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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
- Page 17 and 18: 46XB = (C) MULTIPLE COIN VALU CODES
- Page 19 and 20: 5500 = (U) FULL DAYS/SNF-HOSP FULL
- Page 21 and 22: 6911 = (C) REV CODE 274 ON OUTPAT A
- Page 23 and 24: 94X5 = (C) BLOOD/MSP CODE/COMPUTED
- Page 25 and 26: Appendix L State Table The followin
- Page 27 and 28: Appendix M Identification of variab
- Page 29 and 30: 48 Thyroid disorders 49 Diabetes me
- Page 31 and 32: 159 Urinary tract infections 160 Ca
- Page 33 and 34: Appendix O Agency for Healthcare Re
- Page 35 and 36: 102 Ureteral catheterization 103 Ne
- Page 37 and 38: 216 Respiratory intubation and mech
- Page 39 and 40: 0064 AMEBIC LUNG ABSCESS 0065 AMEBI
- Page 41 and 42: 01136 TB OF BRONCHUS-OTH TEST 0114
- Page 43 and 44: 01326 TUBRCLOMA BRAIN-OTH TEST 0133
- Page 45 and 46: 01576 TB OF BONE NEC-OTH TEST 0158
- Page 47 and 48: 01726 TB PERIPH LYMPH-OTH TEST 0173
- Page 49 and 50: 026 RAT-BITE FEVER* 0260 SPIRILLARY
- Page 51 and 52: 04181 MYCOPLASMA 04182 BACILLUS FRA
- Page 53 and 54: 05579 MEASLES COMPLICATION NEC 0558
- Page 55 and 56: 0771 EPIDEM KERATOCONJUNCTIV 0772 P
- Page 57 and 58: 0907 LATE CONGEN SYPH NOS 0909 CONG
- Page 59 and 60: 09889 GONOCOCCAL INF SITE NEC 099 O
- Page 61 and 62: 1160 BLASTOMYCOSIS 1161 PARACOCCIDI
- Page 63 and 64: 1330 SCABIES 1338 ACARIASIS NEC 133
- Page 65 and 66: 151 MALIGNANT NEO STOMACH* 1510 MAL
- Page 67: 1712 MAL NEO SOFT TISSUE ARM 1713 M
- Page 71 and 72: 20083 MIXED LYMPHOSARC ABDOM 20084
- Page 73 and 74: 20225 SEZARY'S DISEASE INGUIN 20226
- Page 75 and 76: 20610 CHR MONO LEUK W/O RMSION 2061
- Page 77 and 78: 218 UTERINE LEIOMYOMA* 2180 SUBMUCO
- Page 79 and 80: 234 CA IN SITU NEC/NOS* 2340 CA IN
- Page 81 and 82: 2469 DISORDER OF THYROID NOS 250 DI
- Page 83 and 84: 2592 CARCINOID SYNDROME 2593 ECTOPI
- Page 85 and 86: 2766 FLUID OVERLOAD 2767 HYPERPOTAS
- Page 87 and 88: 2882 GENETIC ANOMALY LEUKOCYT 2883
- Page 89 and 90: 29552 LATENT SCHIZOPHREN-CHR 29553
- Page 91 and 92: 2990 INFANTILE AUTISM* 29900 INFANT
- Page 93 and 94: 30403 OPIOID DEPENDENCE-REMISS 3041
- Page 95 and 96: 30721 TRANSIENT TIC, CHILDHOOD 3072
- Page 97 and 98: 3150 SPECIFIC READING DIS* 31500 RE
- Page 99 and 100: 33510 SPINAL MUSCL ATROPHY NOS 3351
- Page 101 and 102: 34600 CLSC MIGRNE WO NTRC MGRN 3460
- Page 103 and 104: 3594 TOXIC MYOPATHY 3595 MYOPATHY I
- Page 105 and 106: 3625 DEGENERATION OF MACULA* 36250
- Page 107 and 108: 36459 IRIS ATROPHY NEC 3646 ANTERIO
- Page 109 and 110: 36731 ANISOMETROPIA 36732 ANISEIKON
- Page 111 and 112: 37005 MYCOTIC CORNEAL ULCER 37006 P
- Page 113 and 114: 37230 CONJUNCTIVITIS NOS 37231 ROSA
- Page 115 and 116: 3752 EPIPHORA* 37520 EPIPHORA NOS 3
- Page 117 and 118: 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
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63622 ILLEG AB W PEL DAMG-COMP 6363
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64120 PREM SEPAR PLACEN-UNSPEC 6412
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64613 EDEMA IN PREG-ANTEPARTUM 6461
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64821 ANEMIA-DELIVERED 64822 ANEMIA
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65270 PROLAPSED ARM-UNSPEC 65271 PR
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65501 FETAL CNS MALFORM-DELIV 65503
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65901 FAIL MECH INDUCT-DELIVER 6590
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66221 PROLONG 2ND STAGE-DELIV 66223
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66584 OB TRAUMA NEC-POSTPARTUM 6659
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670 MAJOR PUERPERAL INFECT* 67000 M
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67494 PUERP COMPL NOS-POSTPART 675
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6825 CELLULITIS OF BUTTOCK 6826 CEL
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7038 DISEASES OF NAIL NEC 7039 DISE
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71145 BACT ARTHRITIS-PELVIS 71146 B
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71298 CRY ARTHROP NOS-OTH SITE 7129
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71635 CLIMACT ARTHRITIS-PELVIS 7163
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71830 RECUR DISLOCAT-UNSPEC 71831 R
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71951 JT STIFFNESS NEC-SHLDER 71952
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724 BACK DISORDER NEC & NOS* 7240 S
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72886 NECROTIZING FASCIITIS 72889 M
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7330 OSTEOPOROSIS* 73300 OSTEOPOROS
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7379 CURVATURE OF SPINE NOS 738 OTH
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74405 ANOMALIES OF INNER EAR 74409
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74904 BILAT CLEFT PALATE-INC 7491 C
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75433 CONG HIP SUBLUX, BILAT 75435
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75681 ABSENCE OF MUSCLE/TENDON 7568
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7641 LT-FOR-DATES W FETAL MAL* 7641
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7732 NB HEMOLYT DIS-ISOIM NEC 7733
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7826 PALLOR & FLUSHING* 78261 PALLO
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78900 ABDMNAL PAIN UNSPCF SITE 7890
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7951 ABN PAP SMEAR-OTH SITE 7952 AB
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80090 OP SKL VLT FX/BR INJ NEC 8009
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80230 MANDIBLE FX NOS-OPEN 80231 FX
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80405 CL SKUL/OTH FX-DEEP COMA 8040
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8060 CLOS CERV FX W CORD INJ* 80600
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81011 FX CLAVIC, STERN END-OPN 8101
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8141 FRACTURE CARPAL BONE-OPN* 8141
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82391 FX FIBULA NOS-OPEN 82392 FX T
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836 DISLOCATION OF KNEE* 8360 TEAR
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84213 SPRAIN INTERPHALANGEAL 84219
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85155 OPN CEREBE CONT-DEEP COM 8515
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8540 BRAIN INJURY NEC* 85400 BRAIN
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86412 LIVER LACERAT, MINOR-OPN 8641
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87333 OPEN WND NAS SINUS-COMPL 8733
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8821 OPN WOUND HAND-COMPLICAT 8822
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90242 INJURY RENAL VEIN 90249 INJUR
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9117 FOREIGN BODY TRUNK-INFEC 9118
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92320 CONTUSION OF HAND(S) 92321 CO
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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
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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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