REV_CNTR_APC_TB Revenue Center Ambulatory Payment Classification (APC) 0000 = Code used when Payment Method Indicator equals 'N9' 0001 = Photochemotherapy 0002 = Fine needle Biopsy/Aspiration 0003 = Bone Marrow Biopsy/Aspiration 0004 = Level I Needle Biopsy/ Aspiration Except Bone Marrow 0005 = Level II Needle Biopsy /Aspiration Except Bone Marrow 0006 = Level I Incision & Drainage 0007 = Level II Incision & Drainage 0008 = Level III Incision & Drainage 0009 = Nail Procedures 0010 = Level I Destruction of Lesion 0011 = Level II Destruction of Lesion 0012 = Level I Debridement & Destruction 0013 = Level II Debridement & Destruction 0014 = Level III Debridement & Destruction 0015 = Level IV Debridement & Destruction 0016 = Level V Debridement & Destruction 0017 = Level VI Debridement & Destruction 0018 = Biopsy Skin, Subcutaneous Tissue or Mucous Membrane 0019 = Level I Excision/ Biopsy 0020 = Level II Excision/ Biopsy 0021 = Level III Excision/ Biopsy 0022 = Level IV Excision/ Biopsy 0023 = Exploration Penetrating Wound 0024 = Level I Skin Repair 0025 = Level II Skin Repair 0026 = Level III Skin Repair 0027 = Level IV Skin Repair 0028 = Level I Incision/Excision Breast 0029 = Incision/Excision Breast (obsolete 12/00); Level II Incision/Excision Breast (effective 1/01) 0030 = Breast Reconstruction/Mastectomy 0031 = Hyperbaric Oxygen (obsolete 1/01) 0032 = Placement Transvenous Catheters/Arterial Cutdown 0033 = Partial Hospitalization 0040 = Arthrocentesis & Ligament/Tendon Injection 0041 = Arthroscopy 0042 = Arthroscopically-Aided Procedures 0043 = Closed Treatment Fracture Finger/Toe/Trunk 0044 = Closed Treatment Fracture/Dislocation Except Finger/Toe/Trunk 0045 = Bone/Joint Manipulation Under Anesthesia 0046 = Open/Percutaneous Treatment Fracture or Dislocation 0047 = Arthroplasty without Prosthesis 0048 = Arthroplasty with Prosthesis 0049 = Level I Musculoskeletal Procedures Except Hand and Foot 0050 = Level II Musculoskeletal Procedures Except Hand and Foot 0051 = Level III Musculoskeletal Procedures Except Hand and Foot 0052 = Level IV Musculoskeletal Procedures Except Hand and Foot 0053 = Level I Hand Musculoskeletal Procedures 0054 = Level II Hand Musculoskeletal Procedures 0055 = Level I Foot Musculoskeletal Procedures 0056 = Level II Foot Musculoskeletal Procedures 0057 = Bunion Procedures 0058 = Level I Strapping and Cast Application 0059 = Level II Strapping and Cast Application 0060 = Manipulation Therapy 0070 = Thoracentesis/Lavage Procedures 0071 = Level I Endoscopy Upper Airway 0072 = Level II Endoscopy Upper Airway 0073 = Level III Endoscopy Upper Airway 0074 = Level IV Endoscopy Upper Airway 0075 = Level V Endoscopy Upper Airway 0076 = Endoscopy Lower Airway 0077 = Level I Pulmonary Treatment 0078 = Level II Pulmonary Treatment 0079 = Ventilation Initiation and Management 0080 = Diagnostic Cardiac Catheterization 0081 = Non-Coronary Angioplasty or Atherectomy 0082 = Coronary Atherectomy 0083 = Coronary Angiosplasty 0084 = Level I Electrophysiologic Evaluation 0085 = Level II Electrophysiologic Evaluation 0086 = Ablate Heart Dysrhythm Focus 0087 = Cardiac Electrophysiologic Recording/Mapping 0088 = Thrombectomy 0089 = Level I Implantation/Removal/Revision of Pacemaker, AICD Vascular Device (obsolete 12/00); Insertion/Replacement of Permanent Pacemaker and Electrodes (eff. 1/01) 0090 = Level II Implantation/Removal/Revision of Pacemaker AICD Vascular Device (obsolete 12/00); Insertion/Replacement of Permanent Pacemaker and Pulse Generator 0091 = Level I Vascular Ligation 0092 = Level II Vascular Ligation 0093 = Vascular Repair/Fistula Construction 0094 = Resuscitation and Cardioversion 0095 = Cardiac Rehabilitation 0096 = Non-Invasive Vascular Studies 0097 = Cardiovascular Stress Test (obsolete 12/00); Cardiac Monitoring for 30 days (eff. 1/01) 0098 = Injection of Sclerosing Solution 0099 = Continuous Cardiac Monitoring (obsolete 12/00); Electrocardiograms (eff. 1/01) 0100 = Stress test and continuous ECG 0101 = Tilt Table Evaluation 0102 = Electronic Analysis of Pacemakers/other Devices 0103 = Miscellaneous Vascular Procedures (eff. 1/01) 0104 = Transcatheter Placement of Intracoronary Stents (eff. 1/01) 0105 = Revision/Removal of Pacemakers, AICD or Vascular (eff. 1/01) 0106 = Insertion/Replacement/Repair of Pacemaker Electrode (eff. 1/01) 0107 = Insertion of Cardioverter-Defibrillator (eff. 1/01) 0108 = Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads (eff. 1/01) 0109 = Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant (obsolete 12/00); Removal of Implanted Devices (eff. 1/01) 0110 = Transfusion 0111 = Blood PRODuct Exchange 0112 = Extracorporeal Photopheresis 0113 = Excision Lymphatic System 0114 = Thyroid/Lymphadenectomy Procedures 0115 = Cannula/Access Device Procedures (eff. 1/01) 0116 = Chemotherapy Administration by Other Technique Except Infusion 0117 = Chemotherapy Administration by Infusion Only 0118 = Chemotherapy Administration by Both Infusion and Other Technique 0119 = Implantation of Devices (eff. 1/01) 0120 = Infusion Therapy Except Chemotherapy 0121 = Level I Tube changes and Repositioning 0122 = Level II Tube changes and Repositioning 0123 = Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant 0124 = Revision of Implanted Infusion Pump (eff. 1/01) 0130 = Level I Laparoscopy 0131 = Level II Laparoscopy 0132 = Level III Laparoscopy 0140 = Esophageal Dilation without Endoscopy 0141 = Upper GI Procedures 0142 = Small Intestine Endoscopy 0143 = Lower GI Endoscopy 0144 = Diagnostic Anoscopy 0145 = Therapeutic Anoscopy 0146 = Level I Sigmoidoscopy 0147 = Level II Sigmoidoscopy 0148 = Level I Anal/Rectal Procedure 0149 = Level II Anal/Rectal Procedure 0150 = Level III Anal/Rectal Procedure 0151 = Endoscopic Retrograde Cholangio-Pancreatography (ERCP) 0152 = Percutaneous Biliary Endoscopic Procedures 0153 = Peritoneal and Abdominal Procedures 0154 = Hernia/Hydrocele Procedures 0157 = Colorectal Cancer Screening: Barium Enema (Not subject to National coinsurance) 0158 = Colorectal Cancer Screening: Colonoscopy Not subject to National coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. Payment rate is lower of the HOPD payment rate or the Ambulatory Surgical Center payment. 0159 = Colorectal Cancer Screening: Flexible Sigmoidoscopy Not subject to National coinsurance. Minimum unadjusted coinsurance is 25% of the payment rate. Payment rate is lower of the HOPD payment rate or the Ambulatory Surgical Center payment. 0160 = Level I Cystourethroscopy and other Genitourinary Procedures 0161 = Level II Cystourethroscopy and other Genitourinary Procedures 0162 = Level III Cystourethroscopy and other Genitourinary Procedures 0163 = Level IV Cystourethroscopy and other Genitourinary Procedures 0164 = Level I Urinary and Anal Procedures 0165 = Level II Urinary and Anal Procedures 0166 = Level I Urethral Procedures 0167 = Level II Urethral Procedures 0168 = Level III Urethral Procedures 0169 = Lithotripsy 0170 = Dialysis for Other Than ESRD Patients 0180 = Circumcision 0181 = Penile Procedures 0182 = Insertion of Penile Prosthesis 0183 = Testes/Epididymis Procedures 0184 = Prostate Biopsy 0190 = Surgical Hysteroscopy 0191 = Level I Female RePRODuctive Procedures 0192 = Level II Female RePRODuctive Procedures 0193 = Level III Female RePRODuctive Procedures 0194 = Level IV Female RePRODuctive Procedures 0195 = Level V Female RePRODuctive Procedures 0196 = Dilatation & Curettage 0197 = Infertility Procedures 0198 = Pregnancy and Neonatal Care Procedures 0199 = Vaginal Delivery 0200 = Therapeutic Abortion 0201 = Spontaneous Abortion 0210 = Spinal Tap 0211 = Level I Nervous System Injections 0212 = Level II Nervous System Injections 0213 = Extended EEG Studies and Sleep Studies 0214 = Electroencephalogram 0215 = Level I Nerve and Muscle Tests 0216 = Level II Nerve and Muscle Tests 0217 = Level III Nerve and Muscle Tests 0220 = Level I Nerve Procedures 0221 = Level II Nerve Procedures 0222 = Implantation of Neurological Device 0223 = Level I Revision/Removal Neurological Device (obsolete 12/00); Implantation of Pain Management Device (eff. 1/01) 0224 = Level II Revision/Removal Neurological Device (obsolete 12/00); Implantation of Reservoir/Pump/Shunt (eff. 1/01) 0225 = Implantation of Neurostimulator Electrodes 0226 = Implantation of Drug Infusion Reservior (eff. 1/01) 0227 = Implantation of Drug Infusion Device (eff. 1/01) 0228 = Creation of Lumbar Subarachnoid Shunt (eff. 1/01) 0229 = Transcatherter Placement of Intravascular Shunts (eff. 1/01) 0230 = Level I Eye Tests 0231 = Level II Eye Tests 0232 = Level I Anterior Segment Eye 0233 = Level II Anterior Segment Eye 0234 = Level III Anterior Segment Eye Procedures 0235 = Level I Posterior Segment Eye Procedures 0236 = Level II Posterior Segment Eye Procedures 0237 = Level III Posterior Segment Eye Procedures 0238 = Level I Repair and Plastic Eye Procedures 0239 = Level II Repair and Plastic Eye Procedures 0240 = Level III Repair and Plastic Eye Procedures 0241 = Level IV Repair and Plastic Eye Procedures 0242 = Level V Repair and Plastic Eye Procedures 0243 = Strabismus/Muscle Procedures 0244 = Corneal Transplant 0245 = Cataract Procedures without IOL Insert 0246 = Cataract Procedures with IOL Insert 0247 = Laser Eye Procedures Except Retinal 0248 = Laser Retinal Procedures 0250 = Nasal Cauterization/Packing 0251 = Level I ENT Procedures 0252 = Level II ENT Procedures 0253 = Level III ENT Procedures 0254 = Level IV ENT Procedures 0256 = Level V ENT Procedures 0257 = Implantation of Cochlear Device (obsolete 1/01) 0258 = Tonsil and Adenoid Procedures 0260 = Level I Plain Film Except Teeth 0261 = Level II Plain Film Except Teeth Including Bone Density Measurement 0262 = Plain Film of Teeth 0263 = Level I Miscellaneous Radiology Procedures 0264 = Level II Miscellaneous Radiology Procedures 0265 = Level I Diagnostic Ultrasound Except Vascular 0266 = Level II Diagnostic Ultrasound Except Vascular 0267 = Vascular Ultrasound 0268 = Guidance Under Ultrasound 0269 = Echocardiogram Except Transesophageal 0270 = Transesophageal Echocardiogram 0271 = Mammography 0272 = Level I Fluoroscopy 0273 = Level II Fluoroscopy 0274 = Myelography 0275 = Arthrography 0276 = Level I Digestive Radiology 0277 = Level II Digestive Radiology 0278 = Diagnostic Urography 0279 = Level I Diagnostic Angiography and Venography Except Extremity 0280 = Level II Diagnostic Angiography and Venography Except Extremity 0281 = Venography of Extremity 0282 = Level I Computerized Axial Tomography 0283 = Level II Computerized Axial Tomography 0284 = Magnetic Resonance Imaging 0285 = Positron Emission Tomography (PET) 0286 = Myocardial Scans 0290 = Standard Non-Imaging Nuclear Medicine 0291 = Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans 0292 = Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans 0294 = Level I Therapeutic Nuclear Medicine 0295 = Level II Therapeutic Nuclear Medicine 0296 = Level I Therapeutic Radiologic Procedures 0297 = Level II Therapeutic Radiologic Procedures 0300 = Level I Radiation Therapy 0301 = Level II Radiation Therapy 0302 = Level III Radiation Therapy 0303 = Treatment Device Construction 0304 = Level I Therapeutic Radiation Treatment Preparation 0305 = Level II Therapeutic Radiation Treatment Preparation 0310 = Level III Therapeutic Radiation Treatment Preparation 0311 = Radiation Physics Services 0312 = Radioelement Applications 0313 = Brachytherapy 0314 = Hyperthermic Therapies 0320 = Electroconvulsive Therapy 0321 = Biofeedback and Other Training 0322 = Brief Individual Psychotherapy 0323 = Extended Individual Psychotherapy 0324 = Family Psychotherapy 0325 = Group Psychotherapy 0330 = Dental Procedures 0340 = Minor Ancillary Procedures 0341 = Immunology Tests 0342 = Level I Pathology 0343 = Level II Pathology 0344 = Level III Pathology 0345 = Transfusion Laboratory Procedures Level I (eff. 1/01) 0346 = Transfusion Laboratory Procedures Level II (eff. 1/01) 0347 = Transfusion Laboratory Procedures Level III (eff. 1/01) 0348 = Fertility Laboratory Procedures (eff. 1/01) 0349 = Miscellaneous Laboratory Procedures (eff. 1/01) 0354 = Administration of Influenza Vaccine (Not subject to national coinsurance) 0355 = Level I Immunizations 0356 = Level II Immunizations 0357 = Level III Immunizations (obsolete 1/01) 0358 = Level IV Immunizations (obsolete 1/01) 0359 = Injections 0360 = Level I Alimentary Tests 0361 = Level II Alimentary Tests 0362 = Fitting of Vision Aids 0363 = Otorhinolaryngologic Function Tests 0364 = Level I Audiometry 0365 = Level II Audiometry 0366 = Electrocardiogram (ECG) (obsolete 1/01) 0367 = Level I Pulmonary Test 0368 = Level II Pulmonary Test 0369 = Level III Pulmonary Test 0370 = Allergy Tests 0371 = Allergy Injections 0372 = Therapeutic Phlebotomy 0373 = Neuropsychological Testing 0374 = Monitoring Psychiatric Drugs 0600 = Low Level Clinic Visits 0601 = Mid Level Clinic Visits 0602 = High Level Clinic Visits 0603 = Interdisciplinary Team Conference (obsolete 1/01) 0610 = Low Level Emergency Visits 0611 = Mid Level Emergency Visits 0612 = High Level Emergency Visits 0620 = Critical Care 0701 = Strontium (eligible for pass-through payments) (obsolete 12/00); SR 89 chloride, per mCi (eff. 1/01) 0702 = Samariam (eligible for pass-through payments) (obsolete 12/00); SM 153 lexidronam, 50 mCi (eff. 1/01) 0704 = IN 111 Satumomab Pendetide (eligible for pass-through payments) 0705 = Tc99 Tetrofosmin (eligible for pass-through payments) 0725 = Leucovorin Calcium (eligible for pass-through payments) 0726 = Dexrazoxane Hydrochloride (eligible for pass-through payments) 0727 = Injection, Etidronate Disodium (eligible for pass-through payments) 0728 = Filgrastim (G-CSF) (eligible for pass-through payments) 0730 = Pamidronate Disodium (eligible for pass-through payments) 0731 = Sargramostim (GM-CSF) (eligible for pass-through payments) 0732 = Mesna (eligible for pass-through payments) 0733 = Non-ESRD Epoetin Alpha (eligible for pass-through payments) 0750 = Dolasetron Mesylate 10 mg (eligible for pass-through payments) 0754 = Metoclopramide HCL (eligible for pass-through payments) 0755 = Thiethylperazine Maleate (eligible for pass-through payments) 0761 = Oral Substitute for IV Antiemtic (eligible for pass-through payments) 0762 = Dronabinol (elibible for pass-through payments) 0763 = Dolasetron Mesylate 100 mg Oral (eligible for pass-through payments) 0764 = Granisetron HCL, 100 mcg (eligible for pass-through payments) 0765 = Granisetron HCL, 1mg Oral (eligible for pass-through payments) 0768 = Ondansetron Hydrochloride per 1 mg Injection (eligible for pass-through payments) 0769 = Ondansetron Hydrochloride 8 mg oral (eligible for pass-through payments) 0800 = Leuprolide Acetate per 3.75 mg (eligible for pass-through payments) 0801 = Cyclophosphamide (eligible for pass-through payments) 0802 = Etoposide (eligible for pass-through payments) 0803 = Melphalan (eligible for pass-through payments) 0807 = Aldesleukin single use vial (eligible for pass-through payments) 0809 = BCG (Intravesical) one vial (eligible for pass-through payments) 0810 = Goserelin Acetate Implant, per 3.6 mg (eligible for pass-through payments) 0811 = Carboplatin 50 mg (eligible for pass-through payments) 0812 = Carmustine 100 mg (eligible for pass-through payments) 0813 = Cisplatin 10 mg (eligible for pass-through payments) 0814 = Asparaginase, 10,000 units (eligible for pass-through payments) 0815 = Cyclophosphamide 100 mg (eligible for pass-through payments) 0816 = Cyclophosphamide, Lyophilized 100 mg (eligible for pass-through payments) 0817 = Cytrabine 100 mg (eligible for pass-through payments) 0818 = Dactinomycin 0.5 mg (eligible for pass-through payments) 0819 = Dacarbazine 100 mg (eligible for pass-through payments) 0820 = Daunorubicin HCI 10 mg (eligible for pass-through payments) 0821 = Daunorubicin Citrate, Liposomal Formulation, 10 mg (eligible for pass-through payments) 0822 = Diethylstibestrol Diphosphate 250 mg (eligible for pass-through payments) 0823 = Docetaxel 20 mg (eligible for pass-through payments) 0824 = Etoposide 10 mg (eligible for pass-through payments) 0826 = Methotrexate Oral 2.5 mg (eligible for pass-through payments) 0827 = Floxuridine injection 500mg 0828 = Gemcitabine HCL 200 mg (eligibile for pass-through payments) 0830 = Irinotecan 20 mg (eligible for pass-through payments) 0831 = Ifosfamide injection 1 gm (eligible for pass-through payments) 0832 = Idarubicin HCL injection 5 mg (eligible for pass-through payments) 0833 = Interferon Alfacon-1, 1 mcg (eligible for pass-through payments) 0834 = Interferon, Alfa-2A, Recombinant 3 million units (eligible for pass-through payments) 0836 = Interferon, Alfa-2B, Recombinant, 1 million units (eligible for pass-through payments) 0838 = Interferon, Gamma 1-B injection, 3 million units (eligible for pass-through payments) 0839 = Mechlorethamine HCL injection 10 mg (eligible for pass-through payments) 0840 = Melphalan HCL 50 mg (eligible for pass-through payments) 0841 = Methotrexate sodium injection 5 mg (eligible for pass-through payments) 0842 = Fludarabine Phosphate injection 50 mg (eligible for pass-through payments) 0843 = Pegaspargase, single dose vial (eligible for pass-through payments) 0844 = Pentostatin injection, 10 mg (eligible for pass-through payments) 0847 = Doxorubicin HCL 10 mg (eligible for pass-through payments) 0849 = Rituximab, 100 mg (eligible for pass-through payments) 0850 = Streptozocin injection, 1 gm (eligible for pass-through payments) 0851 = Thiotepa injection, 15 mg (eligible for pass-through payments) 0852 = Topotecan 4 mg (eligible for pass-through payments) 0853 = Vinblastine Sulfate injection, 1 mg (eligible for pass-through payments) 0854 = Vincristine Sulfate 1 mg (eligible for pass-through payments) 0855 = Vinorelbine Tartrate per 10 mg (eligible for pass-through payments) 0856 = Porfimer Sodium 75 mg (eligible for pass-through payments) 0857 = Bleomycin Sulfate injection 15 units (eligible for pass-through payments) 0858 = Cladribine, 1mg (eligible for pass-through payments) 0859 = Fluorouracil injection 500 mg 0860 = Plicamycin (mithramycin) injection, 2.5 mg 0861 = Leuprolide Acetate 1 mg (eligible for pass-through payments) 0862 = Mitomycin, 5mg (eligible for pass-through payments) 0863 = Paclitaxel, 30mg (eligible for pass-through payments) 0864 = Mitoxantrone HCl, per 5mg (eligible for pass-through payments) 0865 = Interferon alfa-N3, 250,000 IU (eligible for pass-through payments) 0884 = Rho (D) Immune Globulin, Human one dose pack (eligible for pass-through payments) 0886 = Azathioprine, 50 mg oral (Not subject to national coinsurance) 0887 = Azathioprine, Parenteral 100 mg, 20 ml each injection (Not subject to national coinsurance) 0888 = Cyclosporine, Oral 100 mg (Not subject to national coinsurance) 0889 = Cyclosporine, Parenteral (Not subject to national coinsurance) 0890 = Lymphocyte Immune Globulin 250 mg (Not subject to national coinsurance) 0891 = Tacrolimus per 1 mg oral (Not subject to national coinsurance) 0892 = Daclizumab, Parenteral, 25 mg (obsolete 1/01) (eligible for pass-through payments) 0900 = Injection, Alglucerase per 10 units (eligible for pass-through payments) 0901 = Alpha I, Proteinase Inhibitor, Human per 10mg (eligible for pass-through payments) 0902 = Botulinum Toxin, Type A per unit (eligible for pass-through payments) 0903 = CMV Immune Globulin (obsolete 12/00); Cytomegalovirus imm IV, vial (eligible for pass-through payments) (eff. 1/01) 0905 = Immune Globulin per 500 mg (eligible for pass-through payments) 0906 = RSV-ivig 50 mg (eligible for pass-through payments) 0907 = Ganciclovir Sodium 500 mg injection (Not subject to national coinsurance) 0908 = Tetanus Immune Globulin, injection up to 250 units (Not subject to national coinsurance) 0909 = Interferon Beta - 1a 33 mcg (eligible for pass-through payments) 0910 = Interferon Beta - 1b 0.25 mg (eligible for pass-through payments) 0911 = Streptokinase per 250,000 iu (Not subject to national coinsurance) 0913 = Ganciclovir long act implant 4.5 mg (eligible for pass-through payments) 0914 = Reteplase, 37.6 mg (Not subject to national coinsurance) 0915 = Alteplase injection,recombinant, 10mg (Not subject to national coinsurance) 0916 = Imiglucerase per unit (eligible for pass-through payments) 0917 = Dipyridamole, 10mg / Adenosine 6MG (Not subject to national coinsurance) (obsolete 1/01) Pharmalogic stresses (eff. 1/01) 0918 = Brachytherapy Seeds, Any type, Each (eligible for pass-through payments) (obsolete 4/01) 0925 = Factor VIII (Antihemophilic Factor, Human) per iu (eligible for pass-through payments) 0926 = Factor VIII (Antihemophilic Factor, Porcine) per iu (eligible for pass-through payments) 0927 = Factor VIII (Antihemophilic Factor, Recombinant) per iu (eligible for pass-through payments) 0928 = Factor IX, Complex (eligible for pass-through payments) 0929 = Other Hemophilia Clotting Factors per iu (eligible for pass-through payments) (obsolete 1/01) Anti-inhibitor per iu (eff. 1/01) 0930 = Antithrombin III (Human) per iu (eligible for pass-through payments) 0931 = Factor IX (Antihemophilic Factor, Purified, Non-Recombinant) (eligible for pass-through payments) 0932 = Factor IX (Antihemophilic Factor, Recombinant) (eligible for pass-through payments) 0949 = Plasma, Pooled Multiple Donor, Solvent/Detergent Treated, Frozen (not subject to national coinsurance) 0950 = Blood (Whole) For Transfusion (not subject to national coinsurance) 0952 = Cryoprecipitate (not subject to national coinsurance) 0953 = Fibrinogen Unit (not subject to national coinsurance) 0954 = Leukocyte Poor Blood (not subject to national coinsurance) 0955 = Plasma, Fresh Frozen (not subject to national coinsurance) 0956 = Plasma Protein Fraction (not subject to national coinsurance) 0957 = Platelet Concentrate (not subject to national coinsurance) 0958 = Platelet Rich Plasma (not subject to national coinsurance) 0959 = Red Blood Cells (not subject to national coinsurance) 0960 = Washed Red Blood Cells (not subject to national coinsurance) 0961 = Infusion, Albumin (Human) 5%, 500 ml (not subject to national coinsurance) 0962 = Infusion, Albumin (Human) 25%, 50 ml (not subject to national coinsurance) 0970 = New Technology - Level I ($0 - $50) (not subject to national coinsurance) 0971 = New Technology - Level II ($50 - $100) (not subject to national coinsurance) 0972 = New Technology - Level III ($100 - $200) (not subject to national coinsurance) 0973 = New Technology - Level IV ($200 - $300) (not subject to national coinsurance) 0974 = New Technology - Level V ($300 - $500) (not subject to national coinsurance) 0975 = New Technology - Level VI ($500 - $750) (not subject to national coinsurance) 0976 = New Technology - Level VII ($750 - $1000) (not subject to national coinsurance) 0977 = New Technology - Level VIII ($1000 - $1250) (not subject to national coinsurance) 0978 = New Technology - Level IX ($1250 - $1500) (not subject to national coinsurance) 0979 = New Technology - Level X ($1500 - $1750) (not subject to national coinsurance) 0980 = New Technology - Level XI ($1750 - $2000) (not subject to national coinsurance) 0981 = New Technology - Level XII ($2000 - $2500) (not subject to national coinsurance) 0982 = New Technology - Level XIII ($2500 - $3500) (not subject to national coinsurance) 0983 = New Technology - Level XIV ($3500 - $5000) (not subject to national coinsurance) 0984 = New Technology - Level XV ($5000 - $6000) (not subject to national coinsurance) 0987 = New Device Technology - Level I ($0 - $250) (eff. 1/01) 0988 = New Device Technology - Level II ($250 - $500) (eff. 1/01) 0989 = New Device Technology - Level III ($500 - $750) (eff. 1/01) 0990 = New Device Technology - Level IV ($750 - $1000) (eff. 1/01) 0991 = New Device Technology - Level V ($1000 - $1500) (eff. 1/01) 0992 = New Device Technology - Level VI ($1500 - $2000) (eff. 1/01) 0993 = New Device Technology - Level VII ($2000 - $3000) (eff. 1/01) 0994 = New Device Technology - Level VIII ($3000 - $4000) (eff. 1/01) 0995 = New Device Technology - Level IX ($4000 - $5000) (eff. 1/01) 0996 = New Device Technology - Level X ($5000 - $7000) (eff. 1/01) 0997 = New Device Technology - Level XI ($7000 - $9000) (eff. 1/01) 1000 = Perclose Closer Prostar Arterial Vascular Closure (eff. 1/01) 1001 = AcuNav-diagnostic ultrasound ca (eff. 1/01) 1002 = Cochlear Implant System (eff. 1/01) 1003 = Cath, ablation, livewire TC (eff. 1/01) 1004 = Fast-Cath, Swartz, SAFL, CSTA (eff. 1/01) 1006 = ARRAY post chamb IOL (eff. 1/01) 1007 = Ams 700 penile prosthesis (eff. 1/01) 1008 = Urolume-implant urethral stent (eff. 1/01) 1009 = Plasma, cryoprecipitate-reduced, unit (eff. 1/01) 1010 = Blood, L/R CMV-neg (eff. 1/01) 1011 = Platelets, L/R, CMV-neg (eff. 1/01) 1012 = Platelet concentrate, L/R, irradiated, unit (eff. 1/01) 1013 = Platelet concentrate, L/R, unit (eff. 1/01) 1014 = Platelets, aph/pher, L/R, unit (eff. 1/01) 1016 = Blood, L/R, froz/deglycerol/washed (eff. 1/01) 1017 = Platelets, aph/pher, L/R CMV-neg, unit (eff. 1/01) 1018 = Blood, L/R, irradiated (eff. 1/01) 1019 = Platelets, aph/pher, L/R, irradiated, unit (eff. 1/01) 1024 = Quinupristin 150 mg/dalfopriston 350 mg (eff. 1/01) 1025 = Marinr CS catheter (eff. 1/01) 1026 = RF Perfrmr cath 5F RF Marinr (eff. 1/01) 1027 = Magic x/short, radius 14m (eff. 1/01) 1028 = Prcis Twst trnsvg anch sys (eff. 1/01) 1029 = CRE guided balloon dil cath (eff. 1/01) 1030 = Cthtr:Mrshal, Blu Max Utr Dmnd (eff. 1/01) 1033 = Sonicath mdl 37-410 (eff. 1/01) 1034 = SURPASS, Long30 SURPASS-cath (eff. 1/01) 1035 = Cath, Ultra ICE (eff. 1/01) 1036 = R port/reservior impl dev (eff. 1/01) 1037 = Vaxcelchronic dialysis cath (eff. 1/01) 1038 = UltraCross Imaging Cath (eff. 1/01) 1039 = Wallstent/RP:Trach (eff. 1/01) 1040 = Wallstent/RP TIPS -- 20/40/60 (eff. 1/01) 1042 = Wallstent, UltraFlex: Bil (eff. 1/01) 1045 = I-131 MIBG (ioben-sulfate) 0.5 mCi (eff. 1/01) 1047 = Navi-Star, Noga-Star cath (eff. 1/01) 1048 = NeuroCyberneticPros: gen (eff. 1/01) 1051 = Oasis Thrombectomy Cath (eff. 1/01) 1053 = EnSite 3000 catheter (eff. 1/01) 1054 = Hydrolyser Thromb Cath 6/7F (eff. 1/01) 1055 = Transesoph 210, 210-S Cath (eff. 1/01) 1056 = Thermachoice II Cath (eff. 1/01) 1057 = Micromark Tissue Marker (eff. 1/01) 1059 = Carticel, auto cult-chndr cyte (eff. 1/01) 1060 = ACS multi-link tristor stent (eff. 1/01) 1061 = ACS Viking Guiding cath (eff. 1/01) 1063 = EndoTak Endurance EZ,RX leads (eff. 1/01) 1067 = Megalink biliary stent (eff. 1/01) 1068 = Pulsar DDD pmkr (eff. 1/01) 1069 = Discovery DR, pmaker 1071 = Pulsar Max, Pulsar SR pmkr (eff. 1/01) 1072 = Guidant: blln dil cath (eff. 1/01) 1073 = Gynecare Morcellator (eff. 1/01) 1074 = RX/OTW Viatrac-peri dil cath (eff. 1/01) 1075 = Guidant: lead (eff. 1/01) 1076 = Ventak minisc defib (eff. 1/01) 1077 = Ventak VR Prizm VR, sc defib (eff. 1/01) 1078 = Ventak: Prizm, AVIIIDR defib 1079 = CO 57/58 0.5 mCi (eff. 1/01) 1084 = Denileukin diftitox, 300 mcg (eff. 1/01) 1086 = Temozolomide, 5 mg (eff. 1/01) 1087 = I-123 per uCi capsule (eff. 1/01) 1089 = CO 57, 0.5 mCi (eff. 1/01) 1090 = IN 111 Chloride, per mCi (eff. 1/01) 1091 = IN 111 Oxyquinoline, per 5 mCi (eff. 1/01) 1092 = IN 111 Pentetate, per 1.5 mCi (eff. 1/01) 1094 = TC 99M Albumin aggr, per vial 1095 = TC 99M Depreotide, per vial (eff. 1/01) 1096 = TC 99M Exametazime, per dose (eff. 1/01) 1097 = TC 99M Mebrofenin, per vial (eff. 1/01) 1098 = TC 99M Pentetate, per vial (eff. 1/01) 1099 = TC 99M Pyrophosphate, per vial (eff. 1/01) 1100 = Medtronic AVE GT1 guidewire (eff. 1/01) 1101 = Medtronic AVE, AVE Z2 cath (eff. 1/01) 1102 = Synergy Neurostim Genrtr (eff. 1/01) 1103 = Micro Jewell Defibrillator (eff. 1/01) 1104 = RF ConductorAblative Cath (eff. 1/01) 1105 = Sigman 300VDD pacmkr (eff. 1/01) 1106 = SynergyEZ Pt Progmr (eff. 1/01) 1107 = Torqr, Solist cath (eff. 1/01) 1108 = Reveal Cardiac Recorder (eff. 1/01) 1109 = Implantable anchor: Ethicon (eff. 1/01) 1110 = Stable Mapper, cath electrd (eff. 1/01) 1111 = AneuRxAort-Uni-llicstnt & cath (eff. 1/01) 1112 = AneuRx Stent graft/del cath (eff. 1/01) 1113 = Tlnt Endo Sprng Stnt Grft Sys (eff. 1/01) 1114 = TalntSprgStnt + Graf endo pros (eff. 1/01) 1115 = 5038S, 5038, 5038L pace lead (eff. 1/01) 1116 = CapSureSP pacing lead (eff. 1/01) 1117 = Ancure Endograft Del Sys (eff. 1/01) 1118 = Sigma300DR LegIIDR, pacemkr (eff. 1/01) 1119 = Sprint6932, 6943 defib lead (eff. 1/01) 1120 = Sprint6942, 6945 defi lead (eff. 1/01) 1121 = Gem defibrillator (eff. 1/01) 1122 = TC 99M arcitumomab per dose (eff. 1/01) 1123 = Gem II VR defibrillator (eff. 1/01) 1124 = InterStim Test Stim Kit (eff. 1/01) 1125 = Kappa 400SR, Ttopaz II SR pmkr (eff. 1/01) 1126 = Kappa 700 DR pacemkr (eff. 1/01) 1127 = Kappa 700SR, pmkr sgl chamber (eff. 1/01) 1128 = Kappa 700D, Ruby IID pmkr (eff. 1/01) 1129 = Kappa 700VDD, pacmkr (eff. 1/01) 1130 = Sigma 200D, LGCY IID sc pmkr (eff. 1/01) 1131 = Sigma 200DR pmker (eff. 1/01) 1132 = Sigma 200SR Leg II:sc pac (eff. 1/01) 1133 = Sigma SR, Vita SR, pmaker (eff. 1/01) 1134 = Sigma 300D pmker (eff. 1/01) 1135 = Entity DR 5326L/R, DC, pmkr (eff. 1/01) 1136 = Affinity DR 5330L/R, DC, pmkr (eff. 1/01) 1137 = CardioSEAL implant syst (eff. 1/01) 1143 = AddVent mod 2060BL, VDD (eff. 1/01) 1144 = Afnty SP 5130, Integrity SR, pmkr (eff. 1/01) 1145 = Angio-Seal 6fr, 8fr (eff. 1/01) 1147 = AV Plus DX 1368: lead (eff. 1/01) 1148 = Contour MD sc defib (eff. 1/01) 1149 = Entity DC 5226R-pmker (eff. 1/01) 1151 = Passiveplus DXlead, 10mdls (eff. 1/01) 1152 = LifeSite Access System (eff. 1/01) 1153 = Regency SC+ 2402L pmkr (eff. 1/01) 1154 = SPL:SPOI, 0204- defib lead (eff. 1/01) 1155 = Repliform 8 sq cm (eff. 1/01) 1156 = Tr 1102TrSR+ 2260L, 2264L, 5131 (eff. 1/01) 1157 = Trilogy DCT 23/8L pmkr (eff. 1/01) 1158 = TVL lead SV01, SV02, SV04 (eff. 1/01) 1159 = TVL RV02, RV06, RV07: lead (eff. 1/01) 1160 = TVL-ADX 1559: lead (eff. 1/01) 1161 = Tendril DX, 1338 pacing lead (eff. 1/01) 1162 = TempoDr, TrilogyDR+ DC pmkr (eff. 1/01) 1163 = Tendril SDX, 1488T pacing lead (eff. 1/01) 1164 = Iodine-125 brachytx seed (eff. 1/01) 1166 = Cytarabine liposomal, 10 mg (eff. 1/01) 1167 = Epirubicin hcl, 2 mg (eff. 1/01) 1171 = Autosuture site marker stple (eff. 1/01) 1172 = Spacemaker dissect ballon (eff. 1/01) 1173 = Cor stntS540, S670, o-wire stn (eff. 1/01) 1174 = Bard brachytx needle (eff. 1/01) 1178 = Busulfan IV, 6 mg (eff. 1/01) 1180 = Vigor SR, SC, pmkr (eff. 1/01) 1181 = Meridian SSI, SC pmkr (eff. 1/01) 1182 = Pulsar SSI, SC, pmkr (eff. 1/01) 1183 = Jade IIS, Sigma 300S, SC, pmkr (eff. 1/01) 1184 = Sigma 200S, SC, pmkr (eff. 1/01) 1188 = I 131, per mCi (eff. 1/01) 1200 = TC 99M Sodium Clucoheptonate, per vial (eff. 1/01) 1201 = TC 99M succimer, per vial (eff. 1/01) 1202 = TC 99M Sulfur Colloid, per dose (eff. 1/01) 1203 = Verteporfin for Injection (eff. 1/01) 1205 = TC 99M Disofenin, per vial (eff. 1/01) 1207 = Octreotide acetate depot 1 mg (eff. 1/01) 1302 = SQ01:lead (eff. 1/01) 1303 = CapSure Fix 6940/4068-110, lead (eff. 1/01) 1304 = Sonicath mdl 37-416,-418 (eff. 1/01) 1305 = Apligraf (eff. 1/01) 1306 = NeuroCyberneticsPros: lead (eff. 1/01) 1311 = Trilogy DR + DAO pmkr (eff. 1/01) 1312 = Magic WALLSTENT stent-mini (eff. 1/01) 1313 = Magic medium, radius 31mm (eff. 1/01) 1314 = Magic WALLSTENT stent-Long (eff. 1/01) 1315 = Vigor DR, Meridian DR pmkr (eff. 1/01) 1316 = Meridian DDD pmkr (eff. 1/01) 1317 = Discovery SR, pmkr (eff. 1/01) 1318 = Meridian SR pmkr (eff. 1/01) 1319 = Wallstent/RP Enteral--60mm (eff. 1/01) 1320 = Wallstent/RP lliac Del Sys (eff. 1/01) 1325 = Pallidium - 103 seed (eff. 1/01) 1326 = Angio-jet rheolytic thromb cath (eff. 1/01) 1328 = ANS Renew NS trnsmtr (eff. 1/01) 1333 = PALMZA Corinthian bill stent (eff. 1/01) 1334 = Crown, Mini-crown,CrossLC (eff. 1/01) 1335 = Mesh, Prolene (eff. 1/01) 1336 = Constant Flow Imp Pump (eff. 1/01) 1337 = IsoMed 8472-20/35/60 (eff. 1/01) 1348 = I 131 per mCi solution (eff. 1/01) 1350 = Prosta/OncoSeed, RAPID strand, I-125 (eff. 1/01) 1351 = CapSure (Fix) pacing lead (eff. 1/01) 1352 = Gem II defib (eff. 1/01) 1353 = Itrel Interstm neurostim + ext (eff. 1/01) 1354 = Kappa 400DR, Diamond II 820 DR (eff. 1/01) 1355 = Kappa 600 DR, Vita DR (eff. 1/01) 1356 = Profile MD V-186HV3 sc defib (eff. 1/01) 1357 = Angstrom MD V-190HV3 sc defib (eff. 1/01) 1358 = Affinity DC 5230R-Pacemaker (eff. 1/01) 1359 = Pulsar, Pulsar Max DR, pmkr (eff. 1/01) 1363 = Gem DR, DC, defib (eff. 1/01) 1364 = Photon DR V-230HV3 DC defib (eff. 1/01) 1365 = Guidewire, Hi-Torque 14/18/35 (eff. 1/01) 1366 = Guidewire, PTCA, Hi-Torque (eff. 1/01) 1367 = Guidewire, Hi-Torque Crosslt (eff. 1/01) 1369 = ANS Renew Stim Sys recvr (eff. 1/01) 1370 = Tension-Free Vaginal Tape (eff. 1/01) 1371 = Symp Nitinol Transhep Bil Sys (eff. 1/01) 1372 = Cordis Nitinol bil Stent (eff. 1/01) 1375 = Stent, corornary, NIR (eff. 1/01) 1376 = ANS Renew Stim Sys lead (eff. 1/01) 1377 = Specify 3988 neuro lead (eff. 1/01) 1378 = InterStim Tx 3080/3886 lead (eff. 1/01) 1379 = Pisces-Quad 3887 lead (eff. 1/01) 1400 = Diphenhydramine hcl 50 mg (eff. 1/01) 1401 = Prochlorperazine maleate 5 mg (eff. 1/01) 1402 = Promethazine hcl 12.5 mg oral (eff. 1/01) 1403 = Chlorpromazine hcl 10mg oral (eff. 1/01) 1404 = Trimethobenzamide hcl 250mg (eff. 1/01) 1405 = Thiethylperazine maleate 10 mg (eff. 1/01) 1406 = Perphenazine 4 mg oral (eff. 1/01) 1407 = Hydroxyzine pamoate 25 mg (eff. 1/01) 1409 = Factor via recombinant, per 1.2 mg (eff. 1/01) 1410 = Prosorba column (eff. 1/01) 1411 = Herculink, OTW SDS bil stent (eff. 1/01) 1420 = StapleTac2 Bone w/Dermis (eff. 1/01) 1421 = StapleTac2 Bone w/o Dermis (eff. 1/01) 1450 = Orthosphere Arthroplasty (eff. 1/01) 1451 = Orthosphere Arthroplasty Kity (eff. 1/01) 1500 = Atherectomy sys, peripheral (eff. 1/01) 1600 = TC 99M sestamibi, per syringe (eff. 1/01) 1601 = TC 99M medronate, per dose (eff. 1/01) 1602 = TC 99M apcitide, per vial (eff. 1/01) 1603 = TL 201, mCi (eff. 1/01) 1604 = IN 111 capromab pendetide, per dose (eff. 1/01) 1605 = Abciximab injection, 10 mg (eff. 1/01) 1606 = Anistreplase, 30 u (eff. 1/01) 1607 = Eptifibatide injection, 5 mg (eff. 1/01) 1608 = Etanercept injection, 25 mg (eff. 1/01) 1609 = Rho(D) Immune globulin h, sd 100 iu (eff. 1/01) 1611 = Hylan G-F 20 injection, 16 mg (eff. 1/01) 1612 = Daclizumab, parenteral, 25 mg (eff. 1/01) 1613 = Trastuzumab, 10 mg (eff. 1/01) 1614 = Valrubicin, 200 mg (eff. 1/01) 1615 = Basiliximab, 20 mg (eff. 1/01) 1616 = Histrelin Acetate, 0.5 mg (eff. 1/01) 1617 = Lepirdin, 50 mg (eff. 1/01) 1618 = Von Willebrand factor, per iu (eff. 1/01) 1619 = Ga 67, per mCi (eff. 1/01) 1620 = TC 99M Bicisate, per vial (eff. 1/01) 1621 = Xe 133, per mCi (eff. 1/01) 1622 = TC 99M Mertiatide, per vial (eff. 1/01) 1623 = TC 99M Gluceptate (eff. 1/01) 1624 = P32 sodium, per mCi (eff. 1/01) 1625 = IN 111 Pentetreotide, per mCi (eff. 1/01) 1626 = TC 99M Oxidronate, per vial (eff. 1/01) 1627 = TC-99 labeled red blood cell, per test (eff. 1/01) 1628 = P32 phosphate chromic,per mCi (eff. 1/01) 1700 = Authen Mick TP brachy needle (eff. 1/01) (obsolete 4/01) 1701 = Medtec MT-BT-5201-25 ndl (eff. 1/01) (obsolete 4/01) 1702 = WWMT brachytx needle (eff. 1/01) (obsolete 4/01) 1703 = Mentor Prostate Brachy (eff. 1/01) (obsolete 4/01) 1704 = MT-BT-5001-25/5051-25 (eff. 1/01) (obsolete 4/01) 1705 = Best Flexi Brachy Needle (eff. 1/01) (obsolete 4/01) 1706 = Indigo Prostate Seeding Ndl (eff. 1/01) (obsolete 4/01) 1707 = Varisource Implt Ndl (eff. 1/01) (obsolete 4/01) 1708 = UroMed Prostate Seed Ndl (eff. 1/01) (obsolete 4/01) 1709 = Remington Brachytx Needle (eff. 1/01) (obsolete 4/01) 1710 = US Biopsy Prostate Needle (eff. 1/01) (obsolete 4/01) 1711 = MD Tech brachytx needle (eff. 1/01) (obsolete 4/01) 1712 = Imagyn brachytx needle (eff. 1/01) (obsolete 4/01) 1713 = Anchor/screw bn/bn,tis/bn (eff. 4/01) 1714 = Cath, trans atherectomy, dir (eff. 4/01) 1715 = Brachytherapy needle (eff. 4/01) 1716 = Brachytx seed, Gold 198 (eff. 4/01) 1717 = Brachytx seed, HDR Ir-192 (eff. 4/01) 1718 = Brachytx seed, Iodine 125 (eff. 4/01) 1719 = Brachytx seed, Non-HDR Ir-192 (eff. 4/01) 1720 = Brachytx, Palladium 103 (eff. 4/01) 1721 = AICD, dual chamber (eff. 4/01) 1722 = AICD, single chamber (eff. 4/01) 1723 = Cath, ablation, non-cardiac (eff. 4/01) 1724 = Cath, trans atherec, rotation (eff. 4/01) 1725 = Cath, translumin non-laser (eff. 4/01) 1726 = Cath, bal dil, non-vascular (eff. 4/01) 1727 = Cath, bal tis, dis, nonvas (eff. 4/01) 1728 = Cath, brachytx seed adm (eff. 4/01) 1729 = Cath, drainage, biliary (eff. 4/01) 1730 = Cath, EP, 19 or fewer elect (eff. 4/01) 1731 = Cath, EP, 20 or more elect (eff. 4/01) 1732 = Cath, EP, diag/abl, 3D/vect (eff. 4/01) 1733 = Cath, EP, other than temp (eff. 4/01) 1750 = Cath, hemodialysis, long-term (eff. 4/01) 1751 = Cath, inf pr/cent/midline (eff. 4/01) 1752 = Cath, hemodialysis, short-term (eff. 4/01) 1753 = Cath, intravas ultrasound (eff. 4/01) 1754 = Catheter, intradiscal (eff. 4/01) 1755 = Catheter, intraspinal (eff. 4/01) 1756 = Cath, pacing, transesoph (eff. 4/01) 1757 = Cath, thrombectomy/embolect (eff. 4/01) 1758 = Cath, ureteral (eff. 4/01) 1759 = Cath, intra echocardiography (eff. 4/01) 1760 = Closure dev, vasc, imp/insert (eff. 4/01) 1762 = Conn tiss, human (inc fascia) (eff. 4/01) 1763 = Conn tiss, non-human (eff. 4/01) 1764 = Event recorder, cardiac (eff. 4/01) 1767 = Generator, neurostim, imp (eff. 4/01) 1768 = Graft, vascular (eff. 4/01) 1769 = Guide wire (eff. 4/01) 1770 = Imaging coil, MR insertable (eff. 4/01) 1771 = Rep dev, urinary , w/sling (eff. 4/01) 1772 = Infusion pump, programmable (eff. 4/01) 1773 = Retrieval dev, insert (eff. 4/01) 1776 = Joint device (implantable) (eff. 4/01) 1777 = Lead, AICD, endo single coil (eff. 4/01) 1778 = Lead, neurostimulator (eff. 4/01) 1779 = Lead, pmkr, transvenous VDD (eff. 4/01) 1780 = Lens, intraocular (eff. 4/01) 1781 = Mesh (implantable) (eff. 4/01) 1782 = Morcellator (eff. 4/01) 1784 = Ocular dev, intraop, det ret (eff. 4/01) 1785 = Pmkr, dual, rate-resp (eff. 4/01) 1786 = Pmkr, single, rate-resp (eff. 4/01) 1787 = Patient progr, neurostim (eff. 4/01) 1788 = Port, indwelling, imp (eff. 4/01) 1789 = Prosthesis, breast, imp. (eff. 4/01) 1790 = Iridium 192 HDR (eff. 1/01) (obsolete 4/01) 1791 = OncoSeed, Rapid Strand I-125 (eff. 1/01) (obsolete 4/01) 1792 = UroMed I-125 Brachy seed (eff. 1/01) (obsolete 4/01) 1793 = Bard InterSource P-103 seed (eff. 1/01) (obsolete 4/01) 1794 = Bard IsoSeed P-103 seed (eff. 1/01) (obsolete 4/01) 1795 = Bard BrachySource I-125 (eff. 1/01) (obsolete 4/01) 1796 = Source Tech Med I-125 (eff. 1/01) (obsolete 4/01) 1797 = Draximage I-125 seed (eff. 1/01) (obsolete 4/01) 1798 = Syncor I-125 PharmaSeed (eff. 1/01) (obsolete 4/01) 1799 = I-Plant I-125 Brachytx seed (eff. 1/01) (obsolete 4/01) 1800 = Pd-103 brachytx seed (eff. 1/01) (obsolete 4/01) 1801 = IoGold I-125 brachytx seed (eff. 1/01) (obsolete 4/01) 1802 = Iridium 192 brachytx seed (eff. 1/01) (obsolete 4/01) 1803 = Best Iodine 125 brachytx seeds (eff. 1/01) (obsolete 4/01) 1804 = Best Palladium 103 seeds (eff. 1/01) (obsolete 4/01) 1805 = IsoStar Iodine-125 seeds (eff. 1/01) (obsolete 4/01) 1806 = Gold 198 (eff. 1/01) (obsolete 4/01) 1810 = D114S Dilatation Cath (eff. 1/01) (obsolete 4/01) 1811 = Surgical Dynamics Anchors (eff. 1/01) (obsolete 4/01) 1812 = OBL Anchors (eff. 1/01) (obsolete 4/01) 1813 = Prosthesis, penile, inflatab (eff. 4/01) 1815 = Pros, urinary sph, imp (eff. 4/01) 1816 = Receiver/transmitter, neuro (eff. 4/01) 1817 = Septal defect imp sys (eff. 4/01) 1850 = Repliform 14/21 sq cm (eff. 1/01) (obsolete 4/01) 1851 = Repliform 24/28 sq cm (eff. 1/01) (obsolete 4/01) 1852 = TransCyte, per 247 sq cm (eff. 1/01) (obsolete 4/01) 1853 = Suspend, per 8/14 sq cm (eff. 1/01) (obsolete 4/01) 1854 = Suspend, per 24/28 sq cm (eff. 1/01) (obsolete 4/01) 1855 = Suspend, per 36 sq cm (eff. 1/01) (obsolete 4/01) 1856 = Suspend, per 48 sq cm (eff. 1/01) (obsolete 4/01) 1857 = Suspend, per 84 sq cm (eff. 1/01) (obsolete 4/01) 1858 = DuraDerm, per 8/14 sq cm (eff. 1/01) (obsolete 4/01) 1859 = DuraDerm, per 21/24 sq cm (eff. 1/01) (obsolete 4/01) 1860 = DuraDerm, per 48 sq cm (eff. 1/01) (obsolete 4/01) 1861 = DuraDerm, per 36 sq cm (eff. 1/01) (obsolete 4/01) 1862 = DuraDerm, per 72 sq cm (eff. 1/01) (obsolete 4/01) 1863 = DuraDerm, per 84 sq cm (eff. 1/01) (obsolete 4/01) 1864 = SpermaTex, per 13/44 sq cm (eff. 1/01) (obsolete 4/01) 1865 = FasLata, per 8/14 sq cm (eff. 1/01) (obsolete 4/01) 1866 = FasLata, per 24/28 sq cm (eff. 1/01) (obsolete 4/01) 1867 = FasLata, per 36/48 sq cm (eff. 1/01) (obsolete 4/01) 1868 = FasLata, per 96 sq cm (eff. 1/01) (obsolete 4/01) 1869 = Gore Thyroplasty Dev (eff. 1/01) (obsolete 4/01) 1870 = DermMatrix, per 16 sq cm (eff. 1/01) (obsolete 4/01) 1871 = DermMatrix, 32 or 64 sq cm (eff. 1/01) (obsolete 4/01) 1872 = Dermagraft, per 37.5 sq cm (eff. 1/01) (obsolete 4/01) 1873 = Bard 3DMax Mesh (eff. 1/01) (obsolete 4/01) 1874 = Stent, coated/cov w/del sys (eff. 4/01) 1875 = Stent, coated/cov w/o del sys (eff. 4/01) 1876 = Stent, non-coated/no-cov w/del (eff. 4/01) 1877 = Stent, non-coated/cov w/o del (eff. 4/01) 1878 = Martl for vocal cord (eff. 4/01) 1879 = Tissue marker, imp (eff. 4/01) 1880 = Vena cava filter (eff. 4/01) 1881 = Dialysis access system (eff. 4/01) 1882 = AICD, other than sing/dual (eff. 4/01) 1883 = Adapt/ext, pacing/neuro lead (eff. 4/01) 1885 = Cath, translumin angio laser (eff. 4/01) 1887 = Catheter, guiding (eff. 4/01) 1891 = Infusion pump, non-prog, perm (eff. 4/01) 1892 = Intro/sheath , fixed, peel-away (eff. 4/01) 1893 = Intro/sheath, fixed, non-peel (eff. 4/01) 1894 = Intro/sheath, non-laser (eff. 4/01) 1895 = Lead, AICD, endo dual coil (eff. 4/01) 1896 = Lead, AICD, non sing/dual (eff. 4/01) 1897 = Lead, neurostim test kit (eff. 4/01) 1898 = Lead, pmkr, other than trans (eff. 4/01) 1899 = Lead, pmkr/AICD combination (eff. 4/01) 1929 = Maverick PTCA Cath (eff. 1/01) (obsolete 4/01) 1930 = Coyote Dil Cath, 20/30/40mm (eff. 1/01) (obsolete 4/01) 1931 = Talon Dil Cath (eff. 1/01) (obsolete 4/01) 1932 = Scimed remedy Dil Cath (eff. 1/01) (obsolete 4/01) 1933 = Opti-Plast XL/Centurion Cath (eff. 1/01) (obsolete 4/01) 1934 = Ultraverse 3.5F Bal Dil Cath (eff. 1/01) (obsolete 4/01) 1935 = Workhorse PTA Bal Cath (eff. 1/01) (obsolete 4/01) 1936 = Uromax Ultra Bal Dil Cath (eff. 1/01) (obsolete 4/01) 1937 = Synergy Balloon Dil Cath (eff. 1/01) (obsolete 4/01) 1938 = Uroforce Bal Dil Cath (eff. 1/01) (obsolete 4/01) 1939 = Raptur, Ninja PTCA Dil Cath (eff. 1/01) (obsolete 4/01) 1940 = PowerFlex, OPTA 5/LP Bal Cath (eff. 1/01) (obsolete 4/01) 1941 = Jupiter PTA Dil Cath (eff. 1/01) (obsolete 4/01) 1942 = Cordis Maxi LD PTA Bal Cath (eff. 1/01) (obsolete 4/01) 1943 = RXCrossSail OTW OpenSail (eff. 1/01) (obsolete 4/01) 1944 = Rapid Exchange Bil Dil Cath (eff. 1/01) (obsolete 4/01) 1945 = Savvy PTA Dil Cath (eff. 1/01) (obsolete 4/01) 1946 = R1s Rapid Dil Cath (eff. 1/01) (obsolete 4/01) 1947 = Gazelle Bal Dil Cath (eff. 1/01) (obsolete 4/01) 1948 = Pursuit Balloon Cath (eff. 1/01) (obsolete 4/01) 1949 = Oracle Megasonics Cath (eff. 1/01) (obsolete 4/01) 1979 = Visions PV/Avanar US Cath (eff. 1/01) (obsolete 4/01) 1980 = Atlantis SR Coronary Cath (eff. 1/01) (obsolete 4/01) 1981 = PTCA Catheters (eff. 1/01) (obsolete 4/01) 2000 = Orbiter ST Steerable Cath (eff. 1/01) (obsolete 4/01) 2001 = Constellation Diag Cath (eff. 1/01) (obsolete 4/01) 2002 = Irvine 5F Inquiry Diag EP Cath (eff. 1/01) (obsolete 4/01) 2003 = Irvine 6F Inquiry Diag EP Cath (eff. 1/01) (obsolete 4/01) 2004 = Biosense EP Cath -- Octapolar (eff. 1/01) (obsolete 4/01) 2005 = Biosense EP Cath -- Hexapolar (eff. 1/01) (obsolete 4/01) 2006 = Biosense EP Cath -- Decapolar (eff. 1/01) (obsolete 4/01) 2007 = Irvine 6F Luma-Cath EP Cath (eff. 1/01) (obsolete 4/01) 2008 = 7F Luma-Cath EP Cath 81910-15 (eff. 1/01) (obsolete 4/01) 2009 = Irvine 7F Luma-Cath EP Cath (eff. 1/01) (obsolete 4/01) 2010 = Fixed Curve EP Cath (eff. 1/01) (obsolete 4/01) 2011 = Deflectable Tip Cath--Quad (eff. 1/01) (obsolete 4/01) 2012 = Celsius Abln Cath (eff. 1/01) (obsolete 4/01) 2013 = Celsius Large Abln Cath (eff. 1/01) (obsolete 4/01) 2014 = Celsius II Asym Abln Cath (eff. 1/01) (obsolete 4/01) 2015 = Celsius II Sym Abln Cath (eff. 1/01) (obsolete 4/01) 2016 = Navi-Star DS, Navi-Star Ther (eff. 1/01) (obsolete 4/01) 2017 = Navi-Star Abln Cath (eff. 1/01) (obsolete 4/01) 2018 = Polaris T Ablation Cath (eff. 1/01) (obsolete 4/01) 2019 = EP Deflectable Cath (eff. 1/01) (obsolete 4/01) 2020 = Blazer II XP Abln Cath (eff. 1/01) (obsolete 4/01) 2021 = SilverFlex EP Cath (eff. 1/01) (obsolete 4/01) 2022 = CP Chilli Cooled Abln Cath (eff. 1/01) (obsolete 4/01) 2023 = Chilli Cld AblnCath-std, lg (eff. 1/01) (obsolete 4/01) 2100 = CP CS Reference Cath (eff. 1/01) (obsolete 4/01) 2102 = CP Radii 7F EP Cath (eff. 1/01) (obsolete 4/01) 2103 = CP Radii 7F EP Cath w/Track (eff. 1/01) (obsolete 4/01) 2104 = Lasso Deflectable Cath (eff. 1/01) (obsolete 4/01) 2151 = Veripath Guiding Cath (eff. 1/01) (obsolete 4/01) 2152 = Cordis Vista Brite Tip Cath (eff. 1/01) (obsolete 4/01) 2153 = Bard Viking Cath (eff. 1/01) (obsolete 4/01) 2200 = Arrow-Trerotola PTD Cath (eff. 1/01) (obsolete 4/01) 2300 = Varisource Stnd Catheters (eff. 1/01) (obsolete 4/01) 2597 = Clinicath/kit 16/18 sgl/dbl (eff. 1/01) (obsolete 4/01) 2598 = Clinicath 18/20/24-G single (eff. 1/01) (obsolete 4/01) 2599 = Clinicath 16/18-G-double (eff. 1/01) (obsolete 4/01) 2601 = Bard DL Ureteral Cath (eff. 1/01) (obsolete 4/01) 2602 = Vitesse Laser Cath 1.4/1.7mm (eff. 1/01) (obsolete 4/01) 2603 = Vitesse Laser Cath 2.0mm (eff. 1/01) (obsolete 4/01) 2604 = Vitesse E Laser Cath 2.0mm (eff. 1/01) (obsolete 4/01) 2605 = Extreme Laser Catheter (eff. 1/01) (obsolete 4/01) 2606 = SpineCath XL Catheter (eff. 1/01) (obsolete 4/01) 2607 = SpineCath Intradiscal Cath (eff. 1/01) (obsolete 4/01) 2608 = Scimed 6F Wiseguide Cath (eff. 1/01) (obsolete 4/01) 2609 = Flexima Bil Draingage Cath (eff. 1/01) (obsolete 4/01) 2610 = FlexTipPlus Intraspinal Cath (eff. 1/01) (obsolete 4/01) 2611 = AlgoLine Intraspinal Cath (eff. 1/01) (obsolete 4/01) 2612 = InDura Catheter (eff. 1/01) (obsolete 4/01) 2615 = Sealant, pulmonary, liquid (eff. 4/01) 2616 = Brachytx seed, Yttrium-90 (eff. 4/01) 2617 = Stent, non-cor, tem w/o del (eff. 4/01) 2618 = Probe, cryoablation (eff. 4/01) 2619 = Pmkr, dual, non rate-resp (eff. 4/01) 2620 = Pmkr, single, non rate-resp (eff. 4/01) 2621 = Pmkr, other than single/dual (eff. 4/01) 2622 = Prosthesis, penile, non-inf (eff. 4/01) 2625 = Stent, non-cor , tem w/del sys (eff. 4/01) 2626 = Infusion pump, non-prog, temp (eff. 4/01) 2627 = Cath, suprapubic/cystoscopic (eff. 4/01) 2628 = Catheter, occlusion (eff. 4/01) 2629 = Intro/sheath, laser (eff. 4/01) 2630 = Cath, EP, temp-controlled (eff. 4/01) 2631 = Rep dev, urinary, w/o sling (eff. 4/01) 2700 = MycroPhylax Plus CS defib (eff. 1/01) (obsolete 4/01) 2701 = Phylax XM SC defib (eff. 1/01) (obsolete 4/01) 2702 = Ventak Prizm 2VR Defib (eff. 1/01) (obsolete 4/01) 2703 = Ventak Prizm VR HE Defib (eff. 1/01) (obsolete 4/01) 2704 = Ventak Mini IV + Defib (eff. 1/01) (obsolete 4/01) 2801 = Defender IV DR 612 DC defib (eff. 1/01) (obsolete 4/01) 2802 = Phylax AV DC defib (eff. 1/01) (obsolete 4/01) 2803 = Ventak Prizm DR HE Defib (eff. 1/01) (obsolete 4/01) 2804 = Ventak Prizm 2 DR Defib (eff. 1/01) (obsolete 4/01) 2805 = Jewel AF 7250 Defib (eff. 1/01) (obsolete 4/01) 2806 = GEM VR 7227 Defib (eff. 1/01) (obsolete 4/01) 2807 = Contak CD 1823 (eff. 1/01) (obsolete 4/01) 2808 = Contak TR 1241 (eff. 1/01) (obsolete 4/01) 3001 = Kainox SL/RV defib lead (eff. 1/01) (obsolete 4/01) 3002 = EasyTrak Defib Lead (eff. 1/01) (obsolete 4/01) 3003 = Endotak SQ Array XP lead (eff. 1/01) (obsolete 4/01) 3004 = Intervene Defib lead (eff. 1/01) (obsolete 4/01) 3400 = Siltex Spectrum, Contour Prof (eff. 1/01) (obsolete 4/01) 3401 = Saline-Filled Spectrum (eff. 1/01) (obsolete 4/01) 3500 = Mentor alpha I Inf Penile Pros (eff. 1/01) (obsolete 4/01) 3510 = AMS 800 Urinary Pros (eff. 1/01) (obsolete 4/01) 3551 = Choice/PT Graphix/Luge/Trooper (eff. 1/01) (obsolete 4/01) 3552 = Hi-Torque Whisper (eff. 1/01) (obsolete 4/01) 3553 = Cordis guidewires (eff. 1/01) (obsolete 4/01) 3554 = Jindo guidewire (eff. 1/01) (obsolete 4/01) 3555 = Wholey Hi-Torque Plus GW (eff. 1/01) (obsolete 4/01) 3556 = Wave/FlowWire Guidewire (eff. 1/01) (obsolete 4/01) 3557 = HyTek guidewire (eff. 1/01) (obsolete 4/01) 3800 = SynchroMed EL infusion pump (eff. 1/01) (obsolete 4/01) 3801 = Arrow/Microject PCAQ Sys (eff. 1/01) (obsolete 4/01) 3851 = Elastic UV IOL AA-4203T/TF/TL (eff. 1/01) (obsolete 4/01) 4000 = Opus G 4621, 4624 SC pmkr (eff. 1/01) (obsolete 4/01) 4001 = Opus S 4121/4124 SC pmkr (eff. 1/01) (obsolete 4/01) 4002 = Talent 113 SC pmkr (eff. 1/01) (obsolete 4/01) 4003 = Kairos SR SC pmkr (eff. 1/01) (obsolete 4/01) 4004 = Actros SR, Actros SLR SC pmkr (eff. 1/01) (obsolete 4/01) 4005 = Philos SR/SR-B SC pmkr (eff. 1/01) (obsolete 4/01) 4006 = Pulsar Max II SR pmkr (eff. 1/01) (obsolete 4/01) 4007 = Marathon SR pmkr (eff. 1/01) (obsolete 4/01) 4008 = Discovery II SSI pmkr (eff. 1/01) (obsolete 4/01) 4009 = Discovery II SR pmkr (eff. 1/01) (obsolete 4/01) 4300 = Integrity AFx DR 5342 pmkr (eff. 1/01) (obsolete 4/01) 4301 = Integrity AFx DR 5346 pmkr (eff. 1/01) (obsolete 4/01) 4302 = Affinity VDR 5430 DR (eff. 1/01) (obsolete 4/01) 4303 = Brio 112 DC pmkr (eff. 1/01) (obsolete 4/01) 4304 = Brio 212, Talent 213/223 DC pmkr (eff. 1/01) (obsolete 4/01) 4305 = Brio 222 DC pmkr (eff. 1/01) (obsolete 4/01) 4306 = Brio 220 DC pmkr (eff. 1/01) (obsolete 4/01) 4307 = Kairos DR DC pmkr (eff. 1/01) (obsolete 4/01) 4308 = Inos2, Inos2+ DC pmkr (eff. 1/01) (obsolete 4/01) 4309 = Actros DR,D,DR-A, SLR DC pmkr (eff. 1/01) (obsolete 4/01) 4310 = Actros DR-B DC pmkr (eff. 1/01) (obsolete 4/01) 4311 = Philos DR/DR-B/SLR DC (eff. 1/01) (obsolete 4/01) 4312 = Pulsar Max II DR pmkr (eff. 1/01) (obsolete 4/01) 4313 = Marathon DR pmkr (eff. 1/01) (obsolete 4/01) 4314 = Momentum DR pmkr (eff. 1/01) (obsolete 4/01) 4315 = Selection AFm pmkr (eff. 1/01) (obsolete 4/01) 4316 = Discovery II DR (eff. 1/01) (obsolete 4/01) 4317 = Discovery II DDD (eff. 1/01) (obsolete 4/01) 4600 = Snynox, Polyrox, Elox, Retrox (eff. 1/01) (obsolete 4/01) 4602 = Tendril SDX, 1488K pmkr lead (eff. 1/01) (obsolete 4/01) 4603 = Oscor/Flexion pmkr lead (eff. 1/01) (obsolete 4/01) 4604 = CrystallineActFix, CapsureFix (eff. 1/01) (obsolete 4/01) 4605 = CapSure Epi pmkr lead (eff. 1/01) (obsolete 4/01) 4606 = Flextend pmkr lead (eff. 1/01) (obsolete 4/01) 4607 = FinelineII/EZ, ThinlineII/EZ (eff. 1/01) (obsolete 4/01) 5000 = BX Velocity w/Hepacoat (eff. 1/01) (obsolete 4/01) 5001 = Memotherm Bil Stent, sm, med (eff. 1/01) (obsolete 4/01) 5002 = Memotherm Bil Stent, large (eff. 1/01) (obsolete 4/01) 5003 = Memotherm Bil Stent, x-large (eff. 1/01) (obsolete 4/01) 5004 = PalmazCorinthian IQ Bil Stent (eff. 1/01) (obsolete 4/01) 5005 = PalmazCorinthian IQ Trans/Bil (eff. 1/01) (obsolete 4/01) 5006 = PalmazTran Bil Stent Sys-Med (eff. 1/01) (obsolete 4/01) 5007 = PalmazTran XL Bil Stent--40mm (eff. 1/01) (obsolete 4/01) 5008 = PalmazTran XL Bil Stent--50mm (eff. 1/01) (obsolete 4/01) 5009 = VistaFlex Biliary Stent (eff. 1/01) (obsolete 4/01) 5010 = Rapid Exchange Bil Stent Sys (eff. 1/01) (obsolete 4/01) 5011 = IntraStent, IntraStent LP (eff. 1/01) (obsolete 4/01) 5012 = IntraStent DoubleStrut LD (eff. 1/01) (obsolete 4/01) 5013 = IntraStent DoubleStrut XS (eff. 1/01) (obsolete 4/01) 5014 = AVE Bridge Stent Sys-10/17/28 (eff. 1/01) (obsolete 4/01) 5015 = AVE/X3 Bridge Sys, 40-100 (eff. 1/010 (obsolete 4/01) 5016 = Biliary stent single use cov (eff. 1/01) (obsolete 4/01) 5017 = WallstentRP Bil--20/40/60/68mm (eff. 1/01) (obsolete 4/01) 5018 = WallstentRP Bil--80/94mm (eff. 1/01) (obsolete 4/01) 5019 = Flexima Bil Stent Sys (eff. 1/01) (obsolete 4/01) 5020 = Smart Nitinol Stent--20mm (eff. 1/01) (obsolete 4/01) 5021 = Smart Nitinol Stent--40/60mm (eff. 1/01) (obsolete 4/01) 5022 = Smart Nitinol Stent--80mm (eff. 1/01) (obsolete 4/01) 5023 = BX Velocity Stent--8/13mm (eff. 1/01) (obsolete 4/01) 5024 = BX Velocity Stent 18mm (eff. 1/01) (obsolete 4/01) 5025 = BX Velocity Stent 23 mm (eff. 1/01) (obsolete 4/01) 5026 = BX Velocity Stent 28/33mm (eff. 1/01) (obsolete 4/01) 5027 = BX Velocity Stent w/Hep--8/13mm (eff. 1/01) (obsolete 4/01) 5028 = BX Velocity Stent w/Hep--18mm (eff. 1/01) (obsolete 4/01) 5029 = BX Velocity Stent w/Hep--23mm (eff. 1/01) (obsolete 4/01) 5030 = Stent, coronary, S660 9/12mm (eff. 1/01) (obsolete 4/01) 5031 = Stent, coronary, S660 15/18mm (eff. 1/01) (obsolete 4/01) 5032 = Stent, coronary, S660 24/30mm (eff. 1/01) (obsolete 4/01) 5033 = Niroyal Stent Sys, 9mm (eff. 1/01) (obsolete 4/01) 5034 = Niroyal Stent Sys, 12/15mm (eff. 1/01) (obsolete 4/01) 5035 = Niroyal Stent Sys, 18mm (eff. 1/01) (obsolete 4/01) 5036 = Niroyal Stent Sys, 25mm (eff. 1/01) (obsolete 4/01) 5037 = Niroyal Stent Sys, 31mm (eff. 1/01) (obsolete 4/01) 5038 = BX Velocity Stent w/Raptor (eff. 1/01) (obsolete 4/01) 5039 = IntraCoil Periph Stent--40mm (eff. 1/01) (obsolete 4/01) 5040 = IntraCoil Periph Stent--60mm (eff. 1/01) (obsolete 4/01) 5041 = BeStent Over-the-Wire 24/30mm (eff. 1/01) (obsolete 4/01) 5042 = BeStent Over-the-Wire 18mm (eff. 1/01) (obsolete 4/01) 5043 = BeStent Over-the-Wire 15mm (eff. 1/01) (obsolete 4/01) 5044 = BeStent Over-the-Wire 9/12mm (eff. 1/01) (obsolete 4/01) 5045 = Multilink Tetra Cor Stent Sys (eff. 1/01) (obsolete 4/01) 5046 = Radius 20mm cor stent (eff. 1/01) (obsolete 4/01) 5047 = Niroyal Elite Cor Stent Sys (eff. 1/01) (obsolete 4/01) 5048 = GR II Coronary Stent (eff. 1/01) (obsolete 4/01) 5130 = Wilson-Cook Colonic Z-Stent (eff. 1/01) (obsolete 4/01) 5131 = Bard Colorectal Stent-60mm (eff. 1/01) (obsolete 4/01) 5132 = Bard Colorectal Stent-80mm (eff. 1/01) (obsolete 4/01) 5133 = Bard Colorectal Stent-100mm (eff. 1/01) (obsolete 4/01) 5134 = Enteral Wallstent-90mm (eff. 1/01) (obsolete 4/01) 5279 = Contour/Percuflex Stent (eff. 1/01) (obsolete 4/01) 5280 = Inlay Dbl Ureteral Stent (eff. 1/01) (obsolete 4/01) 5281 = Wallgraft Trach Sys 70mm (eff. 1/01) (obsolete 4/01) 5282 = Wallgraft Trach Sys 20/30/50 (eff. 1/01) (obsolete 4/01) 5283 = Wallstent/RP TIPS--80mm (eff. 1/01) (obsolete 4/01) 5284 = Wallstent TrachUltraFlex (eff. 1/01) (obsolete 4/01) 5600 = Closure dev, VasoSeal ES (eff. 1/01) (obsolete 4/01) 5601 = VasoSeal Model 1000 (eff. 1/01) (obsolete 4/01) 6001 = Composix Mesh 8/21 in (eff. 1/01) (obsolete 4/01) 6002 = Composix Mesh 32 in (eff. 1/01) (obsolete 4/01) 6003 = Composix Mesh 48 in (eff. 1/01) (obsolete 4/01) 6004 = Composix Mesh 80 in (eff. 1/01) (obsolete 4/01) 6005 = Composix Mesh 140 in (eff. 1/01) (obsolete 4/01) 6006 = Composix Mesh 144 in (eff. 1/01) (obsolete 4/01) 6012 = Pelvicol Collagen 8/14 sq cm (eff. 1/01) (obsolete 4/01) 6013 = Pelvicol Collagen 21/24/28 sq cm (eff. 1/01) (obsolete 4/01) 6014 = Pelvicol Collagen 36 sq cm (eff. 1/01) (obsolete 4/01) 6015 = Pelvicol Collagen 48 sq cm (eff. 1/01) (obsolete 4/01) 6016 = Pelvicol Collagen 96 sq cm (eff. 1/01) (obsolete 4/01) 6017 = Gore-Tex DualMesh 75/96 sq cm (eff. 1/01) (obsolete 4/01) 6018 = Gore-Tex DualMesh 150 sq cm (eff. 1/01) (obsolete 4/01) 6019 = Gore-Tex DualMesh 285 sq cm (eff. 1/01) (obsolete 4/01) 6020 = Gore-Tex DualMesh 432 sq cm (eff. 1/01) (obsolete 4/01) 6021 = Gore-Tex DualMesh 600 sq cm (eff. 1/01) (obsolete 4/01) 6022 = Gore-Tex DualMesh 884 sq cm (eff. 1/01) (obsolete 4/01) 6023 = Gore-TexPlus 1mm, 75/96 sq cm (eff. 1/01) (obsolete 4/01) 6024 = Gore-TexPlus 1mm, 150 sq cm (eff. 1/01) (obsolete 4/01) 6025 = Gore-TexPlus 1mm, 285 sq cm (eff. 1/01) (obsolete 4/01) 6026 = Gore-TexPlus 1mm, 432 sq cm (eff. 1/01) (obsolete 4/01) 6027 = Gore-TexPlus 1mm, 600 sq cm (eff. 1/01) (obsolete 4/01) 6028 = Gore-TexPlus 1mm, 884 sq cm (eff. 1/01) (obsolete 4/01) 6029 = Gore-TexPlus 2mm, 150 sq cm (eff. 1/01) (obsolete 4/01) 6030 = Gore-TexPlus 2mm, 285 sq cm (eff. 1/01) (obsolete 4/01) 6031 = Gore-TexPlus 2mm, 432 sq cm (eff. 1/01) (obsolete 4/01) 6032 = Gore-TexPlus 2mm, 600 sq cm (eff. 1/01) (obsolete 4/01) 6033 = Gore-TexPlus 2mm, 884 sq cm (eff. 1/01) (obsolete 4/01) 6034 = Bard ePTFE: 150 sq cm-2mm (obsolete 4/01) 6035 = Bard ePTFE: 150sqcm-1mm,75-2mm (eff. 1/01) (obsolete 4/01) 6036 = Bard ePTFE: 50/75sqcm-1,2mm (eff. 1/01) (obsolete 4/01) 6037 = Bard ePTFE: 300 sq cm-1,2mm (eff. 1/01) (obsolete 4/01) 6038 = Bard ePTFE: 600 sq cm-1mm (eff. 1/01) (obsolete 4/01) 6039 = Bard ePTFE: 884sq cm-1mm (eff. 1/01) (obsolete 4/01) 6040 = Bard ePTFE: 600sq cm-2mm (eff. 1/01) (obsolete 4/01) 6041 = Bard ePTFE: 884sq cm -2mm (eff. 1/01) (obsolete 4/01) 6050 = Female Sling Sys w/wo Matrl (eff. 1/01) (obsolete 4/01) 6051 = Stratasis Sling, 20/40 cm (eff. 1/01) (obsolete 4/01) 6052 = Stratasis Sling, 60 cm (eff. 1/01) (obsolete 4/01) 6053 = Surgisis Soft Graft (eff. 1/01) (obsolete 4/01) 6054 = Surgisis Enhanced Graft (eff. 1/01) (obsolete 4/01) 6055 = Surgisis Enhanced Tissue (eff. 1/01) (obsolete 4/01) 6056 = Surgisis Soft Tissue Graft (eff. 1/01) (obsolete 4/01) 6057 = Surgisis Hernia Graft (eff. 1/01) (obsolete 4/01) 6058 = SurgiPro Hernia Plug, med/lg (eff. 1/01) (obsolete 4/01) 6080 = Male Sling Sys w/wo Matrial (eff. 1/01) (obsolete 4/01) 6200 = Exxcel Soft ePTFE vas graft (ef. 1/01) (obsolete 4/01) 6201 = Impra Venaflo--10/20cm (eff. 1/01) (obsolete 4/01) 6202 = Impra Venaflo--30/40 cm (eff. 1/01) (obsolete 4/01) 6203 = Impra Venaflo--50 cm, vt45 (eff. 1/01) (obsolete 4/01) 6204 = Impra Venaflo--stepped (eff. 1/01) (obsolete 4/01) 6205 = Impra Carboflo--10cm (eff. 1/01) (obsolete 4/01) 6206 = Impra Carboflo--20 cm (eff. 1/01) (obsolete 4/01) 6207 = Impra Carboflo--30/35/40cm (eff. 1/01) (obsolete 4/01) 6208 = Impra Carboflo--40/50cm (eff. 1/01) (obsolete 4/01) 6209 = Impra Carboflo--ctrflex (eff. 1/01) (obsolete 4/01) 6210 = Exxcel ePTFE vas graft (eff. 1/01) (obsolete 4/01) 6300 = Vanguard III Endovas Graft (eff. 1/01) (obsolete 4/01) 6500 = Preface Guiding Sheath (eff. 1/01) (obsolete 4/01) 6501 = Soft Tip Sheaths (eff. 1/01) (obsolete 4/01) 6502 = Perry Exchange Dilator (eff. 1/01) (obsolete 4/01) 6525 = Spectranetics Laser Sheath (eff. 1/01) (obsolete 4/01) 6600 = Micro Litho Flex Probes (eff. 1/01) (obsolete 4/01) 6650 = Fast-Cath Guiding Introducer (eff. 1/01) (obsolete 4/01) 6651 = Seal-Away Guding Introducer (eff. 1/01) (obsolete 4/01) 6652 = Bard Excalibur Introducer (eff. 1/01) (obsolete 4/01) 6700 = Focal Seal-L (eff. 1/01) (obsolete 4/01) 7000 = Amifostine, 500 mg (eligible for pass-through payments) 7001 = Amphotericin B lipid complex, 50 mg, Inj (eligible for pass-through payments) 7002 = Clonidine, HCl, 1 MG (eligible for pass-through payments) (obsolete 1/01) 7003 = Epoprostenol, 0.5 MG, inj (eligible for pass-through payments) 7004 = Immune globulin intravenous human 5g, inj (eligible for pass-through payments) 7005 = Gonadorelin hcI, 100 mcg (eligible for pass-through payments) 7007 = Milrinone lacetate, per 5 ml, inj (not subject to national coinsurance) 7010 = Morphine sulfate concentrate (preservative free) per 10 mg (eligible for pass-through payments) 7011 = Oprelevekin, inj, 5 mg (eligible for pass-through payments) 7012 = Pentamidine isethionate, 300 mg (eligible for pass-through payments) (obsolete 1/01) 7014 = Fentanyl citrate, inj, up to 2 ml (eligible for pass-through payments) 7015 = Busulfan, oral 2 mg (eligible for pass-through payments) 7019 = Aprotinin, 10,000 kiu (eligible for pass-through payments) 7021 = Baclofen, intrathecal, 50 mcg (eligible for pass-through payments) (obsolete 1/01) 7022 = Elliotts B Solution, per ml (eligible for pass-through payments) 7023 = Treatment for bladder calculi, I.e. Renacidin per 500 ml (eligible for pass-through payments) 7024 = Corticorelin ovine triflutate, 0.1 mg (eligible for pass-through payments) 7025 = Digoxin immune FAB (Ovine), 10 mg (eligible for pass-through payments) 7026 = Ethanolamine oleate, 1000 ml (eligible for pass-through payments) 7027 = Fomepizole, 1.5 G (eligible for pass-through payments) 7028 = Fosphenytoin, 50 mg (eligible for pass-through payments) 7029 = Glatiramer acetate, 25 mg (eligible for pass-through payments) 7030 = Hemin, 1 mg (eligible for pass-through payments) 7031 = Octreotide Acetate, 500 mcg (eligible for pass-through payments) 7032 = Sermorelin acetate, 0.5 mg (eligible for pass-through payments) 7033 = Somatrem, 5 mg (eligible for pass-through payments) 7034 = Somatropin, 1 mg (eligible for pass-through payments) 7035 = Teniposide, 50 mg (eligible for pass-through payments) 7036 = Urokinase, inj, IV, 250,000 I.U. (not subject to national coinsurance) 7037 = Urofollitropin, 75 I.U. (eligible for pass-through payments) 7038 = Muromonab-CD3, 5 mg (eligible for pass-through payments) 7039 = Pegademase bovine inj 25 I.U. (eligible for pass-through payments) 7040 = Pentastarch 10% inj, 100 ml (eligible for pass-through payments) 7041 = Tirofiban HCL, 0.5 mg (not subject to national coinsurance) 7042 = Capecitabine, oral 150 mg (eligible for pass-through payments) 7043 = Infliximab, 10 MG (eligible for pass-through payments) 7045 = Trimetrexate Glucoronate (eligible for pass-through payments) 7046 = Doxorubicin Hcl Liposome (eligible for pass-through payments) 7047 = Droperidol/fentanyl inj (eff. 1/01) 7048 = Alteplase, 1 mg (eff. 1/01) 7049 = Filgrastim 480 mcg injection (eff. 1/01) 7315 = Sodium hyaluronate, 20 mg (eff. 1/01) 8099 = Spectranetics Lead Lock Dev (eff. 1/01) (obsolete 4/01) 8100 = Adhesion barrier, ADCON-L (eff. 1/01) (obsolete 4/01) 8102 = SurgiVision Esoph Coil (eff. 1/01) (obsolete 4/01) 9000 = Na chromate Cr51, per 0.25mCi (eff. 1/01) 9001 = Linezolid inj, 200mg (eff. 1/01) 9002 = Tenecteplase, 50mg/vial (eff. 1/01) 9003 = Palivizumab, per 50 mg (eff. 1/01) 9004 = Gemtuzumab ozogamicin inj, 5mg (eff. 1/01) 9005 = Reteplase inj, half-kit, 18.8 mg/vial (eff. 1/01) 9006 = Tacrolimus inj, per 5 mg (1 amp) (eff. 1/01) 9007 = Baclofen Intrathecal kit-1amp (eff. 1/01) 9008 = Baclofen Refill Kit--500mcg (eff. 1/01) 9009 = Baclofen Refill Kit--2000mcg (eff. 1/01) 9010 = Baclofen Refill Kit--4000mcg (eff. 1/01) 9011 = Caffeine Citrate, inj, 1ml (eff. 1/01) 9012 = Arsenic Trioxide, 1mg/kg (eff. 4/01) 9013 = Co 57 Cobaltous Cl, 1 ml (eff. 4/01) 9100 = Iodinated I-131 Albumin (eff. 1/01) 9102 = 51 Na chromate, 50mCi (eff. 1/01) 9103 = Na lothalamate I-125, 10uCi (eff. 1/01) 9104 = Anti-thymocyte globin, 25 mg (eff. 1/01) 9105 = Hep B immun glob, per 1 ml (eff. 1/01) 9106 = Sirolimus 1 mg/ml (eff. 1/01) 9107 = Tinzaparin sodium, 2ml vial (eff. 1/01) 9108 = Thyrotropin Alfa, 1.1 mg (eff. 1/01) 9109 = Tirofiban hydrachloride 6.25 mg (eff. 1/01) 9217 = Leuprolide acetate for depot suspension, 7.5 mg (eff. 1/01) 9500 = Platelets, irrad, ea unit (eff. 1/01) 9501 = Platelets, pheresis, ea unit (eff. 1/01) 9502 = Platelets, pher/irrad, ea unit (eff. 1/01) 9503 = Fresh frozen plasma, ea unit (eff. 1/01) 9504 = RBC, deglycerolized, ea unit (eff. 1/01) 9505 = RBC, irradiated, ea unit (eff. 1/01) 9998 = Enoxaparin (eff. 1/01)