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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
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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
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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
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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
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5997 HEMATURIA 5998 URINARY TRACT D
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6168 FEMALE GEN INFLAM NEC 6169 FEM
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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 and 202: 74904 BILAT CLEFT PALATE-INC 7491 C
- Page 203 and 204: 75433 CONG HIP SUBLUX, BILAT 75435
- Page 205: 75681 ABSENCE OF MUSCLE/TENDON 7568
- 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
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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
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E8551 ACC POISN-CNS DEPRES NEC E855
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E8714 POSTENDOSCOPY FORGN BODY E871
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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
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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
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6525 OTH LAP LOC EXC DEST OVA 6529
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686 RADICAL ABD HYSTERECTOMY 687 RA
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7254 TOT BREECH EXTRAC NEC 726 FORC
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7699 FACIAL BONE/JNT OP NEC 77 INCI
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7802 BONE GRAFT TO HUMERUS 7803 BON
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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
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A4356 EXTERNAL URETHRAL CLAMP OR CO
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A4636 REPLACEMENT, HANDGRIP, CANE,
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A6021 COLLAGEN DRESSING, PAD SIZE 1
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EACH DRESSING A6259 TRANSPARENT FIL
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HOMEMIX B4178 PARENTERAL NUTRITION
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C1047 CATHETER, DIAGNOSTIC, NAVI-ST
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C1134 PACEMAKER, DUAL CHAMBER, SIGM
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SOMNOPLASTY COAGULATING ELECTRODE C
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C1812 ANCHOR, OBL 2.0MM MINI TAC AC
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C2104 CATHETER, ELECTROPHYSIOLOGY,
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C4607 LEAD, PACEMAKER, FINELINE II
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C5601 VASCULAR CLOSURE DEVICE, VASC
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C8513 LEAD, NEUROSTIMULATION, PISCE
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E0147 HEAVY DUTY, MULTIPLE BREAKING
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E0424 STATIONARY COMPRESSED GASEOUS
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E0757 IMPLANTABLE NEUROSTIMULATOR R
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AWAY DETACHABLE FOOTRESTS E1100 SEM
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E1635 COMPACT (PORTABLE) TRAVEL HEM
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PATIENT'S CARE, INTEGRATION OF NEW
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G0115 NETT PULM-REHAB; PSYCHOLOGICA
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INVOLVED IN THE PATIENT’S CARE, I
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J0200 INJECTION, ALATROFLOXACIN MES
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J1364 INJECTION, ERYTHROMYCIN LACTO
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J2512 INJECTION, PENTAGASTRIN, PER
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J7320 HYLAN G-F 20, 16 MG, FOR INTR
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J9000 DOXORUBICIN HCL, 10 MG J9001
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K0034 HEEL LOOP,EACH K0035 HEEL LOO
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K0171 ADMINISTRATION SET, SMALL VOL
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K0462 TEMPORARY REPLACEMENT FOR PAT
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L0340 TLSO, ANTERIOR-POSTERIOR-LATE
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CUSTOM FABRICATED L1686 HIP ORTHOSI
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CUSTOM-FABRICATED L2112 ANKLE FOOT
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L2780 ADDITION TO LOWER EXTREMITY O
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L3640 TRANSFER OF AN ORTHOSIS FROM
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RECLINING, PREFABRICATED, INCLUDES
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SYSTEM, PYLON, NO COVER, SACH FOOT,
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L5697 ADDITION TO LOWER EXTREMITY,
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L6100 BELOW ELBOW, MOLDED SOCKET, F
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L6765 TERMINAL DEVICE, HOOK, DORRAN
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L8020 BREAST PROSTHESIS, MASTECTOMY
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P2029 CONGO RED, BLOOD P2031 HAIR A
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Q0172 CHLORPROMAZINE HYDROCHLORIDE,
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Q9936 INJECTION OF EPO, PER 1000 UN
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S2371 EACH ADDITIONAL INTERSPACE (L
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S9310 NURSING SERVICES AND ALL NECE
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V2212 SPHEROCYLINDER, BIFOCAL, PLUS
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V5130 BINAURAL, IN THE EAR V5140 BI
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