Medicare Data Utilities Appendices

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7521 TUBAL/BROAD LIG ANOM* 75210 TUBAL/BROAD LIG ANOM NOS 75211 EMBRYONIC CYST OF ADNEXA 75219 TUBAL/BROAD LIG ANOM NEC 7522 DOUBLING OF UTERUS 7523 UTERINE ANOMALY NEC 7524 CERVIX/OTH FEM GEN ANOM* 75240 CERVIX/FEM GEN ANOM NOS 75241 EMBRYON CYST FEM GEN NEC 75242 IMPERFORATE HYMEN 75249 CERVIX/FEM GEN ANOM NEC 7525 UNDESCENDED TESTICLE* 75251 UNDESCENDED TESTIS 75252 RETRACTILE TESTIS 7526 MALE HYPOSPADIAS/EPISPAD* 75261 HYPOSPADIAS 75262 EPISPADIAS 75263 CONGENITAL CHORDEE 75264 MICROPENIS 75265 HIDDEN PENIS 75269 PENILE ANOMALIES NEC 7527 INDETERMINATE SEX 7528 GENITAL ORGAN ANOM NEC 7529 GENITAL ORGAN ANOM NOS 753 URINARY SYSTEM ANOMALIES* 7530 RENAL AGENESIS 7531 CYSTIC KIDNEY DISEASE* 75310 CYSTIC KIDNEY DISEAS NOS 75311 CONGENITAL RENAL CYST 75312 POLYCYSTIC KIDNEY NOS 75313 POLYCYST KID-AUTOSOM DOM 75314 POLYCYST KID-AUTOSOM REC 75315 RENAL DYSPLASIA 75316 MEDULLARY CYSTIC KIDNEY 75317 MEDULLARY SPONGE KIDNEY 75319 CYSTIC KIDNEY DISEAS NEC 7532 CONGEN URETERAL OBSTRUCT* 75320 OBS DFCT REN PLV&URT NOS 75321 CONGEN OBST URTROPLV JNC 75322 CONG OBST URETEROVES JNC 75323 CONGENITAL URETEROCELE 75329 OBST DEF REN PLV&URT NEC 7533 KIDNEY ANOMALY NEC 7534 URETERAL ANOMALY NEC 7535 BLADDER EXSTROPHY 7536 CONGEN URETHRAL STENOSIS 7537 ANOMALIES OF URACHUS 7538 CYSTOURETHRAL ANOM NEC 7539 URINARY ANOMALY NOS 754 CONG MUSCULOSKEL DEFORM* 7540 CONG SKULL/FACE/JAW DEF 7541 CONGENITAL TORTICOLLIS 7542 CONG POSTURAL DEFORMITY 7543 CONGEN HIP DISLOCATION* 75430 CONG HIP DISLOC, UNILAT 75431 CONGEN HIP DISLOC, BILAT 75432 CONG HIP SUBLUX, UNILAT
75433 CONG HIP SUBLUX, BILAT 75435 CONG HIP DISLOC W SUBLUX 7544 CONG GENU RECURVAT/BOWNG* 75440 CONG GENU RECURVATUM 75441 CONG KNEE DISLOCATION 75442 CONGEN BOWING OF FEMUR 75443 CONG BOWING TIBIA/FIBULA 75444 CONG BOWING LEG NOS 7545 CONG VARUS DEF OF FEET* 75450 TALIPES VARUS 75451 TALIPES EQUINOVARUS 75452 METATARSUS PRIMUS VARUS 75453 METATARSUS VARUS 75459 CONG VARUS FOOT DEF NEC 7546 CONG VALGUS DEF OF FEET* 75460 TALIPES VALGUS 75461 CONGENITAL PES PLANUS 75462 TALIPES CALCANEOVALGUS 75469 CONG VALGUS FOOT DEF NEC 7547 OTH CONG FOOT DEFORM* 75470 TALIPES NOS 75471 TALIPES CAVUS 75479 CONG FOOT DEFORM NEC 7548 OTH NONTERATOGENIC ANOM* 75481 PECTUS EXCAVATUM 75482 PECTUS CARINATUM 75489 NONTERATOGENIC ANOM NEC 755 OTH CONGEN LIMB ANOMALY* 7550 POLYDACTYLY* 75500 POLYDACTYLY NOS 75501 POLYDACTYLY, FINGERS 75502 POLYDACTYLY, TOES 7551 SYNDACTYLY* 75510 SYNDACTYLY, MULTIPLE/NOS 75511 SYNDACTYL FING-NO FUSION 75512 SYNDACTYL FING W FUSION 75513 SYNDACTYL TOE-NO FUSION 75514 SYNDACTYL TOE W FUSION 7552 REDUCT DEFORM UPPER LIMB* 75520 REDUC DEFORM UP LIMB NOS 75521 TRANSVERSE DEFIC ARM 75522 LONGITUD DEFIC ARM NEC 75523 COMBIN LONGIT DEFIC ARM 75524 LONGITUDIN DEFIC HUMERUS 75525 LONGITUD DEFIC RADIOULNA 75526 LONGITUD DEFIC RADIUS 75527 LONGITUDINAL DEFIC ULNA 75528 LONGITUDINAL DEFIC HAND 75529 LONGITUD DEFIC PHALANGES 7553 REDUCT DEFORM LOWER LIMB* 75530 REDUCTION DEFORM LEG NOS 75531 TRANSVERSE DEFIC LEG 75532 LONGITUDIN DEFIC LEG NEC 75533 COMB LONGITUDIN DEF LEG 75534 LONGITUDINAL DEFIC FEMUR 75535 TIBIOFIBULA LONGIT DEFIC 75536 LONGITUDINAL DEFIC TIBIA
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Medicare Data Utilities Appendices
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Appendix C BETOS Table The Berenson
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Appendix D Carrier Claim Payment De
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Appendix G CMS Provider Specialty T
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8O = Clinical social worker (1991)
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75 = Other medical care (GPPP) (not
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Appendix I Line Place of Service Ta
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0406 = (C) MAMMOGRAPHY WITH NO HCPC
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46XB = (C) MULTIPLE COIN VALU CODES
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5500 = (U) FULL DAYS/SNF-HOSP FULL
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6911 = (C) REV CODE 274 ON OUTPAT A
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94X5 = (C) BLOOD/MSP CODE/COMPUTED
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Appendix L State Table The followin
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Appendix M Identification of variab
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48 Thyroid disorders 49 Diabetes me
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159 Urinary tract infections 160 Ca
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Appendix O Agency for Healthcare Re
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102 Ureteral catheterization 103 Ne
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216 Respiratory intubation and mech
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0064 AMEBIC LUNG ABSCESS 0065 AMEBI
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01136 TB OF BRONCHUS-OTH TEST 0114
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01326 TUBRCLOMA BRAIN-OTH TEST 0133
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01576 TB OF BONE NEC-OTH TEST 0158
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01726 TB PERIPH LYMPH-OTH TEST 0173
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026 RAT-BITE FEVER* 0260 SPIRILLARY
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04181 MYCOPLASMA 04182 BACILLUS FRA
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05579 MEASLES COMPLICATION NEC 0558
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0771 EPIDEM KERATOCONJUNCTIV 0772 P
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0907 LATE CONGEN SYPH NOS 0909 CONG
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09889 GONOCOCCAL INF SITE NEC 099 O
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1160 BLASTOMYCOSIS 1161 PARACOCCIDI
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1330 SCABIES 1338 ACARIASIS NEC 133
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151 MALIGNANT NEO STOMACH* 1510 MAL
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1712 MAL NEO SOFT TISSUE ARM 1713 M
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1902 MAL NEO LACRIMAL GLAND 1903 MA
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20083 MIXED LYMPHOSARC ABDOM 20084
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20225 SEZARY'S DISEASE INGUIN 20226
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20610 CHR MONO LEUK W/O RMSION 2061
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218 UTERINE LEIOMYOMA* 2180 SUBMUCO
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234 CA IN SITU NEC/NOS* 2340 CA IN
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2469 DISORDER OF THYROID NOS 250 DI
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2592 CARCINOID SYNDROME 2593 ECTOPI
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2766 FLUID OVERLOAD 2767 HYPERPOTAS
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2882 GENETIC ANOMALY LEUKOCYT 2883
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29552 LATENT SCHIZOPHREN-CHR 29553
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2990 INFANTILE AUTISM* 29900 INFANT
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30403 OPIOID DEPENDENCE-REMISS 3041
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30721 TRANSIENT TIC, CHILDHOOD 3072
Page 97 and 98:
3150 SPECIFIC READING DIS* 31500 RE
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33510 SPINAL MUSCL ATROPHY NOS 3351
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34600 CLSC MIGRNE WO NTRC MGRN 3460
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3594 TOXIC MYOPATHY 3595 MYOPATHY I
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3625 DEGENERATION OF MACULA* 36250
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36459 IRIS ATROPHY NEC 3646 ANTERIO
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36731 ANISOMETROPIA 36732 ANISEIKON
Page 111 and 112:
37005 MYCOTIC CORNEAL ULCER 37006 P
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37230 CONJUNCTIVITIS NOS 37231 ROSA
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3752 EPIPHORA* 37520 EPIPHORA NOS 3
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37775 CORTICAL BLINDNESS 3779 OPTIC
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37953 VISUAL DEPRIVATN NYSTAGM 3795
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38421 CENT PERF TYMPANIC MEMB 38422
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38900 CONDUCT HEARING LOSS NOS 3890
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41020 AMI INFEROLATERAL,UNSPEC 4102
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426 CONDUCTION DISORDERS* 4260 ATRI
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438 LATE EFF CEREBROVASC DIS* 4380
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4518 THROMBOPHLEBITIS NEC* 45181 IL
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4741 T & A HYPERTROPHY* 47410 HYPER
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4951 BAGASSOSIS 4952 BIRD-FANCIERS'
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5226 CHR APICAL PERIODONTITIS 5227
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53089 OTHER DSRDERS ESOPHAGUS 5309
Page 141 and 142:
535 GASTRITIS AND DUODENITIS* 5350
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5539 HERNIA NOS 555 REGIONAL ENTERI
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572 SEQUELA OF CHR LIVER DIS* 5720
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5838 NEPHRITIS NOS W OTH LES* 58381
Page 149 and 150:
5997 HEMATURIA 5998 URINARY TRACT D
Page 151 and 152: 6168 FEMALE GEN INFLAM NEC 6169 FEM
Page 153 and 154: 6281 INFERTIL-PITUITARY ORIG 6282 I
Page 155 and 156: 63622 ILLEG AB W PEL DAMG-COMP 6363
Page 157 and 158: 64120 PREM SEPAR PLACEN-UNSPEC 6412
Page 159 and 160: 64613 EDEMA IN PREG-ANTEPARTUM 6461
Page 161 and 162: 64821 ANEMIA-DELIVERED 64822 ANEMIA
Page 163 and 164: 65270 PROLAPSED ARM-UNSPEC 65271 PR
Page 165 and 166: 65501 FETAL CNS MALFORM-DELIV 65503
Page 167 and 168: 65901 FAIL MECH INDUCT-DELIVER 6590
Page 169 and 170: 66221 PROLONG 2ND STAGE-DELIV 66223
Page 171 and 172: 66584 OB TRAUMA NEC-POSTPARTUM 6659
Page 173 and 174: 670 MAJOR PUERPERAL INFECT* 67000 M
Page 175 and 176: 67494 PUERP COMPL NOS-POSTPART 675
Page 177 and 178: 6825 CELLULITIS OF BUTTOCK 6826 CEL
Page 179 and 180: 7038 DISEASES OF NAIL NEC 7039 DISE
Page 181 and 182: 71145 BACT ARTHRITIS-PELVIS 71146 B
Page 183 and 184: 71298 CRY ARTHROP NOS-OTH SITE 7129
Page 185 and 186: 71635 CLIMACT ARTHRITIS-PELVIS 7163
Page 187 and 188: 71830 RECUR DISLOCAT-UNSPEC 71831 R
Page 189 and 190: 71951 JT STIFFNESS NEC-SHLDER 71952
Page 191 and 192: 724 BACK DISORDER NEC & NOS* 7240 S
Page 193 and 194: 72886 NECROTIZING FASCIITIS 72889 M
Page 195 and 196: 7330 OSTEOPOROSIS* 73300 OSTEOPOROS
Page 197 and 198: 7379 CURVATURE OF SPINE NOS 738 OTH
Page 199 and 200: 74405 ANOMALIES OF INNER EAR 74409
Page 201: 74904 BILAT CLEFT PALATE-INC 7491 C
Page 205 and 206: 75681 ABSENCE OF MUSCLE/TENDON 7568
Page 207 and 208: 7641 LT-FOR-DATES W FETAL MAL* 7641
Page 209 and 210: 7732 NB HEMOLYT DIS-ISOIM NEC 7733
Page 211 and 212: 7826 PALLOR & FLUSHING* 78261 PALLO
Page 213 and 214: 78900 ABDMNAL PAIN UNSPCF SITE 7890
Page 215 and 216: 7951 ABN PAP SMEAR-OTH SITE 7952 AB
Page 217 and 218: 80090 OP SKL VLT FX/BR INJ NEC 8009
Page 219 and 220: 80230 MANDIBLE FX NOS-OPEN 80231 FX
Page 221 and 222: 80405 CL SKUL/OTH FX-DEEP COMA 8040
Page 223 and 224: 8060 CLOS CERV FX W CORD INJ* 80600
Page 225 and 226: 81011 FX CLAVIC, STERN END-OPN 8101
Page 227 and 228: 8141 FRACTURE CARPAL BONE-OPN* 8141
Page 229 and 230: 82391 FX FIBULA NOS-OPEN 82392 FX T
Page 231 and 232: 836 DISLOCATION OF KNEE* 8360 TEAR
Page 233 and 234: 84213 SPRAIN INTERPHALANGEAL 84219
Page 235 and 236: 85155 OPN CEREBE CONT-DEEP COM 8515
Page 237 and 238: 8540 BRAIN INJURY NEC* 85400 BRAIN
Page 239 and 240: 86412 LIVER LACERAT, MINOR-OPN 8641
Page 241 and 242: 87333 OPEN WND NAS SINUS-COMPL 8733
Page 243 and 244: 8821 OPN WOUND HAND-COMPLICAT 8822
Page 245 and 246: 90242 INJURY RENAL VEIN 90249 INJUR
Page 247 and 248: 9117 FOREIGN BODY TRUNK-INFEC 9118
Page 249 and 250: 92320 CONTUSION OF HAND(S) 92321 CO
Page 251 and 252: 94111 1ST DEG BURN EAR 94112 1ST DE
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94311 1ST DEG BURN FOREARM 94312 1S
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9451 1ST DEGREE BURN LEG* 94510 1ST
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94888 80-89% BDY BRN/80-89% 3D 9489
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9590 FACE AND NECK INJURY NOS* 9590
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9697 POISON-PSYCHOSTIMULANTS 9698 P
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9840 TX EFF INORG LEAD COMPND 9841
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99580 ADULT MALTREATMENT NOS 99581
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9994 ANAPHYLACTIC SHOCK-SERUM 9995
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E8147 MV COLL W PEDEST-PEDEST E8148
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E8250 MV N-TRAFF ACC NEC-DRIV E8251
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E8378 WATERCRAFT EXPL-PERS NEC E837
Page 275 and 276:
E8551 ACC POISN-CNS DEPRES NEC E855
Page 277 and 278:
E8714 POSTENDOSCOPY FORGN BODY E871
Page 279 and 280:
E893 CLOTHING FIRE ACCIDENT* E8930
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E9203 KNIFE/SWORD/DAGGER ACC E9204
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E935 ADV EFF ANALGESICS* E9350 ADV
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E9473 ADV EFF ALCOHOL DETER E9474 A
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E9682 ASSAULT-STRIKING W OBJ E9683
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V0261 HEPATITIS B CARRIER V0262 HEP
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V1062 HX OF MYELOID LEUKEMIA V1063
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V169 FAMILY HX-MALIGNANCY NOS V17 F
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V291 NB OBSRV SUSPCT NEURLGCL V292
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V440 TRACHEOSTOMY STATUS V441 GASTR
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V533 ADJUST CARDIAC PACEMAKER* V533
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V6289 PSYCHOLOGICAL STRESS NEC V629
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V738 SCREEN VRAL CHLM DIS NEC* V738
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Appendix Q International Classifica
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0405 GASSERIAN GANGLIONECTOMY 0406
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0752 PINEAL GLAND INCISION 0753 PAR
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098 NASO-LACRIMAL FISTULIZAT* 0981
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1274 CIL BODY DIMINUTION NOS 1279 G
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161 REMOVE PENETRAT FB EYE 162 ORBI
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2098 IMP/REP MCHAN COCHL PROS 2099
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2499 DENTAL OPERATION NEC 25 OPERAT
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2991 PHARYNGEAL DILATION 2992 DIVIS
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3423 CHEST WALL BIOPSY 3424 PLEURAL
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3631 OPEN CHEST TRANS REVASC 3632 O
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385 VARICOSE LIGAT & STRIP* 3850 VA
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406 THORACIC DUCT OPERATIONS* 4061
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4400 VAGOTOMY NOS 4401 TRUNCAL VAGO
Page 333 and 334:
4624 DELAY OPENING ILEOSTOMY 463 OT
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4939 OTHER DESTRUC ANUS LES 494 HEM
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5196 PERC EXTRAC COM DUC CALC 5198
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5495 PERITONEAL INCISION 5496 INJEC
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5749 TU DESTRUC BLADD LES NEC 575 B
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6091 PERCUT PROSTATIC ASPIRAT 6092
Page 345 and 346:
6525 OTH LAP LOC EXC DEST OVA 6529
Page 347 and 348:
686 RADICAL ABD HYSTERECTOMY 687 RA
Page 349 and 350:
7254 TOT BREECH EXTRAC NEC 726 FORC
Page 351 and 352:
7699 FACIAL BONE/JNT OP NEC 77 INCI
Page 353 and 354:
7802 BONE GRAFT TO HUMERUS 7803 BON
Page 355 and 356:
7909 CLOSED FX REDUCTION NEC 791 CL
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8019 OTHER ARTHROTOMY NEC 802 ARTHR
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8151 TOTAL HIP REPLACEMENT 8152 PAR
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8339 EXC LES SOFT TISSUE NEC 834 OT
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8541 UNILAT SIMPLE MASTECTOMY 8542
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8729 SPINAL X-RAY NEC 873 THORAX SO
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8862 CONTR PHLEBOGRAM-PULMON 8863 T
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901 MICRO EXAM-ENDOCRINE* 9011 BACT
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9151 BACT SMEAR-MUSCULOSKEL 9152 CU
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934 SKELETAL & OTH TRACTION* 9341 S
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9507 DARK ADAPTATION STUDY 9509 EYE
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9723 REPLACE TRACH TUBE 9724 REPLAC
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9927 IONTOPHORESIS 9928 IMMUNOTHERA
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Appendix R Diagnostic Related Group
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104 MDC 05P CARDIAC VALVE & OTH MAJ
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218 MDC 08P LOWER EXTREM & HUMER PR
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332 MDC 11M OTHER KIDNEY & URINARY
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446 MDC 21M TRAUMATIC INJURY AGE 0-
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Appendix S Alpha-Numeric HCPCS Code
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A0425 GROUND MILEAGE, PER STATUTE M
Page 395 and 396:
A4356 EXTERNAL URETHRAL CLAMP OR CO
Page 397 and 398:
A4636 REPLACEMENT, HANDGRIP, CANE,
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A6021 COLLAGEN DRESSING, PAD SIZE 1
Page 401 and 402:
EACH DRESSING A6259 TRANSPARENT FIL
Page 403 and 404:
HOMEMIX B4178 PARENTERAL NUTRITION
Page 405 and 406:
C1047 CATHETER, DIAGNOSTIC, NAVI-ST
Page 407 and 408:
C1134 PACEMAKER, DUAL CHAMBER, SIGM
Page 409 and 410:
SOMNOPLASTY COAGULATING ELECTRODE C
Page 411 and 412:
C1812 ANCHOR, OBL 2.0MM MINI TAC AC
Page 413 and 414:
C2104 CATHETER, ELECTROPHYSIOLOGY,
Page 415 and 416:
C4607 LEAD, PACEMAKER, FINELINE II
Page 417 and 418:
C5601 VASCULAR CLOSURE DEVICE, VASC
Page 419 and 420:
C8513 LEAD, NEUROSTIMULATION, PISCE
Page 421 and 422:
E0147 HEAVY DUTY, MULTIPLE BREAKING
Page 423 and 424:
E0424 STATIONARY COMPRESSED GASEOUS
Page 425 and 426:
E0757 IMPLANTABLE NEUROSTIMULATOR R
Page 427 and 428:
AWAY DETACHABLE FOOTRESTS E1100 SEM
Page 429 and 430:
E1635 COMPACT (PORTABLE) TRAVEL HEM
Page 431 and 432:
PATIENT'S CARE, INTEGRATION OF NEW
Page 433 and 434:
G0115 NETT PULM-REHAB; PSYCHOLOGICA
Page 435 and 436:
INVOLVED IN THE PATIENT’S CARE, I
Page 437 and 438:
J0200 INJECTION, ALATROFLOXACIN MES
Page 439 and 440:
J1364 INJECTION, ERYTHROMYCIN LACTO
Page 441 and 442:
J2512 INJECTION, PENTAGASTRIN, PER
Page 443 and 444:
J7320 HYLAN G-F 20, 16 MG, FOR INTR
Page 445 and 446:
J9000 DOXORUBICIN HCL, 10 MG J9001
Page 447 and 448:
K0034 HEEL LOOP,EACH K0035 HEEL LOO
Page 449 and 450:
K0171 ADMINISTRATION SET, SMALL VOL
Page 451 and 452:
K0462 TEMPORARY REPLACEMENT FOR PAT
Page 453 and 454:
L0340 TLSO, ANTERIOR-POSTERIOR-LATE
Page 455 and 456:
CUSTOM FABRICATED L1686 HIP ORTHOSI
Page 457 and 458:
CUSTOM-FABRICATED L2112 ANKLE FOOT
Page 459 and 460:
L2780 ADDITION TO LOWER EXTREMITY O
Page 461 and 462:
L3640 TRANSFER OF AN ORTHOSIS FROM
Page 463 and 464:
RECLINING, PREFABRICATED, INCLUDES
Page 465 and 466:
SYSTEM, PYLON, NO COVER, SACH FOOT,
Page 467 and 468:
L5697 ADDITION TO LOWER EXTREMITY,
Page 469 and 470:
L6100 BELOW ELBOW, MOLDED SOCKET, F
Page 471 and 472:
L6765 TERMINAL DEVICE, HOOK, DORRAN
Page 473 and 474:
L8020 BREAST PROSTHESIS, MASTECTOMY
Page 475 and 476:
P2029 CONGO RED, BLOOD P2031 HAIR A
Page 477 and 478:
Q0172 CHLORPROMAZINE HYDROCHLORIDE,
Page 479 and 480:
Q9936 INJECTION OF EPO, PER 1000 UN
Page 481 and 482:
S2371 EACH ADDITIONAL INTERSPACE (L
Page 483 and 484:
S9310 NURSING SERVICES AND ALL NECE
Page 485 and 486:
V2212 SPHEROCYLINDER, BIFOCAL, PLUS
Page 487:
V5130 BINAURAL, IN THE EAR V5140 BI
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Medicare Data Utilities Appendices

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