HCPCS

Description

Jurisdiction

A0021–A0999

Ambulance services

Local carrier

A4206–A4209

Medical, surgical, and self-administered injection supplies

Local carrier if incident to a physician's service (not separately payable). If other, durable medical equipment Medicare administrative contractor (DME MAC).

A4210

Needle free injection device

DME MAC

A4211

Medical, surgical, and self-administered injection supplies

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4212

Non coring needle or stylet, with or without catheter

Local carrier

A4213–A4215

Medical , surgical, and self-administered injection supplies

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4216–A4217

Saline

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4220

Refill kit for implantable pump

Local carrier

A4221–A4250

Medical, surgical, and self-administered injection supplies

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4253–A4259

Diabetic supplies

DME MAC

A4260

Levonorgestrel implant

Local carrier

A4261

Cervical cap for contraceptive use

Local carrier

A4262–A4263

Lacrimal duct implants

Local carrier

A4265

Paraffin

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4266–A4269

Contraceptives

Local carrier

A4270

Endoscope sheath

Local carrier

A4280

Accessory for breast prosthesis

DME MAC

A4281–A4286

Accessory for breast pump

DME MAC

A4290

Sacral nerve stimulation test lead

Local carrier

A4300–A4301

Implantable catheter

Local carrier

A4305–A4306

Disposable drug delivery system

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4310–A4359

Incontinence supplies/urinary supplies

If provided in the physician's office for a temporary condition, the item is incident to the physician's service and billed to the Local carrier. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device and billed to the DME MAC.

A4361–A4434

Ostomy supplies

If provided in the physician's office for a temporary condition, the item is incident to the physician's service and billed to the Local carrier. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device and billed to the DME MAC.

A4450–A4455

Tape; adhesive remover

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4458

Enema bag

DME MAC

A4462

Abdominal dressing

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4465

Non-elastic binder for extremity

DME MAC

A4470

Gravlee jet washer

Local carrier

A4480

Vabra aspirator

Local carrier

A4481

Tracheostomy supply

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4483

Moisture exchanger

DME MAC

A4490–A4510

Surgical stockings

DME MAC

A4521–A4538

Diapers

DME MAC

A4550

Surgical trays

Local carrier

A4554

Disposable underpads

DME MAC

A4556–A4558

Electrodes; lead wires; conductive paste

Local carrier if incident to a physician's service (not separately payable). If other DME MAC.

A4561–A4562

Pessary

Local carrier

A4565

Sling

Local carrier

A4570

Splint

Local carrier

A4575

Topical hyperbaric oxygen

Chamber, disposable

DME MAC

A4580–A4590

Casting supplies & material

Local carrier

A4595

TENS supplies

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4606

Oxygen probe for oximeter

DME MAC

A4608

Transtracheal oxygen catheter

DME MAC

A4609–A4610

Tracheal suction catheter

DME MAC

A4611–A4613

Oxygen equipment batteries and

Supplies

DME MAC

A4614

Peak flow rate meter

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4615–A4629

Oxygen and tracheostomy supplies

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4630–A4640

DME supplies

DME MAC

A4641–A4646

Imaging agent; contrast material

Local carrier

A4647

Contrast material

Local carrier

A4649

Miscellaneous surgical supplies

Local carrier if incident to a physician's service (not separately payable). If other, DME MAC.

A4651–A4932

Supplies for ESRD

DME MAC

A5051–A5093

Additional ostomy supplies

If provided in the physician's office for a temporary condition, the item is incident to the physician's service and billed to the Local carrier. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device and billed to the DME MAC.

A5102–A5200

Additional incontinence and ostomy supplies

If provided in the physician's office for a temporary condition, the item is incident to the physician's service and billed to the Local carrier. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device and billed to the DME MAC.

A5500–A5511

Therapeutic shoes

DME MAC

A6000

Noncontact wound warming cover

DME MAC

A6010–A6024

Surgical dressing

Local carrier if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC.

A6025

Silicone gel sheet

Local carrier if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other DME MAC.

A6154–A6411

Surgical dressing

Local carrier if incident to a physician's

service (not separately payable) or if supply

for implanted prosthetic device or implanted

DME. If other DME MAC.

A6412

Eye patch

Local carrier if incident to a physician's

service (not separately payable) or if supply

for implanted prosthetic device or implanted

DME. If other DME MAC.

A6441–A6512

Surgical dressings

Local carrier if incident to a physician's

service (not separately payable) or if supply

for implanted prosthetic device or implanted

DME. If other, DME MAC.

A6550–A6551

Supplies for negative pressure

Wound therapy electrical pump

DME MAC

A7000–A7039

Accessories for nebulizers, aspirators, and ventilators

DME MAC

A7042–A7043

Pleural catheter

Local carrier

A7044–A7046

Respiratory accessories

DME MAC

A7501–A7526

Tracheostomy supplies

DME MAC

A9150

Non-prescription drugs

Local carrier

A9270

Noncovered items or services

DME MAC

A9280

Alarm device

DME MAC

A9300

Exercise equipment

DME MAC

A9500–A9700

Supplies for radiology procedures

Local carrier

A9900

Miscellaneous DME supply or

Accessory

Local carrier if used with implanted DME. If other, DME MAC.

A9901

Delivery

DME MAC

A9999

Miscellaneous DME supply or

Accessory

Local carrier if used with implanted DME. If other, DME MAC.

B4034–B9999

Enteral and parenteral therapy

DME MAC

D0120–D9999

Dental procedures

Local carrier

E0100–E0105

Canes

DME MAC

E0110–E0118

Crutches

DME MAC

E0130–E0159

Walkers

DME MAC

E0160–E0175

Commodes

DME MAC

E0176–E0199

Decubitus care equipment

DME MAC

E0200–E0239

Heat/cold applications

DME MAC

E0240–E0248

Bath and toilet aids

DME MAC

E0249

Pad for heating unit

DME MAC

E0250–E0304

Hospital beds

DME MAC

E0305–E0326

Hospital bed accessories

DME MAC

E0350–E0352

Electronic bowel irrigation system

DME MAC

E0370

Heel pad

DME MAC

E0371–E0373

Decubitus care equipment

DME MAC

E0424–E0484

Oxygen and related respiratory Equipment

DME MAC

E0500

IPPB machine

DME MAC

E0550–E0585

Compressors/nebulizers

DME MAC

E0590

Drug dispensing fee

DME MAC

E0600

Suction pump

DME MAC

E0601

CPAP device

DME MAC

E0602–E0604

Breast pump

DME MAC

E0605

Vaporizer

DME MAC

E0606

Drainage board

DME MAC

E0607

Home blood glucose monitor

DME MAC

E0610–E0615

Pacemaker monitor

DME MAC

E0616

Implantable cardiac event recorder

Local carrier

E0617

External defibrillator

DME MAC

E0618–E0619

Apnea monitor

DME MAC

E0620

Skin piercing device

DME MAC

E0621–E0636

Patient lifts

DME MAC

E0637–E0638

Standing devices

DME MAC

E0650–E0675

Pneumatic compressor and appliances

DME MAC

E0691–E0694

Ultraviolet light therapy systems

DME MAC

E0700

Safety equipment

DME MAC

E0701

Helmet

DME MAC

E0710

Restraints

DME MAC

E0720–E0745

Electrical nerve stimulators

DME MAC

E0746

EMG device

Local carrier

E0747–E0748

Osteogenic stimulators

DME MAC

E0749

Implantable osteogenic stimulators

Local carrier

E0752

Implantable nerve stimulator electrodes

Local carrier

E0754

Patient programmer for use with IPG

Local carrier

E0755

Reflex stimulator

DME MAC

E0756–E0759

Implantable nerve stimulator

Local carrier

E0760

Ultrasonic osteogenic stimulator

DME MAC

E0761

Electromagnetic treatment device

DME MAC

E0765

Nerve stimulator

DME MAC

E0776

IV pole

DME MAC

E0779–E0780

External infusion pumps

DME MAC

E0781

Ambulatory infusion pump

Billable to both the local carrier and the DME MAC. This item may be billed to the DME MAC whenever the infusion is initiated in the physician's office but the patient does not return during the same business day.

E0782–E0783

Infusion pumps, implantable

Local carrier

E0784

Infusion pumps, insulin

DME MAC

E0785–E0786

Implantable infusion pump catheter

Local carrier

E0791

Parenteral infusion pump

DME MAC

E0830

Ambulatory traction device

DME MAC

E0840–E0900

Traction equipment

DME MAC

E0910–E0930

Trapeze/fracture frame

DME MAC

E0935

Passive motion exercise device

DME MAC

E0940

Trapeze equipment

DME MAC

E0941

Traction equipment

DME MAC

E0942–E0945

Orthopedic devices

DME MAC

E0946–E0948

Fracture frame

DME MAC

E0950–E1298

Wheelchairs

DME MAC

E1300–E1310

Whirlpool equipment

DME MAC

E1340

Repair or nonroutine service

Local carrier if repair of implanted DME.

If other, DME MAC.

E1353–E1391

Additional oxygen related equipment

DME MAC

E1399

Miscellaneous DME

Local carrier if implanted DME. If other, DME MAC.

E1405–E1406

Additional oxygen equipment

DME MAC

E1500–E1699

Artificial kidney machines and accessories

DME MAC

E1700–E1702

TMJ device and supplies

DME MAC

E1800–E1840

Dynamic flexion devices

DME MAC

E1902

Communication board

DME MAC

E2000

Gastric suction pump

DME MAC

E2100–E2101

Blood glucose monitors with special features

DME MAC

E2120

Pulse generator for tympanic treatment of inner ear

DME MAC

E2201–E2399

Wheelchair accessories

DME MAC

E2402

Negative pressure wound therapy pump

DME MAC

E2500–E2599

Speech generating device

DME MAC

G0001–G9016

Misc. professional services

Local carrier

J0120–J0850

Injection

Local carrier if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.

J0880

Injection

Local carrier

J0895–J3570

Injection

Local carrier if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.

J3590

Unclassified biologics

Local carrier

J7030–J7130

Miscellaneous drugs and solutions

Local carrier if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.

J7190–J7192

Factor VIII

Local carrier

J7193–J7195

Factor IX

Local carrier

J7197

Antithrombin III

Local carrier

J7198

Anti-inhibitor; per I.U.

Local carrier

J7199

Other hemophilia clotting factors

Local carrier

J7300–J7303

Intrauterine copper contraceptive

Local carrier

J7308

Aminolevulinic acid Hcl

Local carrier

J7310

Ganciclovir

Local carrier if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.

J7317–J7320

Injection

Local carrier

J7330

Autologous cultured chondrocytes, implant

Local carrier

J7340–J7350

Dermal and epidermal—tissue of human origin

Local carrier

J7500–J7599

Immunosuppressive drugs

Local carrier if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.

J7608–J7699

Inhalation solutions

Local carrier if incident to a physician's service. If other, DME MAC.

J7799

NOC, other than inhalation drugs through DME

DME MAC

J8499

Prescription drug, oral, non-chemotherapeutic

DME MAC

J8510–J8999

Oral anticancer drugs

DME MAC

J9000–J9999

Chemotherapy drugs

Local carrier if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.

K0001–K0108

Wheelchairs

DME MAC

K0114–K0116

Spinal orthotics

DME MAC

K0195

Elevating leg rests

DME MAC

K0415–K0416

Antiemetic drugs

DME MAC

K0452

Wheelchair bearings

DME MAC

K0455

Infusion pump used for

Uninterrupted administration of

Epoprostenal

DME MAC

K0462

Loaner equipment

DME MAC

K0552

External infusion pump supplies

DME MAC

K0601–K0605

External infusion pump batteries

DME MAC

K0606–K0609

Defibrilator accessories

DME MAC

K0618–K0619

TLSOS

DME MAC

K0620

Surgical dressing

Local carrier if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC.

L0100–L2090

Orthotics

DME MAC

L2106–L2116

Orthotics

DME MAC

L2126–L4398

Orthotics

DME MAC

L5000–L5999

Lower limb prosthetics

DME MAC

L6000–L7499

Upper limb prosthetics

DME MAC

L7500–L7520

Repair of prosthetic device

Local carrier if repair of implanted prosthetic device. If other, DME MAC.

L7900

Vacuum erection system

DME MAC

L8000–L8490

Prosthetics

DME MAC

L8499

Unlisted procedure for miscellaneous prosthetic services

Local carrier if implanted prosthetic device.

If other, DME MAC.

L8500–L8501

Artificial larynx; tracheostomy speaking valve

DME MAC

L8505

Artificial larynx accessory

DME MAC

L8507–L8514

Voice prosthesis

DME MAC

L8600–L8699

Prosthetic implants

Local carrier

L9900

Miscellaneous orthotic or prosthetic component or accessory

Local carrier if used with implanted prosthetic device. If other, DME MAC.

M0064–M0301

Medical services

Local carrier

P2028–P9615

Laboratory tests

Local carrier

Q0035

Influenza vaccine; cardio-kymography

Local carrier

Q0081

Infusion therapy

Local carrier if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

Q0083–Q0085

Chemotherapy administration

Local carrier if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

Q0091

Smear preparation

Local carrier

Q0092

Portable x-ray setup

Local carrier

Q0111–Q0115

Miscellaneous lab services

Local carrier

Q0136

Injection, Epoetin alpha

Local carrier if incident to a physician's service. If other, DME MAC.

Q0137

Injection Darbepoetin

Local carrier if incident to a physician's service. If other, DME MAC.

Q0144

Azithromycin dihydrate

Local carrier if incident to a physician's service. If other, DME MAC.

Q0163–Q0181

Anti-emetic

DME MAC

Q0182–Q0183

Artificial skin

Local carrier

Q0187

Factor VIIA

Local carrier

Q1001–Q1005

New technology IOL

Local carrier

Q2022

Von Willebrand Factor

Local carrier

Q3014

Telehealth originating site facility fee

Local carrier

Q3019–Q3020

ALS transport

Local carrier

Q3025–Q3026

Vaccines

Local carrier

Q3031

Collagen skin test

Local carrier

Q4001–Q4051

Splints and casts

Local carrier

Q4054–Q4055

Injection

DME MAC when for Method II

ESRD beneficiaries. If other, local carrier.

Q4075–Q4077

Injection

Local carrier if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC.

R0070–R0076

Diagnostic radiology services

Local carrier

V2020–V2025

Frames

DME MAC

V2100–V2513

Lenses

DME MAC

V2520–V2523

Hydrophilic contact lenses

Local carrier if incident to a physician's service. If other, DME MAC.

V2530–V2531

Contact lenses, scleral

DME MAC

V2599

Contact lens, other type

Local carrier if incident to a physician's service. If other, DME MAC.

V2600–V2615

Low vision aids

DME MAC

V2623–V2629

Prosthetic eyes

DME MAC

V2630–V2632

Intraocular lenses

Local carrier

V2700–V2780

Miscellaneous vision service

DME MAC

V2781

Progressive lens

DME MAC

V2782–V2784

Lenses

DME MAC

V2785

Processing—corneal tissue

Local carrier

V2786

Lens

DME MAC

V2790

Amniotic membrane

Local carrier

V2797

Vision supply

DME MAC

V2799

Miscellaneous vision service

DME MAC

V5008–V5299

Hearing services

Local carrier

V5336

Repair/modification of augmentative communicative system or device

DME MAC

V5362–V5364

Speech screening

Local carrier