
| 1881 | Dialysis access system (eff. 4/01) |
| 1882 | AICD, other than sing/dual (eff. 4/01) |
| 1883 | Adapt/ext, pacing/neuro lead (eff. 4/01) |
| 1885 | Cath, translumin angio laser (eff. 4/01) |
| 1887 | Catheter, guiding (eff. 4/01) |
| 1891 | Infusion pump, non-prog, perm (eff. 4/01) |
| 1892 | Intro/sheath, fixed, peel-away (eff. 4/01) |
| 1893 | Intro/sheath, fixed, non-peel (eff. 4/01) |
| 1894 | Intro/sheath, non-laser (eff. 4/01) |
| 1895 | Lead, AICD, endo dual coil (eff. 4/01) |
| 1896 | Lead, AICD, non sing/dual (eff. 4/01) |
| 1897 | Lead, neurostim test kit (eff. 4/01) |
| 1898 | Lead, pmkr, other than trans (eff. 4/01) |
| 1899 | Lead, pmkr/AICD combination (eff. 4/01) |
| 1929 | Maverick PTCA Cath (eff. 1/01) (obsolete 4/01) |
| 1930 | Coyote Dil Cath, 20/30/40mm (eff. 1/01) (obsolete 4/01) |
| 1931 | Talon Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1932 | Scimed remedy Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1933 | Opti-Plast XL/Centurion Cath (eff. 1/01) (obsolete 4/01) |
| 1934 | Ultraverse 3.5F Bal Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1935 | Workhorse PTA Bal Cath (eff. 1/01) (obsolete 4/01) |
| 1936 | Uromax Ultra Bal Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1937 | Synergy Balloon Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1938 | Uroforce Bal Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1939 | Raptur, Ninja PTCA Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1940 | PowerFlex, OPTA 5/LP Bal Cath (eff. 1/01) (obsolete 4/01) |
| 1941 | Jupiter PTA Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1942 | Cordis Maxi LD PTA Bal Cath (eff. 1/01) (obsolete 4/01) |
| 1943 | RXCrossSail OTW OpenSail (eff. 1/01) (obsolete 4/01) |
| 1944 | Rapid Exchange Bil Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1945 | Savvy PTA Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1946 | R1s Rapid Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1947 | Gazelle Bal Dil Cath (eff. 1/01) (obsolete 4/01) |
| 1948 | Pursuit Balloon Cath (eff. 1/01) (obsolete 4/01) |
| 1949 | Oracle Megasonics Cath (eff. 1/01) (obsolete 4/01) |
| 1979 | Visions PV/Avanar US Cath (eff. 1/01) (obsolete 4/01) |
| 1980 | Atlantis SR Coronary Cath (eff. 1/01) (obsolete 4/01) |
| 1981 | PTCA Catheters (eff. 1/01) (obsolete 4/01) |
| 2000 | Orbiter ST Steerable Cath (eff. 1/01) (obsolete 4/01) |
| 2001 | Constellation Diag Cath (eff. 1/01) (obsolete 4/01) |
| 2002 | Irvine 5F Inquiry Diag EP Cath (eff. 1/01) (obsolete 4/01) |
| 2003 | Irvine 6F Inquiry Diag EP Cath (eff. 1/01) (obsolete 4/01) |
| 2004 | Biosense EP Cath -- Octapolar (eff. 1/01) (obsolete 4/01) |
| 2005 | Biosense EP Cath -- Hexapolar (eff. 1/01) (obsolete 4/01) |
| 2006 | Biosense EP Cath -- Decapolar (eff. 1/01) (obsolete 4/01) |
| 2007 | Irvine 6F Luma-Cath EP Cath (eff. 1/01) (obsolete 4/01) |
| 2008 | 7F Luma-Cath EP Cath 81910-15 (eff. 1/01) (obsolete 4/01) |
| 2009 | Irvine 7F Luma-Cath EP Cath (eff. 1/01) (obsolete 4/01) |
| 2010 | Fixed Curve EP Cath (eff. 1/01) (obsolete 4/01) |
| 2011 | Deflectable Tip Cath--Quad (eff. 1/01) (obsolete 4/01) |
| 2012 | Celsius Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2013 | Celsius Large Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2014 | Celsius II Asym Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2015 | Celsius II Sym Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2016 | Navi-Star DS, Navi-Star Ther (eff. 1/01) (obsolete 4/01) |
| 2017 | Navi-Star Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2018 | Polaris T Ablation Cath (eff. 1/01) (obsolete 4/01) |
| 2019 | EP Deflectable Cath (eff. 1/01) (obsolete 4/01) |
| 2020 | Blazer II XP Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2021 | SilverFlex EP Cath (eff. 1/01) (obsolete 4/01) |
| 2022 | CP Chilli Cooled Abln Cath (eff. 1/01) (obsolete 4/01) |
| 2023 | Chilli Cld AblnCath-std, lg (eff. 1/01) (obsolete 4/01) |
| 2100 | CP CS Reference Cath (eff. 1/01) (obsolete 4/01) |
| 2102 | CP Radii 7F EP Cath (eff. 1/01) (obsolete 4/01) |
| 2103 | CP Radii 7F EP Cath w/Track (eff. 1/01) (obsolete 4/01) |
| 2104 | Lasso Deflectable Cath (eff. 1/01) (obsolete 4/01) |
| 2151 | Veripath Guiding Cath (eff. 1/01) (obsolete 4/01) |
| 2152 | Cordis Vista Brite Tip Cath (eff. 1/01) (obsolete 4/01) |
| 2153 | Bard Viking Cath (eff. 1/01) (obsolete 4/01) |
| 2200 | Arrow-Trerotola PTD Cath (eff. 1/01) (obsolete 4/01) |
| 2300 | Varisource Stnd Catheters (eff. 1/01) (obsolete 4/01) |
| 2597 | Clinicath/kit 16/18 sgl/dbl (eff. 1/01) (obsolete 4/01) |
| 2598 | Clinicath 18/20/24-G single (eff. 1/01) (obsolete 4/01) |
| 2599 | Clinicath 16/18-G-double (eff. 1/01) (obsolete 4/01) |
| 2601 | Bard DL Ureteral Cath (eff. 1/01) (obsolete 4/01) |
| 2602 | Vitesse Laser Cath 1.4/1.7mm (eff. 1/01) (obsolete 4/01) |
| 2603 | Vitesse Laser Cath 2.0mm (eff. 1/01) (obsolete 4/01) |
| 2604 | Vitesse E Laser Cath 2.0mm (eff. 1/01) (obsolete 4/01) |
| 2605 | Extreme Laser Catheter (eff. 1/01) (obsolete 4/01) |
| 2606 | SpineCath XL Catheter (eff. 1/01) (obsolete 4/01) |
| 2607 | SpineCath Intradiscal Cath (eff. 1/01) (obsolete 4/01) |
| 2608 | Scimed 6F Wiseguide Cath (eff. 1/01) (obsolete 4/01) |
| 2609 | Flexima Bil Draingage Cath (eff. 1/01) (obsolete 4/01) |
| 2610 | FlexTipPlus Intraspinal Cath (eff. 1/01) (obsolete 4/01) |
| 2611 | AlgoLine Intraspinal Cath (eff. 1/01) (obsolete 4/01) |
| 2612 | InDura Catheter (eff. 1/01) (obsolete 4/01) |
| 2615 | Sealant, pulmonary, liquid (eff. 4/01) |
| 2616 | Brachytx seed, Yttrium-90 (eff. 4/01) |
| 2617 | Stent, non-cor, tem w/o del (eff. 4/01) |
| 2618 | Probe, cryoablation (eff. 4/01) |
| 2619 | Pmkr, dual, non rate-resp (eff. 4/01) |
| 2620 | Pmkr, single, non rate-resp (eff. 4/01) |
| 2621 | Pmkr, other than single/dual (eff. 4/01) |
| 2622 | Prosthesis, penile, non-inf (eff. 4/01) |
| 2625 | Stent, non-cor , tem w/del sys (eff. 4/01) |
| 2626 | Infusion pump, non-prog, temp (eff. 4/01) |
| 2627 | Cath, suprapubic/cystoscopic (eff. 4/01) |
| 2628 | Catheter, occlusion (eff. 4/01) |
| 2629 | Intro/sheath, laser (eff. 4/01) |
| 2630 | Cath, EP, temp-controlled (eff. 4/01) |
| 2631 | Rep dev, urinary, w/o sling (eff. 4/01) |
| 2700 | MycroPhylax Plus CS defib (eff. 1/01) (obsolete 4/01) |
| 2701 | Phylax XM SC defib (eff. 1/01) (obsolete 4/01) |
| 2702 | Ventak Prizm 2VR Defib (eff. 1/01) (obsolete 4/01) |
| 2703 | Ventak Prizm VR HE Defib (eff. 1/01) (obsolete 4/01) |
| 2704 | Ventak Mini IV + Defib (eff. 1/01) (obsolete 4/01) |
| 2801 | Defender IV DR 612 DC defib (eff. 1/01) (obsolete 4/01) |
| 2802 | Phylax AV DC defib (eff. 1/01) (obsolete 4/01) |
| 2803 | Ventak Prizm DR HE Defib (eff. 1/01) (obsolete 4/01) |
| 2804 | Ventak Prizm 2 DR Defib (eff. 1/01) (obsolete 4/01) |
| 2805 | Jewel AF 7250 Defib (eff. 1/01) (obsolete 4/01) |
| 2806 | GEM VR 7227 Defib (eff. 1/01) (obsolete 4/01) |
| 2807 | Contak CD 1823 (eff. 1/01) (obsolete 4/01) |
| 2808 | Contak TR 1241 (eff. 1/01) (obsolete 4/01) |
| 3001 | Kainox SL/RV defib lead (eff. 1/01) (obsolete 4/01) |
| 3002 | EasyTrak Defib Lead (eff. 1/01) (obsolete 4/01) |
| 3003 | Endotak SQ Array XP lead (eff. 1/01) (obsolete 4/01) |
| 3004 | Intervene Defib lead (eff. 1/01) (obsolete 4/01) |
| 3400 | Siltex Spectrum, Contour Prof (eff. 1/01) (obsolete 4/01) |
| 3401 | Saline-Filled Spectrum (eff. 1/01) (obsolete 4/01) |
| 3500 | Mentor alpha I Inf Penile Pros (eff. 1/01) (obsolete 4/01) |
| 3510 | AMS 800 Urinary Pros (eff. 1/01) (obsolete 4/01) |
| 3551 | Choice/PT Graphix/Luge/Trooper (eff. 1/01) (obsolete 4/01) |
| 3552 | Hi-Torque Whisper (eff. 1/01) (obsolete 4/01) |
| 3553 | Cordis guidewires (eff. 1/01) (obsolete 4/01) |
| 3554 | Jindo guidewire (eff. 1/01) (obsolete 4/01) |
| 3555 | Wholey Hi-Torque Plus GW (eff. 1/01) (obsolete 4/01) |
| 3556 | Wave/FlowWire Guidewire (eff. 1/01) (obsolete 4/01) |
| 3557 | HyTek guidewire (eff. 1/01) (obsolete 4/01) |
| 3800 | SynchroMed EL infusion pump (eff. 1/01) (obsolete 4/01) |
| 3801 | Arrow/Microject PCAQ Sys (eff. 1/01) (obsolete 4/01) |
| 3851 | Elastic UV IOL AA-4203T/TF/TL (eff. 1/01) (obsolete 4/01) |
| 4000 | Opus G 4621, 4624 SC pmkr (eff. 1/01) (obsolete 4/01) |
| 4001 | Opus S 4121/4124 SC pmkr (eff. 1/01) (obsolete 4/01) |
| 4002 | Talent 113 SC pmkr (eff. 1/01) (obsolete 4/01) |
| 4003 | Kairos SR SC pmkr (eff. 1/01) (obsolete 4/01) |
| 4004 | Actros SR, Actros SLR SC pmkr (eff. 1/01) (obsolete 4/01) |
| 4005 | Philos SR/SR-B SC pmkr (eff. 1/01) (obsolete 4/01) |
| 4006 | Pulsar Max II SR pmkr (eff. 1/01) (obsolete 4/01) |
| 4007 | Marathon SR pmkr (eff. 1/01) (obsolete 4/01) |
| 4008 | Discovery II SSI pmkr (eff. 1/01) (obsolete 4/01) |
| 4009 | Discovery II SR pmkr (eff. 1/01) (obsolete 4/01) |
| 4300 | Integrity AFx DR 5342 pmkr (eff. 1/01) (obsolete 4/01) |
| 4301 | Integrity AFx DR 5346 pmkr (eff. 1/01) (obsolete 4/01) |
| 4302 | Affinity VDR 5430 DR (eff. 1/01) (obsolete 4/01) |
| 4303 | Brio 112 DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4304 | Brio 212, Talent 213/223 DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4305 | Brio 222 DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4306 | Brio 220 DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4307 | Kairos DR DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4308 | Inos2, Inos2+ DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4309 | Actros DR, D, DR-A, SLR DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4310 | Actros DR-B DC pmkr (eff. 1/01) (obsolete 4/01) |
| 4311 | Philos DR/DR-B/SLR DC (eff. 1/01) (obsolete 4/01) |
| 4312 | Pulsar Max II DR pmkr (eff. 1/01) (obsolete 4/01) |
| 4313 | Marathon DR pmkr (eff. 1/01) (obsolete 4/01) |
| 4314 | Momentum DR pmkr (eff. 1/01) (obsolete 4/01) |
| 4315 | Selection AFm pmkr (eff. 1/01) (obsolete 4/01) |
| 4316 | Discovery II DR (eff. 1/01) (obsolete 4/01) |
| 4317 | Discovery II DDD (eff. 1/01) (obsolete 4/01) |
| 4600 | Snynox, Polyrox, Elox, Retrox (eff. 1/01) (obsolete 4/01) |
| 4602 | Tendril SDX, 1488K pmkr lead (eff. 1/01) (obsolete 4/01) |
| 4603 | Oscor/Flexion pmkr lead (eff. 1/01) (obsolete 4/01) |
| 4604 | CrystallineActFix, CapsureFix (eff. 1/01) (obsolete 4/01) |
| 4605 | CapSure Epi pmkr lead (eff. 1/01) (obsolete 4/01) |
| 4606 | Flextend pmkr lead (eff. 1/01) (obsolete 4/01) |
| 4607 | FinelineII/EZ, ThinlineII/EZ (eff. 1/01) (obsolete 4/01) |
| 5000 | BX Velocity w/Hepacoat (eff. 1/01) (obsolete 4/01) |
| 5001 | Memotherm Bil Stent, sm, med (eff. 1/01) (obsolete 4/01) |
| 5002 | Memotherm Bil Stent, large (eff. 1/01) (obsolete 4/01) |
| 5003 | Memotherm Bil Stent, x-large (eff. 1/01) (obsolete 4/01) |
| 5004 | PalmazCorinthian IQ Bil Stent (eff. 1/01) (obsolete 4/01) |
| 5005 | PalmazCorinthian IQ Trans/Bil (eff. 1/01) (obsolete 4/01) |
| 5006 | PalmazTran Bil Stent Sys-Med (eff. 1/01) (obsolete 4/01) |
| 5007 | PalmazTran XL Bil Stent--40mm (eff. 1/01) (obsolete 4/01) |
| 5008 | PalmazTran XL Bil Stent--50mm (eff. 1/01) (obsolete 4/01) |
| 5009 | VistaFlex Biliary Stent (eff. 1/01) (obsolete 4/01) |
| 5010 | Rapid Exchange Bil Stent Sys (eff. 1/01) (obsolete 4/01) |
| 5011 | IntraStent, IntraStent LP (eff. 1/01) (obsolete 4/01) |
| 5012 | IntraStent DoubleStrut LD (eff. 1/01) (obsolete 4/01) |
| 5013 | IntraStent DoubleStrut XS (eff. 1/01) (obsolete 4/01) |
| 5014 | AVE Bridge Stent Sys-10/17/28 (eff. 1/01) (obsolete 4/01) |
| 5015 | AVE/X3 Bridge Sys, 40-100 (eff. 1/010 (obsolete 4/01) |
| 5016 | Biliary stent single use cov (eff. 1/01) (obsolete 4/01) |
| 5017 | WallstentRP Bil--20/40/60/68mm (eff. 1/01) (obsolete 4/01) |
| 5018 | WallstentRP Bil--80/94mm (eff. 1/01) (obsolete 4/01) |
| 5019 | Flexima Bil Stent Sys (eff. 1/01) (obsolete 4/01) |
| 5020 | Smart Nitinol Stent--20mm (eff. 1/01) (obsolete 4/01) |
| 5021 | Smart Nitinol Stent--40/60mm (eff. 1/01) (obsolete 4/01) |
| 5022 | Smart Nitinol Stent--80mm (eff. 1/01) (obsolete 4/01) |
| 5023 | BX Velocity Stent--8/13mm (eff. 1/01) (obsolete 4/01) |
| 5024 | BX Velocity Stent 18mm (eff. 1/01) (obsolete 4/01) |
| 5025 | BX Velocity Stent 23 mm (eff. 1/01) (obsolete 4/01) |
| 5026 | BX Velocity Stent 28/33mm (eff. 1/01) (obsolete 4/01) |
| 5027 | BX Velocity Stent w/Hep--8/13mm (eff. 1/01) (obsolete 4/01) |
| 5028 | BX Velocity Stent w/Hep--18mm (eff. 1/01) (obsolete 4/01) |
| 5029 | BX Velocity Stent w/Hep--23mm (eff. 1/01) (obsolete 4/01) |
| 5030 | Stent, coronary, S660 9/12mm (eff. 1/01) (obsolete 4/01) |
| 5031 | Stent, coronary, S660 15/18mm (eff. 1/01) (obsolete 4/01) |
| 5032 | Stent, coronary, S660 24/30mm (eff. 1/01) (obsolete 4/01) |
| 5033 | Niroyal Stent Sys, 9mm (eff. 1/01) (obsolete 4/01) |
| 5034 | Niroyal Stent Sys, 12/15mm (eff. 1/01) (obsolete 4/01) |
| 5035 | Niroyal Stent Sys, 18mm (eff. 1/01) (obsolete 4/01) |
| 5036 | Niroyal Stent Sys, 25mm (eff. 1/01) (obsolete 4/01) |
| 5037 | Niroyal Stent Sys, 31mm (eff. 1/01) (obsolete 4/01) |
| 5038 | BX Velocity Stent w/Raptor (eff. 1/01) (obsolete 4/01) |
| 5039 | IntraCoil Periph Stent--40mm (eff. 1/01) (obsolete 4/01) |
| 5040 | IntraCoil Periph Stent--60mm (eff. 1/01) (obsolete 4/01) |
| 5041 | BeStent Over-the-Wire 24/30mm (eff. 1/01) (obsolete 4/01) |
| 5042 | BeStent Over-the-Wire 18mm (eff. 1/01) (obsolete 4/01) |
| 5043 | BeStent Over-the-Wire 15mm (eff. 1/01) (obsolete 4/01) |
| 5044 | BeStent Over-the-Wire 9/12mm (eff. 1/01) (obsolete 4/01) |
| 5045 | Multilink Tetra Cor Stent Sys (eff. 1/01) (obsolete 4/01) |
| 5046 | Radius 20mm cor stent (eff. 1/01) (obsolete 4/01) |
| 5047 | Niroyal Elite Cor Stent Sys (eff. 1/01) (obsolete 4/01) |
| 5048 | GR II Coronary Stent (eff. 1/01) (obsolete 4/01) |
| 5130 | Wilson-Cook Colonic Z-Stent (eff. 1/01) (obsolete 4/01) |
| 5131 | Bard Colorectal Stent-60mm (eff. 1/01) (obsolete 4/01) |
| 5132 | Bard Colorectal Stent-80mm (eff. 1/01) (obsolete 4/01) |
| 5133 | Bard Colorectal Stent-100mm (eff. 1/01) (obsolete 4/01) |
| 5134 | Enteral Wallstent-90mm (eff. 1/01) (obsolete 4/01) |
| 5279 | Contour/Percuflex Stent (eff. 1/01) (obsolete 4/01) |
| 5280 | Inlay Dbl Ureteral Stent (eff. 1/01) (obsolete 4/01) |
| 5281 | Wallgraft Trach Sys 70mm (eff. 1/01) (obsolete 4/01) |
| 5282 | Wallgraft Trach Sys 20/30/50 (eff. 1/01) (obsolete 4/01) |
| 5283 | Wallstent/RP TIPS--80mm (eff. 1/01) (obsolete 4/01) |
| 5284 | Wallstent TrachUltraFlex (eff. 1/01) (obsolete 4/01) |
| 5600 | Closure dev, VasoSeal ES (eff. 1/01) (obsolete 4/01) |
| 5601 | VasoSeal Model 1000 (eff. 1/01) (obsolete 4/01) |
| 6001 | Composix Mesh 8/21 in (eff. 1/01) (obsolete 4/01) |
| 6002 | Composix Mesh 32 in (eff. 1/01) (obsolete 4/01) |
| 6003 | Composix Mesh 48 in (eff. 1/01) (obsolete 4/01) |
| 6004 | Composix Mesh 80 in (eff. 1/01) (obsolete 4/01) |
| 6005 | Composix Mesh 140 in (eff. 1/01) (obsolete 4/01) |
| 6006 | Composix Mesh 144 in (eff. 1/01) (obsolete 4/01) |
| 6012 | Pelvicol Collagen 8/14 sq cm (eff. 1/01) (obsolete 4/01) |
| 6013 | Pelvicol Collagen 21/24/28 sq cm (eff. 1/01) (obsolete 4/01) |
| 6014 | Pelvicol Collagen 36 sq cm (eff. 1/01) (obsolete 4/01) |
| 6015 | Pelvicol Collagen 48 sq cm (eff. 1/01) (obsolete 4/01) |
| 6016 | Pelvicol Collagen 96 sq cm (eff. 1/01) (obsolete 4/01) |
| 6017 | Gore-Tex DualMesh 75/96 sq cm (eff. 1/01) (obsolete 4/01) |
| 6018 | Gore-Tex DualMesh 150 sq cm (eff. 1/01) (obsolete 4/01) |
| 6019 | Gore-Tex DualMesh 285 sq cm (eff. 1/01) (obsolete 4/01) |
| 6020 | Gore-Tex DualMesh 432 sq cm (eff. 1/01) (obsolete 4/01) |
| 6021 | Gore-Tex DualMesh 600 sq cm (eff. 1/01) (obsolete 4/01) |
| 6022 | Gore-Tex DualMesh 884 sq cm (eff. 1/01) (obsolete 4/01) |
| 6023 | Gore-TexPlus 1mm, 75/96 sq cm (eff. 1/01) (obsolete 4/01) |
| 6024 | Gore-TexPlus 1mm, 150 sq cm (eff. 1/01) (obsolete 4/01) |
| 6025 | Gore-TexPlus 1mm, 285 sq cm (eff. 1/01) (obsolete 4/01) |
| 6026 | Gore-TexPlus 1mm, 432 sq cm (eff. 1/01) (obsolete 4/01) |
| 6027 | Gore-TexPlus 1mm, 600 sq cm (eff. 1/01) (obsolete 4/01) |
| 6028 | Gore-TexPlus 1mm, 884 sq cm (eff. 1/01) (obsolete 4/01) |
| 6029 | Gore-TexPlus 2mm, 150 sq cm (eff. 1/01) (obsolete 4/01) |
| 6030 | Gore-TexPlus 2mm, 285 sq cm (eff. 1/01) (obsolete 4/01) |
| 6031 | Gore-TexPlus 2mm, 432 sq cm (eff. 1/01) (obsolete 4/01) |
| 6032 | Gore-TexPlus 2mm, 600 sq cm (eff. 1/01) (obsolete 4/01) |
| 6033 | Gore-TexPlus 2mm, 884 sq cm (eff. 1/01) (obsolete 4/01) |
| 6034 | Bard ePTFE: 150 sq cm-2mm (obsolete 4/01) |
| 6035 | Bard ePTFE: 150sqcm-1mm,75-2mm (eff. 1/01) (obsolete 4/01) |
| 6036 | Bard ePTFE: 50/75sqcm-1,2mm (eff. 1/01) (obsolete 4/01) |
| 6037 | Bard ePTFE: 300 sq cm-1,2mm (eff. 1/01) (obsolete 4/01) |
| 6038 | Bard ePTFE: 600 sq cm-1mm (eff. 1/01) (obsolete 4/01) |
| 6039 | Bard ePTFE: 884sq cm-1mm (eff. 1/01) (obsolete 4/01) |
| 6040 | Bard ePTFE: 600sq cm-2mm (eff. 1/01) (obsolete 4/01) |
| 6041 | Bard ePTFE: 884sq cm -2mm (eff. 1/01) (obsolete 4/01) |
| 6050 | Female Sling Sys w/wo Matrl (eff. 1/01) (obsolete 4/01) |
| 6051 | Stratasis Sling, 20/40 cm (eff. 1/01) (obsolete 4/01) |
| 6052 | Stratasis Sling, 60 cm (eff. 1/01) (obsolete 4/01) |
| 6053 | Surgisis Soft Graft (eff. 1/01) (obsolete 4/01) |
| 6054 | Surgisis Enhanced Graft (eff. 1/01) (obsolete 4/01) |
| 6055 | Surgisis Enhanced Tissue (eff. 1/01) (obsolete 4/01) |
| 6056 | Surgisis Soft Tissue Graft (eff. 1/01) (obsolete 4/01) |
| 6057 | Surgisis Hernia Graft (eff. 1/01) (obsolete 4/01) |
| 6058 | SurgiPro Hernia Plug, med/lg (eff. 1/01) (obsolete 4/01) |
| 6080 | Male Sling Sys w/wo Matrial (eff. 1/01) (obsolete 4/01) |
| 6200 | Exxcel Soft ePTFE vas graft (ef. 1/01) (obsolete 4/01) |
| 6201 | Impra Venaflo--10/20cm (eff. 1/01) (obsolete 4/01) |
| 6202 | Impra Venaflo--30/40 cm (eff. 1/01) (obsolete 4/01) |
| 6203 | Impra Venaflo--50 cm, vt45 (eff. 1/01) (obsolete 4/01) |
| 6204 | Impra Venaflo--stepped (eff. 1/01) (obsolete 4/01) |
| 6205 | Impra Carboflo--10cm (eff. 1/01) (obsolete 4/01) |
| 6206 | Impra Carboflo--20 cm (eff. 1/01) (obsolete 4/01) |
| 6207 | Impra Carboflo--30/35/40cm (eff. 1/01) (obsolete 4/01) |
| 6208 | Impra Carboflo--40/50cm (eff. 1/01) (obsolete 4/01) |
| 6209 | Impra Carboflo--ctrflex (eff. 1/01) (obsolete 4/01) |
| 6210 | Exxcel ePTFE vas graft (eff. 1/01) (obsolete 4/01) |
| 6300 | Vanguard III Endovas Graft (eff. 1/01) (obsolete 4/01) |
| 6500 | Preface Guiding Sheath (eff. 1/01) (obsolete 4/01) |
| 6501 | Soft Tip Sheaths (eff. 1/01) (obsolete 4/01) |
| 6502 | Perry Exchange Dilator (eff. 1/01) (obsolete 4/01) |
| 6525 | Spectranetics Laser Sheath (eff. 1/01) (obsolete 4/01) |
| 6600 | Micro Litho Flex Probes (eff. 1/01) (obsolete 4/01) |
| 6650 | Fast-Cath Guiding Introducer (eff. 1/01) (obsolete 4/01) |
| 6651 | Seal-Away Guding Introducer (eff. 1/01) (obsolete 4/01) |
| 6652 | Bard Excalibur Introducer (eff. 1/01) (obsolete 4/01) |
| 6700 | Focal Seal-L (eff. 1/01) (obsolete 4/01) |
| 7000 | Amifostine, 500 mg (eligible for pass-through payments) |
| 7001 | Amphotericin B lipid complex, 50 mg, Inj (eligible for pass-through payments) |
| 7002 | Clonidine, HCl, 1 MG (eligible for pass-through payments) (obsolete 1/01) |
| 7003 | Epoprostenol, 0.5 MG, inj (eligible for pass-through payments) |
| 7004 | Immune globulin intravenous human 5g, inj (eligible for pass-through payments) |
| 7005 | Gonadorelin hcI, 100 mcg (eligible for pass-through payments) |
| 7007 | Milrinone lacetate, per 5 ml, inj (not subject to national coinsurance) |
| 7010 | Morphine sulfate concentrate (preservative free) per 10 mg (eligible for pass-through payments) |
| 7011 | Oprelevekin, inj, 5 mg (eligible for pass-through payments) |
| 7012 | Pentamidine isethionate, 300 mg (eligible for pass-through payments) (obsolete 1/01) |
| 7014 | Fentanyl citrate, inj, up to 2 ml (eligible for pass-through payments) |
| 7015 | Busulfan, oral 2 mg (eligible for pass-through payments) |
| 7019 | Aprotinin, 10,000 kiu (eligible for pass-through payments) |
| 7021 | Baclofen, intrathecal, 50 mcg (eligible for pass-through payments) (obsolete 1/01) |
| 7022 | Elliotts B Solution, per ml (eligible for pass-through payments) |
| 7023 | Treatment for bladder calculi, I.e. Renacidin per 500 ml (eligible for pass-through payments) |
| 7024 | Corticorelin ovine triflutate, 0.1 mg (eligible for pass-through payments) |
| 7025 | Digoxin immune FAB (Ovine), 10 mg (eligible for pass-through payments) |
| 7026 | Ethanolamine oleate, 1000 ml (eligible for pass-through payments) |
| 7027 | Fomepizole, 1.5 G (eligible for pass-through payments) |
| 7028 | Fosphenytoin, 50 mg (eligible for pass-through payments) |
| 7029 | Glatiramer acetate, 25 mg (eligible for pass-through payments) |
| 7030 | Hemin, 1 mg (eligible for pass-through payments) |
| 7031 | Octreotide Acetate, 500 mcg (eligible for pass-through payments) |
| 7032 | Sermorelin acetate, 0.5 mg (eligible for pass-through payments) |
| 7033 | Somatrem, 5 mg (eligible for pass-through payments) |
| 7034 | Somatropin, 1 mg (eligible for pass-through payments) |
| 7035 | Teniposide, 50 mg (eligible for pass-through payments) |
| 7036 | Urokinase, inj, IV, 250,000 I.U. (not subject to national coinsurance) |
| 7037 | Urofollitropin, 75 I.U. (eligible for pass-through payments) |
| 7038 | Muromonab-CD3, 5 mg (eligible for pass-through payments) |
| 7039 | Pegademase bovine inj 25 I.U. (eligible for pass-through payments) |
| 7040 | Pentastarch 10% inj, 100 ml (eligible for pass-through payments) |
| 7041 | Tirofiban HCL, 0.5 mg (not subject to national coinsurance) |
| 7042 | Capecitabine, oral 150 mg (eligible for pass-through payments) |
| 7043 | Infliximab, 10 MG (eligible for pass-through payments) |
| 7045 | Trimetrexate Glucoronate (eligible for pass-through payments) |
| 7046 | Doxorubicin Hcl Liposome (eligible for pass-through payments) |
| 7047 | Droperidol/fentanyl inj (eff. 1/01) |
| 7048 | Alteplase, 1 mg (eff. 1/01) |
| 7049 | Filgrastim 480 mcg injection (eff. 1/01) |
| 7315 | Sodium hyaluronate, 20 mg (eff. 1/01) |
| 8099 | Spectranetics Lead Lock Dev (eff. 1/01) (obsolete 4/01) |
| 8100 | Adhesion barrier, ADCON-L (eff. 1/01) (obsolete 4/01) |
| 8102 | SurgiVision Esoph Coil (eff. 1/01) (obsolete 4/01) |
| 9000 | Na chromate Cr51, per 0.25mCi (eff. 1/01) |
| 9001 | Linezolid inj, 200mg (eff. 1/01) |
| 9002 | Tenecteplase, 50mg/vial (eff. 1/01) |
| 9003 | Palivizumab, per 50 mg (eff. 1/01) |
| 9004 | Gemtuzumab ozogamicin inj, 5mg (eff. 1/01) |
| 9005 | Reteplase inj, half-kit, 18.8 mg/vial (eff. 1/01) |
| 9006 | Tacrolimus inj, per 5 mg (1 amp) (eff. 1/01) |
| 9007 | Baclofen Intrathecal kit-1amp (eff. 1/01) |
| 9008 | Baclofen Refill Kit--500mcg (eff. 1/01) |
| 9009 | Baclofen Refill Kit--2000mcg (eff. 1/01) |
| 9010 | Baclofen Refill Kit--4000mcg (eff. 1/01) |
| 9011 | Caffeine Citrate, inj, 1ml (eff. 1/01) |
| 9012 | Arsenic Trioxide, 1mg/kg (eff. 4/01) |
| 9013 | Co 57 Cobaltous Cl, 1 ml (eff. 4/01) |
| 9100 | Iodinated I-131 Albumin (eff. 1/01) |
| 9102 | 51 Na chromate, 50mCi (eff. 1/01) |
| 9103 | Na lothalamate I-125, 10uCi (eff. 1/01) |
| 9104 | Anti-thymocyte globin, 25 mg (eff. 1/01) |
| 9105 | Hep B immun glob, per 1 ml (eff. 1/01) |
| 9106 | Sirolimus 1 mg/ml (eff. 1/01) |
| 9107 | Tinzaparin sodium, 2ml vial (eff. 1/01) |
| 9108 | Thyrotropin Alfa, 1.1 mg (eff. 1/01) |
| 9109 | Tirofiban hydrachloride 6.25 mg (eff. 1/01) |
| 9217 | Leuprolide acetate for depot suspension, 7.5 mg (eff. 1/01) |
| 9500 | Platelets, irrad, ea unit (eff. 1/01) |
| 9501 | Platelets, pheresis, ea unit (eff. 1/01) |
| 9502 | Platelets, pher/irrad, ea unit (eff. 1/01) |
| 9503 | Fresh frozen plasma, ea unit (eff. 1/01) |
| 9504 | RBC, deglycerolized, ea unit (eff. 1/01) |
| 9505 | RBC, irradiated, ea unit (eff. 1/01) |
| 9998 | Enoxaparin (eff. 1/01) |
Other Info
Some additional information on this variable:
- Short Name: APCHIPPS
- Long Name: REV_CNTR_APC_HIPPS_CD
- Type: CHAR
- Length: 5
- Source: NCH
- Value Format: