NOTE: Deleted codes are valid for dates of service on or before the date of deletion.
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, 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–A4218 |
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 |
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–A4358 |
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. |
A4359 (deleted 12/31/06) |
Incontinence Supplies/Urinary Supplies |
See description above |
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 |
A4461-A4463 |
Surgical Dressing Holders |
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 |
A4520 |
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. |
A4559 |
Coupling Gel |
Local Carrier if incident to a physician's (not separately payable). |
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. |
A4600 |
Sleeve for Intermittent Limb Compression Device |
DME MAC |
A460l |
Lithium Ion Battery for Non-Prosthetic Use |
DME MAC |
A4604 |
Tubing for Positive Airway Pressure Device |
DME MAC |
A4605 |
Tracheal Suction Catheter |
DME MAC |
A4606 |
Oxygen Probe for Oximeter |
DME MAC |
A4608 |
Transtracheal Oxygen 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–A4642 |
Imaging Agent; Contrast Material |
Local Carrier |
A4648 |
Tissue Marker, Implanted |
Local Carrier |
A4649 |
Miscellaneous Surgical Supplies |
Local Carrier if incident to a physician's service (not separately payable). If other, DME MAC. |
A4650 |
Implantable Radiation Dosimeter |
Local Carrier |
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–A5513 |
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. |
A6413 |
Adhesive Bandage |
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. |
A6513 |
Compression Burn Mask |
DME MAC |
A6530-a6549 |
Compression Gradient Stockings |
DME MAC |
A6550 |
Supplies for Negative Pressure
Wound Therapy Electrical Pump |
DME MAC |
A7000–A7002 |
Accessories for Suction Pumps |
DME MAC |
A7003–A7039 |
Accessories for Nebulizers, Aspirators and Ventilators |
DME MAC |
A7040–A7041 |
Chest Drainage Supplies |
Local Carrier |
A7042–A7043 |
Pleural Catheter |
Local Carrier |
A7044–A7046 |
Respiratory Accessories |
DME MAC |
A7501–A7527 |
Tracheostomy Supplies |
DME MAC |
A8000-A8004 |
Protective Helmets |
DME MAC |
A9150 |
Non-Prescription Drugs |
Local Carrier |
A9152-A9153 |
Vitamins |
Local Carrier |
A9155 |
Artificial Saliva |
Local Carrier |
A9180 |
Lice Infestation Treatment |
Local Carrier |
A9270 |
Noncovered Items or Services |
DME MAC |
A9274-A9278 |
Glucose Monitoring |
DME MAC |
A9279 |
Monitoring Feature/Device |
DME MAC |
A9280 |
Alarm Device |
DME MAC |
A9281 |
Reaching/Grabbing Device |
DME MAC |
A9282 |
Wig |
DME MAC |
A9283 |
Foot Off Loading 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 |
E0181–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 |
E0485-E0486 |
Oral Device to Reduce Airway Collapsibility
|
DME MAC |
E0500 |
IPPB Machine |
DME MAC |
E0550–E0585 |
Compressors/Nebulizers |
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–E0642 |
Standing Devices/Lifts |
DME MAC |
E0650–E0676 |
Pneumatic Compressor and Appliances |
DME MAC |
E0691–E0694 |
Ultraviolet Light Therapy Systems |
DME MAC |
E0700 |
Safety Equipment |
DME MAC |
E0701 (deleted 12/31/06) |
Protective Helmet |
DME MAC |
E0705 |
Transfer Board |
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 |
E0755 |
Reflex Stimulator |
DME MAC |
E0760 |
Ultrasonic osteogenic stimulator |
DME MAC |
E0761 |
Electromagnetic Treatment Device |
DME MAC |
E0764 |
Functional Neuromuscular Stimulator |
DME MAC |
E0765 |
Nerve Stimulator |
DME MAC |
E0769 |
Electrical Wound Treatment Device |
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-e0936 |
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 Non-routine Service |
Local Carrier if repair of implanted DME.
If other, DME MAC. |
E1353–E1392 |
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–E1841 |
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 |
E2601–E2621 |
Wheelchair Cushions |
DME MAC |
E8000–E8002 |
Gate Trainers |
DME MAC |
G0008–G0332 |
Misc. Professional Services |
Local Carrier |
G0333 |
Dispensing Fee |
DME MAC |
G0337-G0368 |
Misc. Professional Services |
Local Carrier |
G0372 |
Misc. Professional Services |
Local Carrier |
G0375-G0376 |
Misc. Professional Services |
Local Carrier |
G0378-G9140 |
Misc. Professional Services |
Local Carrier |
J0120–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. |
J7187–J7195 |
Antihemophilic Factor |
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, Long-Acting Implant |
Local Carrier |
J7311 |
Fluocinolone Acetonide, intravitrea implant |
Local Carrier |
J7317 (deleted 12/31/06) |
Sodium Hyaluronate |
Local Carrier |
J7319 (deleted 12/31/06) |
Hyaluronan |
Local Carrier |
J7320 (deleted 12/31/06) |
Hylan |
Local Carrier |
J7321-J7324 |
Hyaluronan |
Local Carrier |
J7330 |
Autologous Cultured Chondrocytes Implant |
Local Carrier |
J7340–J7349 |
Dermal and Epidermal Tissue |
Local Carrier |
J7350 (deleted 12/31/06) |
Dermal and Epidermal Tissue |
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. |
J7602–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 |
J8498 |
Anti-emetic Drug |
DME MAC |
J8499 |
Prescription Drug, Oral, Non-Chemotherapeutic |
DME MAC |
J8501–J8999 |
Oral Anti-Cancer 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 |
K0195 |
Elevating Leg Rests |
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 |
K0553-K0555 (deleted 12/31/07) |
Accessories for CPAP and Ventilators |
DME MAC |
K0601–K0605 |
External Infusion Pump Batteries |
DME MAC |
K0606–K0609 |
Defibrilator Accessories |
DME MAC |
K0669 |
Wheelchair Cushion |
DME MAC |
K0730 |
Inhalation Drug Delivery System |
DME MAC |
K0733 |
Power Wheelchair Accessory |
DME MAC |
K0734-K0737 |
Power Wheelchair Seat Cushions |
DME MAC |
K0738 |
Oxygen Equipment |
DME MAC |
K0800-K0899 |
Power Mobility Devices |
DME MAC |
L0100 (deleted 12/31/06) |
Orthotics |
DME MAC |
L0110 (deleted 12/31/06) |
Orthotics |
DME MAC |
L0112–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. |
L7600 |
Prosthetic Donning Sleeve |
DME MAC |
L7611-l7622 |
Prosthetic Terminal Devices |
DME MAC |
L7900 |
Vacuum Erection System |
DME MAC |
L8000–L8485 |
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–L8515 |
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; Cardiokymography |
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 |
Q0144 |
Azithromycin Dihydrate |
Local Carrier if incident to a physician's service. If other, DME MAC. |
Q0163–Q0181 |
Anti-emetic |
DME MAC |
Q0480–Q0505 |
Ventricular Assist Devices |
Local Carrier |
Q0510–Q0514 |
Drug Dispensing Fees |
DME MAC |
Q0515 |
Sermorelin Acetate |
Local Carrier |
Q1003–Q1005 |
New Technology IOL |
Local Carrier |
Q2004 |
Irrigation Solution |
Local Carrier |
Q2009 |
Fosphenytoin |
Local Carrier |
Q2017 |
Teniposide |
Local Carrier |
Q3001 |
Radio Elements for Brachytherapy |
Local Carrier |
Q3014 |
Telehealth Originating Site Facility Fee |
Local Carrier |
Q3025–Q3026 |
Vaccines |
Local Carrier |
Q3031 |
Collagen Skin Test |
Local Carrier |
Q4001–Q4051 |
Splints and Casts |
Local Carrier |
Q4080 |
Inhalation Drug |
Local Carrier if incident to a physician’s service or used in an implanted infusion pump. If other, DME MAC. |
Q4081 |
Epoetin |
DME MAC for method II home dialysis. If other, Local Carrier. |
Q4082 |
Drug Subject to Competitive Acquisition Program |
Local Carrier |
Q4083-Q4086 (deleted 12/31/07) |
Hyaluronan |
Local Carrier |
Q4087-Q4092 (deleted 12/31/07) |
Injection |
Local Carrier |
Q4093-Q4094 (deleted 12/31/07) |
Inhalation Solutions |
Local Carrier if incident to a physician's service or used in an implanted infusion pump. If other DME MAC. |
Q4095 (deleted 12/31/07) |
Injection |
Local Carrier |
Q4096-Q4098 |
Injection |
Local Carrier if incident to a physician's service or used in an implanted infusion pump. |
Q4099 |
Inhalation Solutions |
DME MAC |
Q5001-Q5009 |
Hospice Services |
Local Carrier |
Q9945-Q9950 (deleted 12/31/07) |
Imaging Agents |
Local Carrier |
Q9951-Q9954 |
Imaging Agents |
Local Carrier |
Q9955-Q9957 |
Microspheres |
Local Carrier |
Q9958-Q9967 |
Imaging Agents |
Local Carrier |
R0070–R0076 |