Medicare Data Utilities Appendices

TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH
A9150 NON-PRESCRIPTION DRUGS
A9160 NON-COVERED SVC. BY PODIATRIST
A9170 NON-COVERED SVC. BY CHIROPRACTOR
A9190 PERSONAL COMFORT ITEM
A9270 NON-COVERED ITEM OR SERVICE
A9300 EXERCISE EQUIPMENT
A9500 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M
SESTAMIBI, PER DOSE
A9502 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M
TETROFOSMIN, PER UNIT DOSE
A9503 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M,
MEDRONATE, UP TO 30 MCI
A9504 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC 99M
APCITIDE
A9505 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, THALLOUS CHLORIDE TL
201, PER MCI
A9507 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, INDIUM IN 111 CAPROMAB
PENDETIDE, PER DOSE
A9508 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, IOBENGUANE SULFATE
I-131, PER 0.5 MCI
A9510 SUPPLY OF RADIOPHARMACEUTICAL DIAGNOSTIC IMAGING AGENT, TECHNETIUM TC99M
DISOFENIN, PER VIAL
A9600 SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, STRONTIUM-89 CHLORIDE, PER MCI
A9605 SUPPLY OF THERAPEUTIC RADIOPHARMACEUTICAL, SAMARIUM SM 153 LEXIDRONAMM, 50 MCI
A9700 SUPPLY OF INJECTABLE CONTRAST MATERIAL FOR USE IN ECHOCARDIOGRAPHY, PER STUDY
A9900 MISCELLANEOUS DME SUPPLY, ACCESSORY, AND/OR SERVICE COMPONENT OF ANOTHER HCPCS
CODE
A9901 DME DELIVERY, SET UP, AND/OR DISPENSING SERVICE COMPONENT OF ANOTHER HCPCS CODE
B4034 ENTERAL FEEDING SUPPLY KIT; SYRINGE, PER DAY
B4035 ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY
B4036 ENTERAL FEEDING SUPPLY KIT; GRAVITY FED, PER DAY
B4081 NASOGASTRIC TUBING WITH STYLET
B4082 NASOGASTRIC TUBING WITHOUT STYLET
B4083 STOMACH TUBE - LEVINE TYPE
B4084 GASTROSTOMY/JEJUNOSTOMY TUBING
B4085 GASTROSTOMY TUBE, SILICONE WITH SLIDING RING, EACH
B4150 ENTERAL FORMULAE; CATEGORY I; SEMI-SYNTHETIC INTACT PROTEIN/PROTEIN ISOLATES,
ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4151 ENTERAL FORMULAE; CATEGORY I; NATURAL INTACT PROTEIN/PROTEIN ISOLATES,
ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4152 ENTERAL FORMULAE; CATEGORY II; INTACT PROTEIN/PROTEIN ISOLATES (CALORICALLY
DENSE), ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4153 ENTERAL FORMULAE; CATEGORY III; HYDROLIZED PROTEIN/AMINO ACIDS, ADMINISTERED
THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4154 ENTERAL FORMULAE; CATEGORY IV; DEFINED FORMULA FOR SPECIAL METABOLIC NEED,
ADMINISTERED THROUGH AN ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4155 ENTERAL FORMULAE; CATEGORY V; MODULAR COMPONENTS, ADMINISTERED THROUGH AN
ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4156 ENTERAL FORMULAE; CATEGORY VI; STANDARDIZED NUTRIENTS, ADMINISTERED THROUGH AN
ENTERAL FEEDING TUBE, 100 CALORIES = 1 UNIT
B4164 PARENTERAL NUTRITION SOLUTION: CARBOHYDRATES (DEXTROSE), 50% OR LESS (500 ML =
1 UNIT) - HOMEMIX
B4168 PARENTERAL NUTRITION SOLUTION; AMINO ACID, 3.5%, (500 ML = 1 UNIT) - HOMEMIX
B4172 PARENTERAL NUTRITION SOLUTION; AMINO ACID, 5.5% THROUGH 7%, (500 ML = 1 UNIT) -
HOMEMIX
B4176 PARENTERAL NUTRITION SOLUTION; AMINO ACID, 7% THROUGH 8.5%, (500 ML = 1 UNIT) -