Type of Service (TOS) Indicator S: Surgical Dressings or Other Medical Supplies
HCPCS codes | ||
| Code | Description | |
|---|---|---|
| A4206 | Syringe with needle, sterile, 1 cc or less, each | |
| A4207 | Syringe with needle, sterile 2 cc, each | |
| A4208 | Syringe with needle, sterile 3 cc, each | |
| A4209 | Syringe with needle, sterile 5 cc or greater, each | |
| A4210 | Needle-free injection device, each | |
| A4211 | Supplies for self-administered injections | |
| A4212 | Non-coring needle or stylet with or without catheter | |
| A4213 | Syringe, sterile, 20 cc or greater, each | |
| A4215 | Needle, sterile, any size, each | |
| A4244 | Alcohol or peroxide, per pint | |
| A4245 | Alcohol wipes, per box | |
| A4246 | Betadine or phisohex solution, per pint | |
| A4247 | Betadine or iodine swabs/wipes, per box | |
| A4300 | Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access | |
| A4301 | Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) | |
| A4450 | Tape, non-waterproof, per 18 square inches | |
| A4452 | Tape, waterproof, per 18 square inches | |
| A4461 | Surgical dressing holder, non-reusable, each | |
| A4462 | ABDOMINAL DRESSING HOLDER, EACH | |
| A4463 | Surgical dressing holder, reusable, each | |
| A4648 | Tissue marker, implantable, any type, each | |
| A4650 | Implantable radiation dosimeter, each | |
| A6010 | Collagen based wound filler, dry form, sterile, per gram of collagen | |
| A6011 | Collagen based wound filler, gel/paste, per gram of collagen | |
| A6021 | Collagen dressing, sterile, size 16 sq. in. or less, each | |
| A6022 | Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each | |
| A6023 | Collagen dressing, sterile, size more than 48 sq. in., each | |
| A6024 | Collagen dressing wound filler, sterile, per 6 inches | |
| A6154 | Wound pouch, each | |
| A6196 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing | |
| A6197 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | |
| A6198 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 48 sq. in., each dressing | |
| A6199 | Alginate or other fiber gelling dressing, wound filler, sterile, per 6 inches | |
| A6200 | COMPOSITE DRESSING, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING | |
| A6201 | COMPOSITE DRESSING, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING | |
| A6202 | COMPOSITE DRESSING, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING | |
| A6203 | Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | |
| A6204 | Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | |
| A6205 | Composite dressing, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | |
| A6206 | Contact layer, sterile, 16 sq. in. or less, each dressing | |
| A6207 | Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | |
| A6208 | Contact layer, sterile, more than 48 sq. in., each dressing | |
| A6209 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6210 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6211 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6212 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | |
| A6213 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | |
| A6214 | Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | |
| A6215 | Foam dressing, wound filler, sterile, per gram | |
| A6216 | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6217 | Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6218 | Gauze, non-impregnated, non-sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6219 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | |
| A6220 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | |
| A6221 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | |
| A6222 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6223 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6224 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6228 | Gauze, impregnated, water or normal saline, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6229 | Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6230 | Gauze, impregnated, water or normal saline, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6231 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size 16 sq. in. or less, each dressing | |
| A6232 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size greater than 16 sq. in., but less than or equal to 48 sq. in., each dressing | |
| A6233 | Gauze, impregnated, hydrogel, for direct wound contact, sterile, pad size more than 48 sq. in., each dressing | |
| A6234 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6235 | Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6236 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6237 | Hydrocolloid dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | |
| A6238 | Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | |
| A6239 | Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | |
| A6240 | Hydrocolloid dressing, wound filler, paste, sterile, per ounce | |
| A6241 | Hydrocolloid dressing, wound filler, dry form, sterile, per gram | |
| A6242 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6243 | Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6244 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6245 | Hydrogel dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | |
| A6246 | Hydrogel dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | |
| A6247 | Hydrogel dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | |
| A6248 | Hydrogel dressing, wound filler, gel, per fluid ounce | |
| A6250 | Skin sealants, protectants, moisturizers, ointments, any type, any size | |
| A6251 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6252 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6253 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6254 | Specialty absorptive dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | |
| A6255 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | |
| A6256 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing | |
| A6257 | Transparent film, sterile, 16 sq. in. or less, each dressing | |
| A6258 | Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | |
| A6259 | Transparent film, sterile, more than 48 sq. in., each dressing | |
| A6260 | Wound cleansers, any type, any size | |
| A6261 | Wound filler, gel/paste, per fluid ounce, not otherwise specified | |
| A6262 | Wound filler, dry form, per gram, not otherwise specified | |
| A6266 | Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard | |
| A6402 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6403 | Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6404 | Gauze, non-impregnated, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | |
| A6407 | Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard | |
| A6410 | Eye pad, sterile, each | |
| A6411 | Eye pad, non-sterile, each | |
| A6412 | Eye patch, occlusive, each | |
| A6441 | Padding bandage, non-elastic, non-woven/non-knitted, width greater than or equal to three inches and less than five inches, per yard | |
| A6442 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width less than three inches, per yard | |
| A6443 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to three inches and less than five inches, per yard | |
| A6444 | Conforming bandage, non-elastic, knitted/woven, non-sterile, width greater than or equal to 5 inches, per yard | |
| A6445 | Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard | |
| A6446 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard | |
| A6447 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to five inches, per yard | |
| A6448 | Light compression bandage, elastic, knitted/woven, width less than three inches, per yard | |
| A6449 | Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | |
| A6450 | Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard | |
| A6451 | Moderate compression bandage, elastic, knitted/woven, load resistance of 1.25 to 1.34 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard | |
| A6452 | High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inches, per yard | |
| A6453 | Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard | |
| A6454 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard | |
| A6455 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to five inches, per yard | |
| A6456 | Zinc paste impregnated bandage, non-elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | |
| A6457 | Tubular dressing with or without elastic, any width, per linear yard | |
| A6460 | Synthetic resorbable wound dressing, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | |
| A6461 | Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | |
| A6501 | Compression burn garment, bodysuit (head to foot), custom fabricated | |
| A6502 | Compression burn garment, chin strap, custom fabricated | |
| A6503 | Compression burn garment, facial hood, custom fabricated | |
| A6504 | Compression burn garment, glove to wrist, custom fabricated | |
| A6505 | Compression burn garment, glove to elbow, custom fabricated | |
| A6506 | Compression burn garment, glove to axilla, custom fabricated | |
| A6507 | Compression burn garment, foot to knee length, custom fabricated | |
| A6508 | Compression burn garment, foot to thigh length, custom fabricated | |
| A6509 | Compression burn garment, upper trunk to waist including arm openings (vest), custom fabricated | |
| A6510 | Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated | |
| A6511 | Compression burn garment, lower trunk including leg openings (panty), custom fabricated | |
| A6512 | Compression burn garment, not otherwise classified | |
| A6531 | Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each | |
| A6532 | Gradient compression stocking, below knee, 40-50 mmhg, used as a surgical dressing, each | |
| A6545 | Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each | |
| C1052 | Hemostatic agent, gastrointestinal, topical | |
| C1062 | Intravertebral body fracture augmentation with implant (e.g., metal, polymer) | |
| C1600 | Catheter, transluminal intravascular lesion preparation device, bladed, sheathed (insertable) | |
| C1601 | Endoscope, single-use (i.e. disposable), pulmonary, imaging/illumination device (insertable) | |
| C1602 | Orthopedic/device/drug matrix/absorbable bone void filler, antimicrobial-eluting (implantable) | |
| C1603 | Retrieval device, insertable, laser (used to retrieve intravascular inferior vena cava filter) | |
| C1604 | Graft, transmural transvenous arterial bypass (implantable), with all delivery system components | |
| C1605 | Pacemaker, leadless, dual chamber (right atrial and right ventricular implantable components), rate-responsive, including all necessary components for implantation | |
| C1606 | Adapter, single-use (i.e. disposable), for attaching ultrasound system to upper gastrointestinal endoscope | |
| C1713 | Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) | |
| C1714 | Catheter, transluminal atherectomy, directional | |
| C1715 | Brachytherapy needle | |
| C1716 | Brachytherapy source, non-stranded, gold-198, per source | |
| C1717 | Brachytherapy source, non-stranded, high dose rate iridium-192, per source | |
| C1718 | BRACHYTHERAPY SOURCE, IODINE 125, PER SOURCE | |
| C1719 | Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source | |
| C1720 | BRACHYTHERAPY SOURCE, PALLADIUM 103, PER SOURCE | |
| C1721 | Cardioverter-defibrillator, dual chamber (implantable) | |
| C1722 | Cardioverter-defibrillator, single chamber (implantable) | |
| C1724 | Catheter, transluminal atherectomy, rotational | |
| C1725 | Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) | |
| C1726 | Catheter, balloon dilatation, non-vascular | |
| C1727 | Catheter, balloon tissue dissector, non-vascular (insertable) | |
| C1728 | Catheter, brachytherapy seed administration | |
| C1729 | Catheter, drainage | |
| C1730 | Catheter, electrophysiology, diagnostic, other than 3d mapping (19 or fewer electrodes) | |
| C1731 | Catheter, electrophysiology, diagnostic, other than 3d mapping (20 or more electrodes) | |
| C1732 | Catheter, electrophysiology, diagnostic/ablation, 3d or vector mapping | |
| C1733 | Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, other than cool-tip | |
| C1734 | Orthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable) | |
| C1747 | Endoscope, single-use (i.e. disposable), urinary tract, imaging/illumination device (insertable) | |
| C1749 | Endoscope, retrograde imaging/illumination colonoscope device (implantable) | |
| C1750 | Catheter, hemodialysis/peritoneal, long-term | |
| C1751 | Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) | |
| C1752 | Catheter, hemodialysis/peritoneal, short-term | |
| C1753 | Catheter, intravascular ultrasound | |
| C1754 | Catheter, intradiscal | |
| C1755 | Catheter, intraspinal | |
| C1756 | Catheter, pacing, transesophageal | |
| C1757 | Catheter, thrombectomy/embolectomy | |
| C1758 | Catheter, ureteral | |
| C1759 | Catheter, intracardiac echocardiography | |
| C1760 | Closure device, vascular (implantable/insertable) | |
| C1761 | Catheter, transluminal intravascular lithotripsy, coronary | |
| C1762 | Connective tissue, human (includes fascia lata) | |
| C1763 | Connective tissue, non-human (includes synthetic) | |
| C1764 | Event recorder, cardiac (implantable) | |
| C1765 | Adhesion barrier | |
| C1766 | Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away | |
| C1767 | Generator, neurostimulator (implantable), non-rechargeable | |
| C1768 | Graft, vascular | |
| C1769 | Guide wire | |
| C1770 | Imaging coil, magnetic resonance (insertable) | |
| C1771 | Repair device, urinary, incontinence, with sling graft | |
| C1772 | Infusion pump, programmable (implantable) | |
| C1773 | Retrieval device, insertable (used to retrieve fractured medical devices) | |
| C1776 | Joint device (implantable) | |
| C1777 | Lead, cardioverter-defibrillator, endocardial single coil (implantable) | |
| C1778 | Lead, neurostimulator (implantable) | |
| C1779 | Lead, pacemaker, transvenous vdd single pass | |
| C1780 | Lens, intraocular (new technology) | |
| C1781 | Mesh (implantable) | |
| C1782 | Morcellator | |
| C1783 | Ocular implant, aqueous drainage assist device | |
| C1784 | Ocular device, intraoperative, detached retina | |
| C1785 | Pacemaker, dual chamber, rate-responsive (implantable) | |
| C1786 | Pacemaker, single chamber, rate-responsive (implantable) | |
| C1787 | Patient programmer, neurostimulator | |
| C1788 | Port, indwelling (implantable) | |
| C1789 | Prosthesis, breast (implantable) | |
| C1813 | Prosthesis, penile, inflatable | |
| C1814 | Retinal tamponade device, silicone oil | |
| C1815 | Prosthesis, urinary sphincter (implantable) | |
| C1816 | Receiver and/or transmitter, neurostimulator (implantable) | |
| C1817 | Septal defect implant system, intracardiac | |
| C1818 | Integrated keratoprosthesis | |
| C1819 | Surgical tissue localization and excision device (implantable) | |
| C1820 | Generator, neurostimulator (implantable), with rechargeable battery and charging system | |
| C1821 | Interspinous process distraction device (implantable) | |
| C1822 | Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system | |
| C1823 | Generator, neurostimulator (implantable), non-rechargeable, with transvenous sensing and stimulation leads | |
| C1824 | Generator, cardiac contractility modulation (implantable) | |
| C1825 | Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s) | |
| C1826 | Generator, neurostimulator (implantable), includes closed feedback loop leads and all implantable components, with rechargeable battery and charging system | |
| C1827 | Generator, neurostimulator (implantable), non-rechargeable, with implantable stimulation lead and external paired stimulation controller | |
| C1830 | Powered bone marrow biopsy needle | |
| C1831 | Interbody cage, anterior, lateral or posterior, personalized (implantable) | |
| C1832 | Autograft suspension, including cell processing and application, and all system components | |
| C1833 | Monitor, cardiac, including intracardiac lead and all system components (implantable) | |
| C1834 | Pressure sensor system, includes all components (e.g., introducer, sensor), intramuscular (implantable), excludes mobile (wireless) software application | |
| C1839 | Iris prosthesis | |
| C1840 | Lens, intraocular (telescopic) | |
| C1841 | Retinal prosthesis, includes all internal and external components | |
| C1842 | Retinal prosthesis, includes all internal and external components; add-on to c1841 | |
| C1874 | Stent, coated/covered, with delivery system | |
| C1875 | Stent, coated/covered, without delivery system | |
| C1876 | Stent, non-coated/non-covered, with delivery system | |
| C1877 | Stent, non-coated/non-covered, without delivery system | |
| C1878 | Material for vocal cord medialization, synthetic (implantable) | |
| C1879 | Tissue marker (implantable) | |
| C1880 | Vena cava filter | |
| C1881 | Dialysis access system (implantable) | |
| C1882 | Cardioverter-defibrillator, other than single or dual chamber (implantable) | |
| C1883 | Adapter/extension, pacing lead or neurostimulator lead (implantable) | |
| C1884 | Embolization protective system | |
| C1885 | Catheter, transluminal angioplasty, laser | |
| C1886 | Catheter, extravascular tissue ablation, any modality (insertable) | |
| C1887 | Catheter, guiding (may include infusion/perfusion capability) | |
| C1888 | Catheter, ablation, non-cardiac, endovascular (implantable) | |
| C1889 | Implantable/insertable device, not otherwise classified | |
| C1890 | No implantable/insertable device used with device-intensive procedures | |
| C1891 | Infusion pump, non-programmable, permanent (implantable) | |
| C1892 | Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away | |
| C1893 | Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away | |
| C1894 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser | |
| C1895 | Lead, cardioverter-defibrillator, endocardial dual coil (implantable) | |
| C1896 | Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) | |
| C1897 | Lead, neurostimulator test kit (implantable) | |
| C1898 | Lead, pacemaker, other than transvenous vdd single pass | |
| C1899 | Lead, pacemaker/cardioverter-defibrillator combination (implantable) | |
| C1900 | Lead, left ventricular coronary venous system | |
| C1982 | Catheter, pressure-generating, one-way valve, intermittently occlusive | |
| C2596 | Probe, image-guided, robotic, waterjet ablation | |
| C2613 | Lung biopsy plug with delivery system | |
| C2614 | Probe, percutaneous lumbar discectomy | |
| C2615 | Sealant, pulmonary, liquid | |
| C2616 | Brachytherapy source, non-stranded, yttrium-90, per source | |
| C2617 | Stent, non-coronary, temporary, without delivery system | |
| C2618 | Probe/needle, cryoablation | |
| C2619 | Pacemaker, dual chamber, non rate-responsive (implantable) | |
| C2620 | Pacemaker, single chamber, non rate-responsive (implantable) | |
| C2621 | Pacemaker, other than single or dual chamber (implantable) | |
| C2622 | Prosthesis, penile, non-inflatable | |
| C2623 | Catheter, transluminal angioplasty, drug-coated, non-laser | |
| C2624 | Implantable wireless pulmonary artery pressure sensor with delivery catheter, including all system components | |
| C2625 | Stent, non-coronary, temporary, with delivery system | |
| C2626 | Infusion pump, non-programmable, temporary (implantable) | |
| C2627 | Catheter, suprapubic/cystoscopic | |
| C2628 | Catheter, occlusion | |
| C2629 | Introducer/sheath, other than guiding, other than intracardiac electrophysiological, laser | |
| C2630 | Catheter, electrophysiology, diagnostic/ablation, other than 3d or vector mapping, cool-tip | |
| C2631 | Repair device, urinary, incontinence, without sling graft | |
| C2633 | BRACHYTHERAPY SOURCE, CESIUM-131, PER SOURCE | |
| J7350 | DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, INJECTABLE, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, BUT WITHOUT METABOLIZED ACTIVE ELEMENTS, PER 10 MG | |
| K0620 | TUBULAR ELASTIC DRESSING, ANY WIDTH, PER LINEAR YARD | |
| K0744 | Absorptive wound dressing for use with suction pump, home model, portable, pad size 16 square inches or less | |
| K0745 | Absorptive wound dressing for use with suction pump, home model, portable, pad size more than 16 square inches but less than or equal to 48 square inches | |
| K0746 | Absorptive wound dressing for use with suction pump, home model, portable, pad size greater than 48 square inches | |
| L8110 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 30-40 MMHG, EACH | |
| L8120 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 40-50 MMHG, EACH | |
| Q0182 | DERMAL AND EPIDERMAL, TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER | |
| Q0183 | DERMAL TISSUE, OF HUMAN ORIGIN, WITH AND WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, BUT WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER | |
| Q4001 | Casting supplies, body cast adult, with or without head, plaster | |
| Q4002 | Cast supplies, body cast adult, with or without head, fiberglass | |
| Q4003 | Cast supplies, shoulder cast, adult (11 years +), plaster | |
| Q4004 | Cast supplies, shoulder cast, adult (11 years +), fiberglass | |
| Q4005 | Cast supplies, long arm cast, adult (11 years +), plaster | |
| Q4006 | Cast supplies, long arm cast, adult (11 years +), fiberglass | |
| Q4007 | Cast supplies, long arm cast, pediatric (0-10 years), plaster | |
| Q4008 | Cast supplies, long arm cast, pediatric (0-10 years), fiberglass | |
| Q4009 | Cast supplies, short arm cast, adult (11 years +), plaster | |
| Q4010 | Cast supplies, short arm cast, adult (11 years +), fiberglass | |
| Q4011 | Cast supplies, short arm cast, pediatric (0-10 years), plaster | |
| Q4012 | Cast supplies, short arm cast, pediatric (0-10 years), fiberglass | |
| Q4013 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster | |
| Q4014 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass | |
| Q4015 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster | |
| Q4016 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass | |
| Q4017 | Cast supplies, long arm splint, adult (11 years +), plaster | |
| Q4018 | Cast supplies, long arm splint, adult (11 years +), fiberglass | |
| Q4019 | Cast supplies, long arm splint, pediatric (0-10 years), plaster | |
| Q4020 | Cast supplies, long arm splint, pediatric (0-10 years), fiberglass | |
| Q4021 | Cast supplies, short arm splint, adult (11 years +), plaster | |
| Q4022 | Cast supplies, short arm splint, adult (11 years +), fiberglass | |
| Q4023 | Cast supplies, short arm splint, pediatric (0-10 years), plaster | |
| Q4024 | Cast supplies, short arm splint, pediatric (0-10 years), fiberglass | |
| Q4025 | Cast supplies, hip spica (one or both legs), adult (11 years +), plaster | |
| Q4026 | Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass | |
| Q4027 | Cast supplies, hip spica (one or both legs), pediatric (0-10 years), plaster | |
| Q4028 | Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass | |
| Q4029 | Cast supplies, long leg cast, adult (11 years +), plaster | |
| Q4030 | Cast supplies, long leg cast, adult (11 years +), fiberglass | |
| Q4031 | Cast supplies, long leg cast, pediatric (0-10 years), plaster | |
| Q4032 | Cast supplies, long leg cast, pediatric (0-10 years), fiberglass | |
| Q4033 | Cast supplies, long leg cylinder cast, adult (11 years +), plaster | |
| Q4034 | Cast supplies, long leg cylinder cast, adult (11 years +), fiberglass | |
| Q4035 | Cast supplies, long leg cylinder cast, pediatric (0-10 years), plaster | |
| Q4036 | Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass | |
| Q4037 | Cast supplies, short leg cast, adult (11 years +), plaster | |
| Q4038 | Cast supplies, short leg cast, adult (11 years +), fiberglass | |
| Q4039 | Cast supplies, short leg cast, pediatric (0-10 years), plaster | |
| Q4040 | Cast supplies, short leg cast, pediatric (0-10 years), fiberglass | |
| Q4041 | Cast supplies, long leg splint, adult (11 years +), plaster | |
| Q4042 | Cast supplies, long leg splint, adult (11 years +), fiberglass | |
| Q4043 | Cast supplies, long leg splint, pediatric (0-10 years), plaster | |
| Q4044 | Cast supplies, long leg splint, pediatric (0-10 years), fiberglass | |
| Q4045 | Cast supplies, short leg splint, adult (11 years +), plaster | |
| Q4046 | Cast supplies, short leg splint, adult (11 years +), fiberglass | |
| Q4047 | Cast supplies, short leg splint, pediatric (0-10 years), plaster | |
| Q4048 | Cast supplies, short leg splint, pediatric (0-10 years), fiberglass | |
| Q4049 | Finger splint, static | |
| Q4050 | Cast supplies, for unlisted types and materials of casts | |
| Q4051 | Splint supplies, miscellaneous (includes thermoplastics, strapping, fasteners, padding and other supplies) | |
| S8490 | Insulin syringes (100 syringes, any size) | |
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