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["OUTPATIENT RATE TABLE DRIVER LIST   "]
["LOW RANGE","HIGH RANGE","SERVICE","RATE TABLE","  GOVERNMENT RATE MULTIPLIER","  USE MODIFIER"]
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["10021","69990","OPE","CMAC RATE",1,1]
[70010,"79999","RAD","CMAC RATE",1,1]
[80047,89398,"LAB","CMAC RATE",1,1]
["90281","90399","IMM","IMMUNIZATION RATE TABLE"]
[90460,90461,"IMM","CMAC RATE",1]
["90471","90474","OPE","CMAC RATE",1,1]
[90476,90756,"IMM","IMMUNIZATION RATE TABLE"]
[90785,99195,"OPE","CMAC RATE",1,1]
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["99201",99607,"OPE","CMAC RATE",1,1]
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["0001M","0009M","OPE","CMAC RATE",1]
["0042T","0504T","OPE","CMAC RATE",1,1]
["0001U","0023U","LAB","CMAC RATE",1,1]
["A0021","A0999","AMB","AMBULANCE",1,1]
["A4206","A5513","DME","DME/DMS RATE"]
["A6000","A6550","DME","DME/DMS RATE"]
["A7000","A7527","DME","DME/DMS RATE"]
["A8000","A8004","DME","DME/DMS RATE"]
["A9150","A9572","DME","DME/DMS RATE"]
["A9575","A9598","IMM","IMMUNIZATION RATE TABLE"]
["A9600","A9999","DME","DME/DMS RATE"]
["B4034","B9999","OPE","CMAC RATE"]
["C1713","C8936","OPE","CMAC RATE",null,1]
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["D0120","D9999","DEN","DENTAL",1,1]
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["G9143","G9143","OPE","CMAC RATE",null,1]
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["J0120","J9999","IMM","IMMUNIZATION RATE TABLE",null,1]
["K0001","K0195","DME","DME/DMS RATE",null,1]
["K0455","K0900","DME","DME/DMS RATE",null,1]
["L0112","L9900","DME","DME/DMS RATE",null,1]
["M0075","M0301","OPE","CMAC RATE",1,1]
["P2028","P7001","OPE","CMAC RATE",1,1]
["P9010","P9604","IMM","IMMUNIZATION RATE TABLE"]
["P9612","P9615","OPE","CMAC RATE",null,1]
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["Q0138","Q0181","IMM","IMMUNIZATION RATE TABLE"]
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["Q4074","Q4182","IMM","IMMUNIZATION RATE TABLE"]
["Q5001","Q5010","OPE  ","CMAC RATE",1,1]
["Q5101","Q9983","IMM","IMMUNIZATION RATE TABLE"," "]
["R0070","R0076","RAD","CMAC RATE",null,1]
["S0012","S9999","OPE","CMAC RATE",1,1]
["T1000","T5999","OPE","CMAC RATE",null,1]
["V2020","V5364","DME/DMS","DME/DMS RATE",null,1]
["W0119","W9999","DEN","DENTAL",1,1]

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["CHCS  File #100512  KGADS MODIFIERS LIST                               "]
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[]
[null,"MODIFIER  DESCRIPTION","Values","Values"]
[22,"Increased Procedural Services"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
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[null,null,90460,90461]
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[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
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[null,null,"H0001","H2037"]
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[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
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[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
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[null,null,"Q0477","Q0514"]
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[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
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[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
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[null,null,"Q5001","Q5010"]
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[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
[23,"Unusual anesthesia"]
[null,null,100,1999]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
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[null,null,"W0119","W9999"]
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[null,null,99201,99607]
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[null,null,"G0008","G9140"]
[null,null,"M0075","M0301"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"W0119","W9999"]
[26,"Professional Component"]
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[null,null,"V2020","V5364"]
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[null,null,"G0008","G9140"]
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[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[50,"Bilateral procedure"]
[null,null,10021,69990]
[null,null,70010,79999]
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[null,null,"C1713","C8936"]
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[62,"Co-Surgeons"]
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[63,"Procedure performed on infants"]
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[66,"Team Surgeons"]
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[null,null,"0042T","0504T"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
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[73,"Discontinued OP procedure prior to anesthesia admin"]
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[null,null,"M0075","M0301"]
[null,null,"P9612","P9615"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[74,"Discontinued OP procedure after anesthesia admin"]
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[null,null,"0042T","0504T"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"M0075","M0301"]
[null,null,"P9612","P9615"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[76,"Repeat procedure by the same physician"]
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[null,null,70010,79999]
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[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
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[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
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[null,null,"M0075","M0301"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[77,"Repeat procedure by another physician"]
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[null,null,70010,79999]
[null,null,80047,89398]
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[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
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[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"M0075","M0301"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[78,"Rtn to the OR for related proc during post-op period"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
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[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"M0075","M0301"]
[null,null,"P9612","P9615"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[79,"Unrelated proc/serv by same phys during post-op period"]
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[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"W0119","W9999"]
[80,"Assistant surgeon"]
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[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[81,"Minimum assistant surgeon"]
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[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[82,"Assistant surg when qual resident surg not available"]
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[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
[]
[90,"Reference (outside) laboratory"]
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[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"P2028","P7001"]
[null,null,"Q0035","Q0115"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[91,"Repeat clinical diagnostic laboratory test"]
[null,null,80047,89398]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"P2028","P7001"]
[null,null,"Q0035","Q0115"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[92,"Alternative Laboratory Platform Testing"]
[null,null,80047,89398]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"P2028","P7001"]
[null,null,"Q0035","Q0115"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[95,"Synch Telemedicine Srvc Via Real-Time Audio and Video"]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q2052","Q3014"]
[96,"Habilitative Services"]
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[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
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[null,null,99199,99199]
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[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
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[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
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[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
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[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
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[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
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[null,null,"Q3031","Q3031"]
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[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
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[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
[97,"Rehabilitative Modifiers"]
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[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
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[null,null,"B4034","B9999"]
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[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
[99,"Multiple modifiers"]
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[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
[0,"No Modifier - DO NOT DISPLAY \"00\""]
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[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
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[null,null,90471,90474]
[null,null,90476,90756]
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[null,null,"0001M","0009M"]
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[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
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[null,null,"Q0515","Q0515"]
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[null,null,"Q2052","Q3014"]
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[null,null,"Q3031","Q3031"]
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[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
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[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["1P","Performance Mesur Excl Mod due to Medical Reasons"]
[null,null,"0001F","9007F"]
[null,null,"G0008","G9140"]
[null,null,"Q4074","Q4182"]
["2P","Performance Mesur excl due to patient reasons"]
[null,null,"0001F","9007F"]
[null,null,"G0008","G9140"]
[null,null,"Q4074","Q4182"]
["3P","Performance Mesur excl due to system reasons"]
[null,null,"0001F","9007F"]
[null,null,"G0008","G9140"]
[null,null,"Q4074","Q4182"]
["8P","Performance Mesur rprtng, actn not perfrmd, NOS"]
[null,null,"0001F","9007F"]
[null,null,"G0008","G9140"]
[null,null,"Q4074","Q4182"]
["A1","Dressing for one wound"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A2","Dressing for two wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A3","Dressing for three wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A4","Dressing for four wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A5","Dressing for five wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A6","Dressing for six wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A7","Dressing for seven wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A8","Dressing for eight wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["A9","Dressing for nine or more wounds"]
[null,null,"A6000","A6550"]
[null,null,"Q4074","Q4182"]
["AA","Anesth service perform personally by anesthesiologist"]
[null,null,100,1999]
["AD","Med sup by a phys, >4 concurrent anesth procedures"]
[null,null,100,1999]
["AE","Registered Dietician"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
[null,null,"0001F","9007F"]
["AF","Specialty Physician (Critical Access not used in MHS)"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
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[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
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[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
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[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
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[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
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[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
[]
["AG","Primary Physician (Critical Access not used in MHS)"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
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[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
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[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
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["AK","Nonparticipating Physician"]
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["AO","Prov declined alt pmt method"]
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["AP","No refraction determination during ophthal exam"]
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["AQ","Physician service, Shortage area"]
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["AR","Physician services in a physician scarcity area"]
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["AS","PA/NP/clin nurse spec svs for assistant at surgery"]
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["AT","Acute treatment"]
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["AV","Item furnished with pros device, pros, or orthotic"]
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["AW","Item furnished in conjuction with a surgical dressing"]
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["AX","Item furnished in conjunction with a dialysis service"]
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["AZ","Physician serv in dent HPSA"]
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["BA","Furnished in conjunct w/parenternal enteral nutrition"]
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["BL","Special acquisition of blood and blood products"]
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["BO","Orally administered nutrition, not by feeding tube"]
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["BR","Patient informed, elect to rent"]
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["BU","Patient informed, decision unknown rent or purchase"]
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["CA","Emergency treatment on outpt who expires"]
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["CB ","Separately reimbursable service for ESRD patient"]
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["CC","Procedure code change"]
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[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["CD","AMCC test, not separately billable"]
[null,null,80047,89398]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
["CE","AMCC test, beyond normal frequency"]
[null,null,80047,89398]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
["CF","AMCC test, separately billable"]
[null,null,80047,89398]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
["CG","Policy criteria applied"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["CH","0 percent impaired, limited or restricted"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CI","At least 1% but < 20% impaired, limited or restricted"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CJ","At least 20% but < 40% impaired, lmtd or rstrctd"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CK","At least 40% but < 60% impaired, lmtd or rstrctd"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CL","At least 60% but < 80% impaired, lmtd or rstrctd"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CM","At least 80% but < 100% impaired, lmtd or rstrctd"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CN","100%, impaired, limited or restricted"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["CR","Catastrophe/disaster related"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["CS","Gulf oil spill related"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["CT","Computed tomography does not meet NEMA standard"]
[null,null,70010,79999]
["DA","Oral health assess by other than dentist"]
[null,null,"D0120","D9999"]
[null,null,"W0119","W9999"]
["DD  ","Ambulance:Dx/tx site(not P/H) to another dx/tx site"]
[null,null,"A0021","A0999"]
["DE","Ambulance:Dx/tx site(not P/H) to non-residenc lvng loc"]
[null,null,"A0021","A0999"]
["DG","Ambulance:Dx/tx site(not P/H) to hosp dialysis unit"]
[null,null,"A0021","A0999"]
["DH","Ambulance:Dx/tx site(not MD office/hospital) to hosp"]
[null,null,"A0021","A0999"]
["DI","Ambulance:Dx/tx site(not P/H) to transfer site"]
[null,null,"A0021","A0999"]
["DJ","Ambulance:Dx/tx site(not P/H) to non-hosp dialysis"]
[null,null,"A0021","A0999"]
["DN","Ambulance:Dx/tx site(not P/H) to skilled nursing fac"]
[null,null,"A0021","A0999"]
["DP","AmbulanceDx/tx site(not MD office/hosp) to MD office"]
[null,null,"A0021","A0999"]
["DR","Ambulance:Dx/tx site(not MD office/hosp) to residence"]
[null,null,"A0021","A0999"]
["DS","Ambulance:Dx/tx site(not P/H) to accident scene"]
[null,null,"A0021","A0999"]
["DX","Ambulance:Dx/tx site(not P/H),stop at MD ofc,then hosp"]
[null,null,"A0021","A0999"]
["E1","Upper left, eyelid"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["E2","Lower left, eyelid"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["E3","Upper right, eyelid"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["E4","Lower right, eyelid"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["EA","ESA, anemia, chemo-induced"]
[null,null,"J0120","J9999"]
["EB","ESA, anemia, radio-induced"]
[null,null,"J0120","J9999"]
["EC","ESA, anemia, non-chemo/radio"]
[null,null,"J0120","J9999"]
["ED","HCT>39% or Hgb>13g>=3 cycle/Ambul:Instl lvng-dx site\n"]
[null,null,"A0021","A0999"]
[null,null,"J0120","J9999"]
[null,null,"Q4074","Q4182"]
["EE","HCT>39% or Hgb>13g<3 cycle/Ambul:Instl lvng-instl lvng"]
[null,null,"A0021","A0999"]
[null,null,"J0120","J9999"]
[null,null,"Q4074","Q4182"]
["EG","Ambulance:Inst lvng fac to hosp dialysis unit"]
[null,null,"A0021","A0999"]
["EH","Ambulance:Institutional living fac to hosp"]
[null,null,"A0021","A0999"]
["EI","Ambulance:Institutional living fac to transfer site"]
[null,null,"A0021","A0999"]
["EJ","Add'l claim,defined tx course/Ambul:Inst lvng-ESRD fac"]
[null,null,90281,90399]
[null,null,90785,99195]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
["EM","Emergency reserve supply (ESRD benefit only)"]
[null,null,"A4206","A5513"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
["EN","Ambulance:Institution living fac to SNF"]
[null,null,"A0021","A0999"]
["EP","Medicaid EPSDT program/Ambul:Inst lvng to residence"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["ER","Ambulance:Institutional living fac to residence"]
[null,null,"A0021","A0999"]
["ES","Ambulance:Institution living fac to accident scene"]
[null,null,"A0021","A0999"]
["ET","Emergency Services"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["EX","Expatriate Bene/Ambl:Instl lvng,MD office,then hosp"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["EY","No provider order for this item or service"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["F1","Left hand, second digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F2","Left hand, third digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F3","Left hand, fourth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F4","Left hand, fifth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F5","Right hand, thumb"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F6","Right hand, second digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F7","Right hand, third digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["F8","Right hand, fourth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
["F9","Right hand, fifth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["FA","Left hand, thumb"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,99199,99199]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["FB","Item provided w/o cost to provider, supplier or pract"]
[null,null,10021,69990]
["FC","Partial credit received for replaced device"]
[null,null,10021,69990]
["FP","Provided as part of Medicaid Family Planning Program"]
[null,null,10021,69990]
[null,null,80047,89398]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"A4206","A5513"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"S0012","S9999"]
["FX","X-ray taken using film"]
[null,null,70010,79999]
[null,null,"R0070","R0076"]
["FY","X-rays taken using computed radiography"]
[null,null,70010,79999]
[null,null,"G0008","G9140"]
["G1","Most recent URR reading of less than 60"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
["G2","Most recent URR reading of 60 to 64.9"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
["G3","Most recent URR reading of 65 to 69.9"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
["G4","Most recent URR reading of 70 to 74.9"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
["G5","Most recent URR reading of 75 or greater"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
["G6","ESRD pt, <6 dialysis sessions provided this month"]
[null,null,90785,99195]
[null,null,"G0008","G9140"]
["G7","Preg by rape/incest/MD-certified as life threatening"]
[null,null,10021,69990]
[null,null,"S0012","S9999"]
["G8","MAC for deep complex/complicated/highly invasive surg"]
[null,null,100,1999]
["G9","MAC for pt w/hx of severe cardiopulmonary condition"]
[null,null,100,1999]
["GA","Waiver of liability statement on file"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GB","Claim re-submitted, not covered by global payment "]
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[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GC","Svs partly done by resident w direct of teach phys"]
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[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
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[null,null,"H0001","H2037"]
[null,null,"M0075","M0301"]
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[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
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[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
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[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GD","Ambl:Hosp-based dialysis fac, to Non-MD ofc/non-hosp"]
[null,null,"A0021","A0999"]
["GE","Resident w/o mentor,PC except/Amb:hosp dial-instl lvng"]
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[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GF","Non-physician service in critical access hospital"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"Q0035","Q0115"]
[null,null,"S0012","S9999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GG","Screen&dx mammo,same pt&day/Ambl:hsp dialys-hsp dialys"]
[null,null,"A0021","A0999"]
[null,null,70010,79999]
[null,null,"G0008","G9140"]
["GH","Screening convert to dx mammo/Ambl:hosp dialys to hosp"]
[null,null,"A0021","A0999"]
[null,null,70010,79999]
[null,null,"G0008","G9140"]
["GI","Ambulance:Hosp dialysis to site of transfer"]
[null,null,"A0021","A0999"]
["GJ","ER/Urgent care,Opt-out MD/Ambl:hosp dialy-freestanding"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
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[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
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[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
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[null,null,"Q5001","Q5010"]
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[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GK","Actual item/service ordered by physician"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
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[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
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[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
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[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
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[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
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[null,null,"Q5001","Q5010"]
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[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GL","Med unnecess upgrade, not stnd item, N/C, no ABN"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["GM","Multiple patients on one ambulance trip"]
[null,null,"A0021","A0999"]
["GN","SPP outpt plan of care/Ambul:hosp dialysis to SNF"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"V2020","V5364"]
["GO","OT outpatient plan of care"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
["GP","PT outpt plan of care/Ambul:hosp dialysis to MD office"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
["GQ","Via asynchronous telecommunications system"]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
["GR","Performed by VA resident/Ambl:hosp dialy to residence"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GS","EPO/darbepoietin reduced/Ambl:hosp dialy to accident"]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"J0120","J9999"]
[null,null,"Q4074","Q4182"]
["GT","Via interactive audio/video telecommunication service"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0042T","0504T"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"M0075","M0301"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GU","Liability waiver routine notice"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GV","Attending phys not empl/paid by the pt's hospice prov"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GW","Serv not related to hospice pt's terminal condition"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GX","Voluntary liability note/Ambl:hosp dialy-MD ofc-hosp\n"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GY","Item/Service not a Medicare benefit"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["GZ","Expect denial; not reasonable or necessary"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["H9","Court-ordered"]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HA","Child/adolescent program"]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HB","Adult program, non geriatric"]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HC","Adult program, geriatric"]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HD","Pregnant/parenting women's pgm/Ambl:hosp-dx/tx site"]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HE","Mental health program/Ambl:hosp-instl lvng"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HF","Substance abuse program"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HG","Opioid addiction txt program/Ambl:hosp to hosp dialys"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HH","Integrated mental hlth/SA pgm/Ambl:hosp to hosp"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HI","MH intel/dev disab pgm/Ambl:hosp to transfer site"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HJ","Employee assistance prgram/Ambl:hosp to non-hosp dialy"]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HK","Specialized mental health programs for high-risk pop"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HL","Intern"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HM","Less than bachelor degree level"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HN","Bachelors degree/Ambulance:hospital to a SNF"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HO","Masters degree"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HP","Doctoral level/Ambl:hosp to MD office"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HQ","Group Setting"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HR","Family/couple w client there/Ambulance:hosp to residnc"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HS","Family/couple wo client/Ambl:hosp to accident site"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HT","Mulit-disciplinary team"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HU","Funded by child welfare agency"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HV","Funded by state addictions agency"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HW","Funded by state mental health agency"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HX","Paid by court/local agency/Ambl:hosp to MD ofc to hosp"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HY","Funded by juvenile justice agency"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["HZ","Funded by criminal justice agency"]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["ID","Ambulance:transfer site to non-MD office/non-hosp"]
[null,null,"A0021","A0999"]
["IE","Ambulance:transfer site to non-residence living fac"]
[null,null,"A0021","A0999"]
["IG","Ambulance:transfer site to hosp dialysis unit"]
[null,null,"A0021","A0999"]
["IH","Ambulance:transfer site to hosp"]
[null,null,"A0021","A0999"]
["II  ","Ambulance:transfer site to another transfer site"]
[null,null,"A0021","A0999"]
["IJ","Ambulance:transfer site to non-hosp dialysis fac"]
[null,null,"A0021","A0999"]
["IN","Ambulance:transfer site to skilled nursing fac"]
[null,null,"A0021","A0999"]
["IP","Ambulance:transfer site to MD office"]
[null,null,"A0021","A0999"]
["IR","Ambulance:transfer site to residence"]
[null,null,"A0021","A0999"]
["IS","Ambulance:transfer site to scene of accident "]
[null,null,"A0021","A0999"]
["IX","Ambulance:transfer site stop at MD office,then hosp"]
[null,null,"A0021","A0999"]
["J1","CAP no-pay for prescript num"]
[null,null,"J0120","J9999"]
[null,null,"C8957","C9293"]
[null,null,"T1000","T5999"]
["J2","CAP Restocking of emer drugs after emer admin"]
[null,null,"J0120","J9999"]
[null,null,"C8957","C9293"]
[null,null,"T1000","T5999"]
["J3","CAP Drug reimbursed under avg sales price"]
[null,null,"J0120","J9999"]
[null,null,"C8957","C9293"]
[null,null,"T1000","T5999"]
["J4","DMEPOS comp bid furn by hosp"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["JA","Administered intravenously"]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"C8957","C9293"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["JB","Administered subcutaneously"]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"C8957","C9293"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["JC","Skin substitute used as a graft"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"Q4074","Q4182"]
["JD","Skin substitut not used as graft/Ambl:ESRD fac-dx site"]
[null,null,"A0021","A0999"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"Q4074","Q4182"]
["JE","Administered via dialysate/Ambl:ESRD fac-instl lvng"]
[null,null,"A0021","A0999"]
["JG","Payable 340B drug pricing/Ambl:ESRD fac-hosp dialy"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"C8957","C9293"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"S0012","S9999"]
["JH","Ambulance:Non-hosp dialysis fac to hosp"]
[null,null,"A0021","A0999"]
["JI","Ambulance:Non-hosp dialysis fac to transfer site"]
[null,null,"A0021","A0999"]
["JJ  ","Ambulance:Non-hosp dialysis to non-hosp dialysis"]
[null,null,"A0021","A0999"]
["JN","Ambulance:Non-hosp dialysis fac to skilled nursing fac"]
[null,null,"A0021","A0999"]
["JP","Ambulance:Non-hosp dialysis fac to MD office to hosp"]
[null,null,"A0021","A0999"]
["JR","Ambulance:Non-hosp dialysis fac to residence"]
[null,null,"A0021","A0999"]
["JS","Ambulance:Non-hosp dialysis fac to accident scene"]
[null,null,"A0021","A0999"]
["JW","Drug amount discarded/not administered to any patient"]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"C8957","C9293"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["JX  ","Ambulance:Non-hosp dialysis,MD office stop,then hosp"]
[null,null,"A0021","A0999"]
["K0","  K0 - LE prosthesis, level 0"]
[null,null,"L0112","L9900"]
["K1","  K1 - LE prosthesis, level 1"]
[null,null,"L0112","L9900"]
["K2","  K2 - LE prosthesis, level 2"]
[null,null,"L0112","L9900"]
["K3","  K3 - LE prosthesis, level 3"]
[null,null,"L0112","L9900"]
["K4","  K4 - LE prosthesis, level 4"]
[null,null,"L0112","L9900"]
["KA","Add-on option/accessory for wheelchair"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
["KB","Bene requested upgrade for ABN, >4 modifiers on claim"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KC","Replacement of special power wheelchair interface"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
["KD","Drug or biological infused through DME"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C8957","C9293"]
[null,null,"G0008","G9140"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q3027","Q3028"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["KE","Bid under round 1 DMEPOS CB"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KF","Item designed by FDA as class III device"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KG","DMEPOS comp bid prgm no 1"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KH","DMEPOS, initial claim, purchase, or 1st month rental"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KI","DMEPOS item, second or third month rental"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KJ","DMEPOS item, PEN pump or capped rental, months 4-15"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KK","DMEPOS comp bid prgm no 2"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KL","DMEPOS mailorder comp bid"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KM","Replacement of facial prosthesis (new)"]
[null,null,"L0112","L9900"]
["KN","Replacement of facial prosthesis (previous)"]
[null,null,"L0112","L9900"]
["KO","Single drug unit dose formulation"]
[null,null,"C8957","C9293"]
[null,null,"J0120","J9999"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["KP","First drug of a multiple drug unit dose formulation"]
[null,null,"C8957","C9293"]
[null,null,"J0120","J9999"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["KQ","2nd or subsqnt drug of a mult drug unit dose formultn"]
[null,null,"C8957","C9293"]
[null,null,"J0120","J9999"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
["KR","Rental item-billing for partial month"]
[null,null,"E0100","E8002"]
["KS","Glucose monitor supply for DM bene not tx w/insulin"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"E0100","E8002"]
["KT","Lives in travels out receives competitive bid item"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KU","DMEPOS comp bid prgm no 3"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KV","DMEPOS item, profession serv"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["KW","DMEPOS comp bid prgm no 4"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0477","Q0514"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KX","Documentation on file"]
[null,null,10021,69990]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"V2020","V5364"]
["KY","DMEPOS comp bid prgm no 5"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0477","Q0514"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
["KZ","New coverage not implemented by managed care"]
[null,null,90785,99195]
["LC","Left circumflex, coronary artery"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
["LD","Left anterior descending coronary artery"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
["LL","Lease/rental"]
[null,null,"E0100","E8002"]
["LM","Left main coronary artery"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
["LR","Laboratory round trip"]
[null,null,"P9612","P9615"]
["LS","FDA - monitored intraocular lens implant"]
[null,null,"Q1004","Q2004"]
["LT","Left side"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"L0112","L9900"]
[null,null,"Q1004","Q2004"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"V2020","V5364"]
["M2 ","Medicare secondary payer (MSP)"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["MS","Med/Surg Supplies - 6 month maintenance service"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
["NB","Drug specific nebulizer"]
[null,null,"A7000","A7527"]
[null,null,"E0100","E8002"]
["ND","Ambulance:SNF to Non-MD office/non-hosp"]
[null,null,"A0021","A0999"]
["NE","Ambulance:SNF to non-residence living facility"]
[null,null,"A0021","A0999"]
["NG","Ambulance:SNF to hosp-based dialysis fac"]
[null,null,"A0021","A0999"]
["NH","Ambulance:SNF to hosp"]
[null,null,"A0021","A0999"]
["NI","Ambulance:SNF to site of transfer"]
[null,null,"A0021","A0999"]
["NJ","Ambulance:SNF to non-hosp dialysis fac"]
[null,null,"A0021","A0999"]
["NN  ","Ambulance:SNF to another SNF"]
[null,null,"A0021","A0999"]
["NP","Ambulance:SNF to MD office"]
[null,null,"A0021","A0999"]
["NR","New when rented/Ambulance:SNF to residence"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"E0100","E8002"]
[null,null,"L0112","L9900"]
["NS","Ambulance:SNF to accident scene "]
[null,null,"A0021","A0999"]
["NU","New equipment"]
[null,null,"A0021","A0999"]
[null,null,"E0100","E8002"]
[]
["NX","Ambulance:SNF w/stop at MD office,then to hosp"]
[null,null,"A0021","A0999"]
["P1","Normal healthy patient"]
[null,null,100,1999]
["P2","Patient with mild systemic disease"]
[null,null,100,1999]
["P3","Patient with severe systemic disease"]
[null,null,100,1999]
["P4","Pt w/severe systemic disease constant threat to life"]
[null,null,100,1999]
["P5","Moribund pt not expected to survive w/o operation"]
[null,null,100,1999]
["P6","Brain-dead pt, organs removed for donor purposes"]
[null,null,100,1999]
["PA","Surgery, wrong body part"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
["PB","Surgical or other invasive procedure on wrong patient"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
["PC","Wrong surgery or other invasive procedure on patient"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"S0012","S9999"]
[null,null,"W0119","W9999"]
["PD","IP Admit w/in 3 Days/Ambl:MD ofc to Dx/Tx site not P/H"]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
["PE  ","Ambulance:MD office to institutional lvng fac "]
[null,null,"A0021","A0999"]
["PG  ","Ambulance:MD office to hospital dialysis unit"]
[null,null,"A0021","A0999"]
["PH  ","Ambulance:MD office to hospital"]
[null,null,"A0021","A0999"]
["PI","PET or PET/CT initial tx strategy/Ambl:MD ofc-trnsfr"]
[null,null,"A0021","A0999"]
[null,null,70010,79999]
[null,null,"G0008","G9140"]
["PJ","Ambulance:MD office, to non-hosp dialysis fac"]
[null,null,"A0021","A0999"]
["PL","Progressive addition lenses"]
[null,null,"V2020","V5364"]
["PM","Post mortem"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["PN","Non-excepted,off-campus,outpt,hosp dpt/Ambl:Md ofc-SNF"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["PO","Excepted off-campus srvc, provider-based"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["PP  ","Ambulance:MD office to another MD office"]
[null,null,"A0021","A0999"]
["PR","Ambulance:MD office to residence"]
[null,null,"A0021","A0999"]
["PS","PET or PET/CT,subsequent tx strategy/Ambl:Ofc-accidnt "]
[null,null,"A0021","A0999"]
[null,null,70010,79999]
[null,null,"G0008","G9140"]
["PT","Colorectal Screening to diagnostic"]
[null,null,10021,69990]
[null,null,"G0008","G9140"]
["PX","Ambulance:MD ofc then to other MD ofc then hosp"]
[null,null,"A0021","A0999"]
["Q0","Investigational clin svc provided in clin research"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,"0042T","0504T"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9612","P9615"]
["Q1","Routine clinical research"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["Q2","Demonstration procedure/service"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["Q3","Live kidney donor surgery and related services"]
[null,null,10021,69990]
[null,null,"S0012","S9999"]
["Q4","Order/refer phys service qualifies as a serv exempt"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["Q5","Outpt PT svs, substitute MD/PT, w/ reciprocal billing"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["Q6","Outpt physical thrpy svs,substitute MD/PT,fee-for-time"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["Q7","One class A finding"]
[null,null,10021,69990]
[null,null,"G0008","G9140"]
["Q8","Two class B findings"]
[null,null,10021,69990]
[null,null,"G0008","G9140"]
["Q9","One class B and two class C findings"]
[null,null,10021,69990]
[null,null,"G0008","G9140"]
["QC","Single channel monitoring"]
[null,null,90785,99195]
["QD","Record/storage, solid state memory by digital record"]
[null,null,90785,99195]
["QE","Prescribed amount of oxygen is < 1 liter per minute"]
[null,null,"E0100","E8002"]
["QF","O2 > 4 liters/min (LPM),portable O2 prescribed"]
[null,null,"E0100","E8002"]
["QG","Prescribed amount of oxygen is > 4 liters per minute"]
[null,null,"E0100","E8002"]
["QH","O2 conserv device being used with O2 delivery system"]
[null,null,"E0100","E8002"]
["QJ","Prisioner/pt in custody, meets 42 CFR 411.4(b)"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["QK","Med direction of 2,3,4 concurrent anes procedures"]
[null,null,100,1999]
["QL","Patient pronounced dead after ambulance called"]
[null,null,"A0021","A0999"]
["QM","Ambulance svc provided, by provider of svcs"]
[null,null,"A0021","A0999"]
["QN","Ambulance svc furnished directly, provider of svcs"]
[null,null,"A0021","A0999"]
["QP","Lab test(s) ordered indiv or CPT panel ..."]
[null,null,80047,89398]
[null,null,"0001U","0023U"]
[null,null,"P9612","P9615"]
["QS","Monitored anesthesia care"]
[null,null,100,1999]
["QT","Record/storage on tape by an analog tape recorder"]
[null,null,90785,99195]
["QW","CLIA waived test"]
[null,null,80047,89398]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
["QX","CRNA service with medical direction by a physician"]
[null,null,100,1999]
["QY","Med direction of 1 CRNA by anesthesiologist"]
[null,null,100,1999]
["QZ","CRNA service without medical direction by a physician"]
[null,null,100,1999]
["RA","Replacement of a DME item"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0477","Q0514"]
[null,null,"V2020","V5364"]
["RB","Replacement of part of DME furnished as part of repair"]
[null,null,"E0100","E8002"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"Q0477","Q0514"]
[null,null,"V2020","V5364"]
["RC","Right coronary artery"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
["RD","Drug admin not incident-to/Ambl:residenc to dx/tx site"]
[null,null,"A0021","A0999"]
[null,null,"C8957","C9293"]
[null,null,"J0120","J9999"]
[null,null,"Q0138","Q0181"]
[null,null,"S0012","S9999"]
["RE","Ambulance:Residence to non-residence living fac"]
[null,null,"A0021","A0999"]
["RG","Ambulance:Residence to hosp dialysis unit"]
[null,null,"A0021","A0999"]
["RH","Ambulance:Residence to hosp"]
[null,null,"A0021","A0999"]
["RI","Ramus intermedius cornary a/Ambl:residenc-transfr site"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"G0008","G9140"]
["RJ","Ambulance:Residence to non-hosp dialysis fac"]
[null,null,"A0021","A0999"]
["RN","Ambulance:Residence to skilled nursing fac"]
[null,null,"A0021","A0999"]
["RP  ","Ambulance:Residence to Physician's office"]
[null,null,"A0021","A0999"]
["RR","DME Rental/Ambulance:Residence to another Residence"]
[null,null,"A0021","A0999"]
[null,null,"E0100","E8002"]
["RS","Ambulance:Residence to scene of accident "]
[null,null,"A0021","A0999"]
["RT","Right side"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,90785,99195]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"L0112","L9900"]
[null,null,"Q1004","Q2004"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"V2020","V5364"]
["RX","Ambl:Residence to stop at MD's office enroute to hosp"]
[null,null,"A0021","A0999"]
["SA","Nurse practitioner in collaboration with physician"]
[null,null,10021,69990]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["SB","Nurse midwife"]
[null,null,10021,69990]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001M","0009M"]
[null,null,"0001U","0023U"]
[null,null,"G0008","G9140"]
["SC","Medically necessary service or supply"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["SD","Hitek hm infusion trng(xtr trnd RN)/Ambl:acdnt-dx site"]
[null,null,"A0021","A0999"]
[null,null,99201,99607]
[null,null,"S0012","S9999"]
["SE","State &/or fed-funded/Ambulance:accident to res fac"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["SF","2nd opinion ordered by PRO per sec 9401 pl 99-272"]
[null,null,99201,99607]
[null,null,90785,99195]
["SG","ASC facility service/Ambulance:accident to hosp dialys"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["SH","2nd concurrent infusion/Ambulance:accident to hosp"]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"Q0138","Q0181"]
[null,null,"S0012","S9999"]
["SI","Ambulance:accident scene to site of transfer"]
[null,null,"A0021","A0999"]
["SJ","3+/> concurrent infusions/Ambulance:accident to ESRD"]
[null,null,99201,99607]
[null,null,90785,99195]
[null,null,"A0021","A0999"]
[null,null,"G0008","G9140"]
[null,null,"Q0138","Q0181"]
[null,null,"S0012","S9999"]
["SK","Member of high risk population"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["SL","State supplied vaccine"]
[null,null,90476,90756]
[null,null,"G0008","G9140"]
["SM","Second surgical opinion"]
[null,null,99201,99607]
[null,null,90785,99195]
["SN","Third surgical opinion/Ambulance:accident to SNF"]
[null,null,"A0021","A0999"]
[null,null,99201,99607]
[null,null,90785,99195]
["SP","Ambulance:Accident scene to Phys office"]
[null,null,"A0021","A0999"]
["SQ","Item ordered by home health"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"E0100","E8002"]
[null,null,"T1000","T5999"]
["SR","Ambulance:Accident scene to residence"]
[null,null,"A0021","A0999"]
["SS","HIT in infusion suite/Ambulance:accident to accident"]
[null,null,"A0021","A0999"]
[null,null,99500,99607]
[null,null,"S0012","S9999"]
["ST","Related to trauma or injury"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["SU","Procedure in provider's office"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99201,99607]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["SV","Pharms delivered to patient's home but not utilized"]
[null,null,"J0120","J9999"]
[null,null,"S0012","S9999"]
["SW","Services provided by a certified diabetic educator"]
[null,null,90785,99195]
["SX","Ambulance:Accident scene to MD office then to hosp"]
[null,null,"A0021","A0999"]
["SY","Contact w/high-risk population"]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
["T1","Left foot, second digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T2","Left foot, third digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T3","Left foot, fourth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T4","Left foot, fifth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T5","Right foot, great toe"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T6","Right foot, second digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T7","Right foot, third digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T8","Right foot, fourth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["T9","Right foot, fifth digit"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["TA","Left foot, great toe"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,"0001F","9007F"]
[null,null,"0042T","0504T"]
[null,null,"G0008","G9140"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["TB","Separately payable drugs - 340B prgm, info only"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"C8957","C9293"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"S0012","S9999"]
["TC","Technical component"]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"H0001","H2037"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0515","Q0515"]
[null,null,"Q2009","Q2050"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"W0119","W9999"]
["TD","Registered Nurse"]
[null,null,"T1000","T5999"]
["TE","LPN/LVN"]
[null,null,"T1000","T5999"]
["TF","Intermediate level of care"]
[null,null,"T1000","T5999"]
["TG","Complex/ high tech level of care"]
[null,null,"T1000","T5999"]
["TH","OB treatment/ services, prenatal or postpartem"]
[null,null,"T1000","T5999"]
["TJ","Program group, child and/ or adolescent"]
[null,null,"T1000","T5999"]
["TK","Extra patient or passenger, non-ambulence"]
[null,null,"A0021","A0999"]
[null,null,"T1000","T5999"]
["TL","Early intervention/ individualized fam service plan"]
[null,null,90785,99195]
[null,null,"T1000","T5999"]
["TM","Individualized education program (IEP)"]
[null,null,"T1000","T5999"]
["TN","Rural/ outside providers' customary service area"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["TP","Medical transport, unloaded vehicle"]
[null,null,"A0021","A0999"]
[null,null,"T1000","T5999"]
["TQ","Basic life support transport, volunteer amb provider"]
[null,null,"A0021","A0999"]
[null,null,"T1000","T5999"]
["TR","School based IEP for student outside district "]
[null,null,"T1000","T5999"]
["TS","Follow-up service"]
[null,null,90785,99195]
[null,null,"T1000","T5999"]
["TT","Indiv service provided to >1 patient in same setting"]
[null,null,92002,92004]
[null,null,92012,92014]
[null,null,99201,99217]
[null,null,99218,99220]
[null,null,99221,99255]
[null,null,99281,99285]
[null,null,99288,99499]
[null,null,"T1000","T5999"]
["TU","Special payment rate, overtime"]
[null,null,"T1000","T5999"]
["TV","Special payment rates, holidays/ weekends"]
[null,null,"T1000","T5999"]
["TW","Back-up equipment"]
[null,null,"T1000","T5999"]
["U1","Medicaid level of care 1, as defined by each state"]
[null,null,"T1000","T5999"]
["U2","Medicaid level of care 2, as defined by each state"]
[null,null,"V2020","V5364"]
[null,null,"T1000","T5999"]
["U3","Medicaid level of care 3, as defined by each state"]
[null,null,"T1000","T5999"]
["U4","Medicaid level of care 4, as defined by each state"]
[null,null,"T1000","T5999"]
["U5","Medicaid level of care 5, as defined by each state"]
[null,null,"T1000","T5999"]
["U6","Medicaid level of care 6, as defined by each state"]
[null,null,"T1000","T5999"]
["U7","Medicaid level of care 7, as defined by each state"]
[null,null,"T1000","T5999"]
["U8","Medicaid level of care 8, as defined by each state"]
[null,null,"T1000","T5999"]
["U9","Medicaid level of care 9, as defined by each state"]
[null,null,"T1000","T5999"]
["UA","Medicaid level of care 10, as defined by each state"]
[null,null,"T1000","T5999"]
["UB","Medicaid level of care 11, as defined by each state"]
[null,null,"T1000","T5999"]
["UC","Medicaid level of care 12, as defined by each state"]
[null,null,"T1000","T5999"]
["UD","Medicaid level of care 13, as defined by each state"]
[null,null,"T1000","T5999"]
["UE","Used Durable Medical Equipment"]
[null,null,"E0100","E8002"]
["UF","Services provided in the morning"]
[null,null,"T1000","T5999"]
["UG","Services provided in the afternoon"]
[null,null,"T1000","T5999"]
["UH","Services provided in the evening"]
[null,null,"T1000","T5999"]
["UJ","Services provided at night"]
[null,null,"T1000","T5999"]
["UK","Svcs provided to someone other than the client"]
[null,null,"T1000","T5999"]
["UN","Two patients served"]
[null,null,"A0021","A0999"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["UP","Three patients served"]
[null,null,"A0021","A0999"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["UQ","Four patients served"]
[null,null,"A0021","A0999"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["UR","Five patients served"]
[null,null,"A0021","A0999"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["US","Six or more patients served"]
[null,null,"A0021","A0999"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
["V1","Demonstration modifier 1"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["V2","Demonstration modifier 2"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["V3","Demonstration modifier 3"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["V5","Vascular catheter"]
[null,null,90785,99195]
[null,null,"Q4074","Q4182"]
["V6","Arteriovenus graft"]
[null,null,90785,99195]
[null,null,"Q4074","Q4182"]
["V7","Arteriovenous fistula"]
[null,null,90785,99195]
[null,null,"Q4074","Q4182"]
["VM","Medicare Diabetes Prevention Program"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
["VP","Aphakic patient"]
[null,null,"V2020","V5364"]
["X1","Pt Relationship Codes (PRC) -  Continuous/broad srvcs"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["X2","Pt Relationship Codes (PRC) - Continuous/focused srvcs"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["X3","Pt Relationship Codes (PRC) - Episodic/broad services"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["X4","Pt Relationship Codes (PRC) - Episodic/focused srvcs"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
[null,null,"C8957","C9293"]
[null,null,"C9352","C9399"]
[null,null,"C9447","C9497"]
[null,null,"C9600","C9899"]
[null,null,"D0120","D9999"]
[null,null,"E0100","E8002"]
[null,null,"G0008","G9140"]
[null,null,"G9143","G9143"]
[null,null,"G9147","G9977"]
[null,null,"H0001","H2037"]
[null,null,"J0120","J9999"]
[null,null,"K0001","K0195"]
[null,null,"K0455","K0900"]
[null,null,"L0112","L9900"]
[null,null,"M0075","M0301"]
[null,null,"P2028","P7001"]
[null,null,"P9010","P9604"]
[null,null,"P9612","P9615"]
[null,null,"Q0035","Q0115"]
[null,null,"Q0138","Q0181"]
[null,null,"Q0477","Q0514"]
[null,null,"Q0515","Q0515"]
[null,null,"Q1004","Q2004"]
[null,null,"Q2009","Q2050"]
[null,null,"Q2052","Q3014"]
[null,null,"Q3027","Q3028"]
[null,null,"Q3031","Q3031"]
[null,null,"Q4001","Q4051"]
[null,null,"Q4074","Q4182"]
[null,null,"Q5001","Q5010"]
[null,null,"Q5101","Q9983"]
[null,null,"R0070","R0076"]
[null,null,"S0012","S9999"]
[null,null,"T1000","T5999"]
[null,null,"V2020","V5364"]
[null,null,"W0119","W9999"]
["X5","PRC - Only as ordered by another clinician"]
[null,null,100,1999]
[null,null,10021,69990]
[null,null,70010,79999]
[null,null,80047,89398]
[null,null,90281,90399]
[null,null,90460,90461]
[null,null,90471,90474]
[null,null,90476,90756]
[null,null,90785,99195]
[null,null,99199,99199]
[null,null,99201,99607]
[null,null,"0001F","9007F"]
[null,null,"0001M","0009M"]
[null,null,"0042T","0504T"]
[null,null,"0001U","0023U"]
[null,null,"A0021","A0999"]
[null,null,"A4206","A5513"]
[null,null,"A6000","A6550"]
[null,null,"A7000","A7527"]
[null,null,"A8000","A8004"]
[null,null,"A9150","A9572"]
[null,null,"A9575","A9598"]
[null,null,"A9600","A9999"]
[null,null,"B4034","B9999"]
[null,null,"C1713","C8936"]
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["PL",1,1,"PL",0,null,null,0]
["PM",1,1,"PM",0,null,null,0]
["PN",1,1,"PN",0,null,null,0]
["PO",1,1,"PO",0,null,null,0]
["PP",1,1,"PP",0,null,null,0]
["PR",1,1,"PR",0,null,null,0]
["PS",1,1,"PS",0,null,null,0]
["PT",1,1,"PT",0,null,null,0]
["PX",1,1,"PX",0,null,null,0]
["Q0",1,1,"Q0",0,null,null,0]
["Q1",1,1,"Q1",0,null,null,0]
["Q2",1,1,"Q2",0,null,null,0]
["Q3",1,1,"Q3",0,null,null,0]
["Q4",1,1,"Q4",0,null,null,0]
["Q5",1,1,"Q5",0,null,null,0]
["Q6",1,1,"Q6",0,null,null,0]
["Q7",1,1,"Q7",0,null,null,0]
["Q8",1,1,"Q8",0,null,null,0]
["Q9",1,1,"Q9",0,null,null,0]
["QC",1,1,"QC",0,null,null,0]
["QD",1,1,"QD",0,null,null,0]
["QE",1,1,"QE",0,null,null,0]
["QF",1,1,"QF",0,null,null,0]
["QG",1,1,"QG",0,null,null,0]
["QH",1,1,"QH",0,null,null,0]
["QJ",1,1,"QJ",0,null,null,0]
["QK",1,1,"QK",0,null,null,0]
["QL",1,1,"QL",0,null,null,0]
["QM",1,1,"QM",0,null,null,0]
["QN",1,1,"QN",0,null,null,0]
["QP",1,1,"QP",0,null,null,0]
["QS",1,1,"QS",0,null,null,0]
["QT",1,1,"QT",0,null,null,0]
["QW",1,1,"QW",0,null,null,0]
["QX",1,0,"QX",1,"BILL 2ND PROVIDER",1,0]
["QY",1,0,"QY",1,"BILL 2ND PROVIDER",1,0]
["QZ",1,0,"QZ",1,"BILL 2ND PROVIDER",1,0]
["RA",1,1,"RA",0,null,null,0]
["RB",1,1,"RB",0,null,null,0]
["RC",1,1,"RC",0,null,null,0]
["RD",1,1,"RD",0,null,null,0]
["RE",1,1,"RE",0,null,null,0]
["RG",1,1,"RG",0,null,null,0]
["RH",1,1,"RH",0,null,null,0]
["RI",1,1,"RI",0,null,null,0]
["RJ",1,1,"RJ",0,null,null,0]
["RN",1,1,"RN",0,null,null,0]
["RP",1,1,"RP",0,null,null,0]
["RR",1,1,"RR",0,null,0,0]
["RS",1,1,"RS",0,null,null,0]
["RT",1,1,"RT",0,null,null,0]
["RX",1,1,"RX",0,null,null,0]
["SA",1,1,"SA",0,null,null,0]
["SB",1,1,"SB",0,null,null,0]
["SC",1,1,"SC",0,null,null,0]
["SD",1,1,"SD",0,null,null,0]
["SE",1,1,"SE",0,null,null,0]
["SF",1,1,"SF",0,null,null,0]
["SG",1,1,"SG",0,null,null,0]
["SH",1,1,"SH",0,null,null,0]
["SI",1,1,"SI",0,null,null,0]
["SJ",1,1,"SJ",0,null,null,0]
["SK",1,1,"SK",0,null,null,0]
["SL",1,1,"SL",0,null,null,0]
["SM",1,1,"SM",0,null,null,0]
["SN",1,1,"SN",0,null,null,0]
["SP",1,1,"SP",0,null,null,0]
["SQ",1,1,"SQ",0,null,null,0]
["SR",1,1,"SR",0,null,null,0]
["SS",1,1,"SS",0,null,null,0]
["ST",1,1,"ST",0,null,null,0]
["SU",1,1,"SU",0,null,null,0]
["SV",1,1,"SV",0,null,null,0]
["SW",1,1,"SW",0,null,null,0]
["SX",1,1,"SX",0,null,null,0]
["SY",1,1,"SY",0,null,null,0]
["T1",1,1,"T1",0,null,null,1]
["T2",1,1,"T2",0,null,null,1]
["T3",1,1,"T3",0,null,null,1]
["T4",1,1,"T4",0,null,null,1]
["T5",1,1,"T5",0,null,null,1]
["T6",1,1,"T6",0,null,null,1]
["T7",1,1,"T7",0,null,null,1]
["T8",1,1,"T8",0,null,null,1]
["T9",1,1,"T9",0,null,null,1]
["TA",1,1,"TA",0,null,null,1]
["TB",1,1,"TB",0,null,null,1]
["TC",1,1,"TC",0,null,0,0]
["TD",1,1,"TD",0,null,null,0]
["TE",1,1,"TE",0,null,null,0]
["TF",1,1,"TF",0,null,null,0]
["TG",1,1,"TG",0,null,null,0]
["TH",1,1,"TH",0,null,null,0]
["TJ",1,1,"TJ",0,null,null,0]
["TK",1,1,"TK",0,null,null,0]
["TL",1,1,"TL",0,null,null,0]
["TM",1,1,"TM",0,null,null,0]
["TN",1,1,"TN",0,null,null,0]
["TP",1,1,"TP",0,null,null,0]
["TQ",1,1,"TQ",0,null,null,0]
["TR",1,1,"TR",0,null,null,0]
["TS",1,1,"TS",0,null,null,0]
["TT",1,1,"TT",0,null,null,0]
["TU",1,1,"TU",0,null,null,0]
["TV",1,1,"TV",0,null,null,0]
["TW",1,1,"TW",0,null,null,0]
["U1",1,1,"U1",0,null,null,0]
["U2",1,1,"U2",0,null,null,0]
["U3",1,1,"U3",0,null,null,0]
["U4",1,1,"U4",0,null,null,0]
["U5",1,1,"U5",0,null,null,0]
["U6",1,1,"U6",0,null,null,0]
["U7",1,1,"U7",0,null,null,0]
["U8",1,1,"U8",0,null,null,0]
["U9",1,1,"U9",0,null,null,0]
["UA",1,1,"UA",0,null,null,0]
["UB",1,1,"UB",0,null,null,0]
["UC",1,1,"UC",0,null,null,0]
["UD",1,1,"UD",0,null,null,0]
["UE",1,1,"UE",0,null,null,0]
["UF",1,1,"UF",0,null,null,0]
["UG",1,1,"UG",0,null,null,0]
["UH",1,1,"UH",0,null,null,0]
["UJ",1,1,"UJ",0,null,null,0]
["UK",1,1,"UK",0,null,null,0]
["UN",1,1,"UN",0,null,null,0]
["UP",1,1,"UP",0,null,null,0]
["UQ",1,1,"UQ",0,null,null,0]
["UR",1,1,"UR",0,null,null,0]
["US",1,1,"US",0,null,null,0]
["V1",1,1,"V1",0,null,null,0]
["V2",1,1,"V2",0,null,null,0]
["V3",1,1,"V3",0,null,null,0]
["V5",1,1,"V5",0,null,null,0]
["V6",1,1,"V6",0,null,null,0]
["V7",1,1,"V7",0,null,null,0]
["VM",1,1,"VM",0,null,null,0]
["VP",1,1,"VP",0,null,null,0]
["X1",1,1,"X1",0,null,null,0]
["X2",1,1,"X2",0,null,null,0]
["X3",1,1,"X3",0,null,null,0]
["X4",1,1,"X4",0,null,null,0]
["X5",1,1,"X5",0,null,null,0]
["XE",1,1,"XE",0,null,null,0]
["XP",1,1,"XP",0,null,null,0]
["XS",1,1,"XS",0,null,null,0]
["XU",1,1,"XU",0,null,null,0]
["ZA",1,1,"ZA",0,null,null,0]
["ZB",1,1,"ZB",0,null,null,0]
["ZC",1,1,"ZC",0,null,null,0]

{"sheet":"Changes 2018","index":3,"n_rows":78,"n_cols":4,"rows_kept":78,"cut":false,"hidden":false,"merged":[]}
["Background:  Tab 100512"]
["The MMT Tab 100512 is used for CHCS KGADS module.  KGADS is the professional services data collection module.  All the tabs within the MMT must be kept as is to meet system specifications.  The modifier descritpion in Tab 100512 is a 54-character maximum."]
["\nTab 100512 is used to provide edits when assigning CPT/HCPCS.  The CHCS KGADS module was used before the CCE module and is still used to date.  CPT/HCPCS ranges are used and Tab 8058.4 is used as the guide.  Modifiers are not to be used for all of the code ranges.  \n\nNote: Usually, it would be inappropriate to use the modifier on all the codes in all the ranges, but by having the ranges, it sometimes keeps inappropriate use from occurring.  "]
[]
["MMT Changes for 2018"]
[]
["New Code Range for 2018","Dental Services",null,"Changes made with the July Update"]
["W0119 - W9999"]
[]
[]
[]
["CY 2017 Code","CY 2018 Code (NEW)"]
["0468T","0504T"]
["G9862","G9977"]
["Q4175","Q4182"]
[]
[]
["CY 2017 Code (DELETED)","CY 2018 Code"]
["A9599","A9598"]
["Q0478","Q0477"]
["Q9989","Q9983"]
[]
["New Code Range for 2018","Laboratory Services"]
["0001U - 0023U"]
[]
["New Modifiers for 2018"]
[" FY"]
["JG","Current Ambulance Modifier"]
["TB"]
["VM"]
[" X1"]
["X2"]
[" X3"]
["X4"]
["X5"]
[" ZC"]
[]
["Deleted Modifiers"]
["CP"]
["SZ"]
[]
["Modifier Description Changed"]
["Q5"]
["Q6"]
[]
["Code Range Split"]
["CY 2017","CY 2018"]
["Q3031 - Q4051","Q3031 - Q3031"]
[null,"Q4001 - Q4051"]
[]
["Ambulance Modifiers  \n(active modifiers added to the table)\n"]
["DD"]
["II"]
["JJ"]
["JX"]
["NN"]
["PE"]
["PG"]
["PH"]
["PP"]
["RP"]
[]
["Updated Ambulance Code Range to existing modifiers\n"]
["(Modifiers with dual descriptions)"]
["ED","PD"]
["EE","PI"]
["EJ","PS"]
["GE","RD"]
["GG","RI"]
["GH","RR"]
["GN","SD"]
["GP","SG"]
["GS","SH"]
["JD","SJ"]
["JG","SN"]
["NR","SS"]
[]
["Note: Ambulance modifier descriptions identified with a preceeding \"Ambulance: or Ambl:\""]