| A9150 |
Non-prescription drugs |
| A9152 |
Single vitamin/mineral/trace element, oral, per dose, not otherwise specified |
| A9153 |
Multiple vitamins, with or without minerals and trace elements, oral, per dose, not otherwise specified |
| A9155 |
Artificial saliva, 30 ml |
| A9180 |
Pediculosis (lice infestation) treatment, topical, for administration by patient/caretaker |
| A9270 |
Non-covered item or service |
| A9272 |
Wound suction, disposable, includes dressing, all accessories and components, any type, each |
| A9273 |
Cold or hot fluid bottle, ice cap or collar, heat and/or cold wrap, any type |
| A9274 |
External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories |
| A9275 |
Home glucose disposable monitor, includes test strips |
| A9276 |
Sensor; invasive (e.g., subcutaneous), disposable, for use with interstitial continuous glucose monitoring system, one unit = 1 day supply |
| A9277 |
Transmitter; external, for use with interstitial continuous glucose monitoring system |
| A9278 |
Receiver (monitor); external, for use with interstitial continuous glucose monitoring system |
| A9279 |
Monitoring feature/device, stand-alone or integrated, any type, includes all accessories, components and electronics, not otherwise classified |
| A9280 |
Alert or alarm device, not otherwise classified |
| A9281 |
Reaching/grabbing device, any type, any length, each |
| A9282 |
Wig, any type, each |
| A9283 |
Foot pressure off loading/supportive device, any type, each |
| A9284 |
Spirometer, non-electronic, includes all accessories |
| A9285 |
Inversion/eversion correction device |
| A9286 |
Hygienic item or device, disposable or non-disposable, any type, each |
| A9300 |
Exercise equipment |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
| A9501 |
Technetium tc-99m teboroxime, diagnostic, per study dose |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
| A9503 |
Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries |
| A9504 |
Technetium tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries |
| A9505 |
Thallium tl-201 thallous chloride, diagnostic, per millicurie |
| A9507 |
Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries |
| A9508 |
Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie |
| A9509 |
Iodine i-123 sodium iodide, diagnostic, per millicurie |
| A9510 |
Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries |
| A9512 |
Technetium tc-99m pertechnetate, diagnostic, per millicurie |
| A9513 |
Lutetium lu 177, dotatate, therapeutic, 1 millicurie |
| A9515 |
Choline c-11, diagnostic, per study dose up to 20 millicuries |
| A9516 |
Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries |
| A9517 |
Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie |
| A9520 |
Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries |
| A9521 |
Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries |
| A9524 |
Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries |
| A9526 |
Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries |
| A9527 |
Iodine i-125, sodium iodide solution, therapeutic, per millicurie |
| A9528 |
Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie |
| A9529 |
Iodine i-131 sodium iodide solution, diagnostic, per millicurie |
| A9530 |
Iodine i-131 sodium iodide solution, therapeutic, per millicurie |
| A9531 |
Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) |
| A9532 |
Iodine i-125 serum albumin, diagnostic, per 5 microcuries |
| A9536 |
Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries |
| A9537 |
Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries |
| A9538 |
Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries |
| A9539 |
Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries |
| A9540 |
Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries |
| A9541 |
Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries |
| A9542 |
Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries |
| A9543 |
Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries |
| A9544 |
Iodine i-131 tositumomab, diagnostic, per study dose |
| A9545 |
Iodine i-131 tositumomab, therapeutic, per treatment dose |
| A9546 |
Cobalt co-57/58, cyanocobalamin, diagnostic, per study dose, up to 1 microcurie |
| A9547 |
Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie |
| A9548 |
Indium in-111 pentetate, diagnostic, per 0.5 millicurie |
| A9550 |
Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie |
| A9551 |
Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
| A9553 |
Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries |
| A9554 |
Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries |
| A9555 |
Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries |
| A9556 |
Gallium ga-67 citrate, diagnostic, per millicurie |
| A9557 |
Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries |
| A9558 |
Xenon xe-133 gas, diagnostic, per 10 millicuries |
| A9559 |
Cobalt co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcurie |
| A9560 |
Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries |
| A9561 |
Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries |
| A9562 |
Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries |
| A9563 |
Sodium phosphate p-32, therapeutic, per millicurie |
| A9564 |
Chromic phosphate p-32 suspension, therapeutic, per millicurie |
| A9566 |
Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries |
| A9567 |
Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries |
| A9568 |
Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries |
| A9569 |
Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose |
| A9570 |
Indium in-111 labeled autologous white blood cells, diagnostic, per study dose |
| A9571 |
Indium in-111 labeled autologous platelets, diagnostic, per study dose |
| A9572 |
Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries |
| A9575 |
Injection, gadoterate meglumine, 0.1 ml |
| A9576 |
Injection, gadoteridol, (prohance multipack), per ml |
| A9577 |
Injection, gadobenate dimeglumine (multihance), per ml |
| A9578 |
Injection, gadobenate dimeglumine (multihance multipack), per ml |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
| A9580 |
Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries |
| A9581 |
Injection, gadoxetate disodium, 1 ml |
| A9582 |
Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries |
| A9583 |
Injection, gadofosveset trisodium, 1 ml |
| A9584 |
Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries |
| A9585 |
Injection, gadobutrol, 0.1 ml |
| A9586 |
Florbetapir f18, diagnostic, per study dose, up to 10 millicuries |
| A9587 |
Gallium ga-68, dotatate, diagnostic, 0.1 millicurie |
| A9588 |
Fluciclovine f-18, diagnostic, 1 millicurie |
| A9589 |
Instillation, hexaminolevulinate hydrochloride, 100 mg |
| A9590 |
Iodine i-131, iobenguane, 1 millicurie |
| A9591 |
Fluoroestradiol f 18, diagnostic, 1 millicurie |
| A9597 |
Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified |
| A9598 |
Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified |
| A9599 |
Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified |
| A9600 |
Strontium sr-89 chloride, therapeutic, per millicurie |
| A9604 |
Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries |
| A9606 |
Radium ra-223 dichloride, therapeutic, per microcurie |
| A9698 |
Non-radioactive contrast imaging material, not otherwise classified, per study |
| A9699 |
Radiopharmaceutical, therapeutic, not otherwise classified |
| A9700 |
Supply of injectable contrast material for use in echocardiography, per study |
| A9900 |
Miscellaneous dme supply, accessory, and/or service component of another hcpcs code |
| A9901 |
Dme delivery, set up, and/or dispensing service component of another hcpcs code |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |