HCPCS |
Description |
Jurisdiction |
Comments |
A4206 - A4209 |
Medical, surgical, and self- administered injection supplies |
Part B MAC 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 |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4213 - A4215 |
Medical, surgical, and self-administered injection supplies |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4216 - A4218 |
Saline |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4221 - A4239 |
Self-administered injection and diabetic supplies |
DME MAC |
|
A4244 - A4250 |
Medical, Surgical, and Self-administered injection supplies |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC |
|
A4252 - A4259; A4271 |
Diabetic supplies |
DME MAC |
|
A4265 |
Paraffin |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4280 |
Accessory for breast prosthesis |
DME MAC |
|
A4281 - A4287 |
Accessory for breast pump |
DME MAC |
|
A4305 - A4306 |
Disposable drug delivery system |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4310 - A4340 |
Incontinence supplies/urinary supplies
|
||
A4341 - A4342 |
Urinary supplies |
DME MAC |
|
A4344 - A4358 |
Incontinence supplies/urinary supplies
|
||
A4360 - A4437 |
Urinary supplies
|
||
A4450 - A4452 |
Tape; adhesive remover |
Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device. If other, DME MAC. |
|
A4453 |
Enema catheter |
DME MAC |
|
A4455 - A4456 |
Tape; adhesive remover |
Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device. If other, DME MAC. |
|
A4453 |
Enema catheter |
DME MAC |
|
A4455 - A4456 |
Tape; adhesive remover |
Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device. If other, DME MAC. |
|
A4458 - A4459 |
Enema bag/system |
DME MAC |
|
A4461 - A4463 |
Surgical dressing holders |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
DME MAC |
|||
A4481 |
Tracheostomy supply |
Part B MAC 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 |
|
A4553 - A4554 |
Underpads |
DME MAC |
|
A4555 - A4558 |
Electrodes; lead wires; conductive paste |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4559 |
Coupling gel |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4560 |
Disposable NMES |
DME MAC |
|
A4575 |
Topical hyperbaric oxygen chamber, disposable |
DME MAC |
|
A4593-A4594 |
Stimulator and Supplies |
DME MAC |
|
A4595 |
TENS supplies |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4596 |
Electrical Stimulator Supplies |
DME MAC |
|
A4600 |
Sleeve for intermittent limb Compression Device |
DME MAC |
|
A4601 - A4602 |
Lithium replacement batteries |
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 |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4615 - A4629 |
Oxygen & tracheostomy supplies |
Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
|
A4630 - A4640 |
DME supplies |
DME MAC |
|
A4649 |
Miscellaneous surgical supplies |
Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
|
A4651 - A4932 |
Supplies for ESRD |
DME MAC (not separately payable) |
|
A5051 - A5093 |
Additional ostomy supplies
|
||
A5102 - A5200 |
Additional incontinence and ostomy supplies
|
||
A5500 - A5514 |
Therapeutic shoes |
DME MAC |
|
A6000 |
Non-contact wound warming cover |
DME MAC |
|
A6010-A6024 |
Surgical dressing |
Part B MAC 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 |
Part B MAC 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 |
Part B MAC 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 |
Part B MAC 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 |
Part B MAC 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 - A6457 |
Surgical dressings |
Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
|
A6501-A6512 |
Surgical dressing |
Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME, MAC |
|
A6520 - A6549 |
Gradient Compression Garments |
DME MAC |
|
A6550 |
Supplies for negative pressure wound therapy electrical pump |
DME MAC |
|
A6590 - A7002 |
Accessories for suction pumps |
DME MAC |
|
A7003 - A7039 |
Accessories for nebulizers, aspirators, and ventilators |
DME MAC |
|
A7044 - A7047 |
Respiratory accessories |
DME MAC |
|
A7049 |
Respiratory Item |
DME MAC |
|
A7501 - A7527 |
Tracheostomy supplies |
DME MAC |
|
A8000 - A8004 |
Protective helmets |
DME MAC |
|
A9156; A9268-A9269 |
Mucoadhesive and Programable oral capsule |
DME MAC |
|
A9270 |
Noncovered items or services |
DME MAC |
|
A9272 |
Disposable wound suction pump |
DME MAC |
|
A9273 |
Hot water bottles, ice caps or collars, and heat and/or cold wraps |
DME MAC |
|
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 |
|
A9284 - A9286 |
Non-electric spirometer, inversion devices and hygienic items |
DME MAC |
|
A9300 |
Exercise equipment |
DME MAC |
|
A9900 |
Miscellaneous DME supply or accessory |
Part B MAC if used with implanted DME. If other, DME MAC. |
|
A9901 |
Delivery |
DME MAC |
|
A9999 |
Miscellaneous DME supply or accessory |
Part B MAC if used with implanted DME. If other, DME MAC. |
|
B4034 - B9999 |
Enteral and parenteral therapy |
DME MAC |
|
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 |
|
E0328 - E0329 |
Pediatric hospital beds |
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 |
|
E0487 |
Electric spirometer |
DME MAC |
|
E0490 - E0493 |
Oral Neuromuscular Stimulator |
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 |
|
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 |
|
Pneumatic/ Non-Pneumatic Devices and Appliances |
DME MAC |
||
E0691 - E0694 |
Ultraviolet light therapy systems |
DME MAC |
|
E0700 |
Safety equipment |
DME MAC |
|
E0705 |
Transfer board |
DME MAC |
|
E0710 - E0711 |
Restraints/Enclosures |
DME MAC |
|
E0720 - E0745 |
Electrical nerve stimulators |
DME MAC |
|
E0747 - E0748 |
Osteogenic stimulators |
DME MAC |
|
E0755 - E0770 |
Stimulation devices |
DME MAC |
|
E0776 |
IV pole |
DME MAC |
|
E0779 - E0780 |
External infusion pump |
DME MAC |
|
E0781 |
Ambulatory infusion pump |
DME MAC |
|
E0784 |
Infusion pumps, insulin |
DME MAC |
|
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 |
|
E1352 - E1392 |
Additional oxygen related equipment |
DME MAC |
|
E1399 |
Miscellaneous DME |
Part B MAC if implanted DME. If other, DME MAC. |
|
E1405 - E1406 |
Additional oxygen equipment |
DME MAC |
|
E1500 - E1625 |
Artificial kidney machines and accessories |
DME MAC (not separately payable) |
|
E1630 - E1699 |
Artificial kidney machines and accessories |
DME MAC (not separately payable) |
|
E1700 - E1702 |
TMJ device and supplies |
DME MAC |
|
E1800 - E1841 |
Dynamic flexion devices |
DME MAC |
|
E1902 |
Communication board |
DME MAC |
|
E1905 |
CBT Device |
DME MAC |
|
Suction pump |
DME MAC |
||
E2100 - E2103 |
Blood glucose monitors with special features: Continuous Glucose Monitor |
DME MAC |
|
E2120 |
Pulse generator for tympanic treatment of inner ear |
DME MAC |
|
E2201 - E2398 |
Wheelchair accessories |
DME MAC |
|
E2402 |
Negative pressure wound and therapy pump |
DME MAC |
|
E2500 - E2599 |
Speech generating device |
DME MAC |
|
E2601 - E2633 |
Wheelchair cushions and accessories |
DME MAC |
|
E8000 - E8002 |
Gait trainers |
DME MAC |
|
G0333 |
Dispensing fee |
DME MAC |
|
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
||
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
||
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
||
Oral |
Part B MAC or DME MAC |
||
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
||
NOC drugs |
Part B MAC or DME MAC |
||
J0800 - J1019 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J1021 - J1029 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J1031 - J1039 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J1041 - J1094 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J1100 - J1104 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J1106 - J1839 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J1841 - J1849 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J1851 - J2402 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J2403 |
Miscellaneous Drug and Solutions |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J2404-J2779 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J2780 has been terminated as of 7/1/24 |
J2781 – J2786 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J2788 – J2919 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J2931-J3400 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J3410 - J3570 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J7030 - J7131 |
Miscellaneous Drugs and Solutions |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J7165 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J7171 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC |
|
J7340 |
Carbidopa/Levodopa |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J7500 - J7599 |
Immunosuppressive drugs |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J7604 - J7699 |
Inhalation solutions |
Part B MAC if incident to a physician's service. If other, DME MAC. |
|
J7799 - J7999 |
NOC drugs, Other than inhalation drugs |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J8498 |
Anti-emetic drug |
DME MAC |
|
J8499 |
Prescription drug, oral, non-chemotherapeutic |
Part B MAC if incident to a physician's service. If other, DME MAC. |
|
J8501 - J8999 |
Oral anti-cancer drugs |
DME MAC |
|
J9000 - J9069 |
Chemotherapy drugs |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J9071- J9249 |
Chemotherapy drugs |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
J9251-J9370 |
Chemotherapy drugs |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J9371 has been terminated as of 7/1/24 |
J9372- J9999 |
Chemotherapy drugs |
Part B MAC 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 |
|
K0555 - K0605 |
External Infusion pump supplies |
DME MAC |
|
K0606 - K0609 |
Defibrillator accessories |
DME MAC |
|
K0669 |
Wheelchair cushion |
DME MAC |
|
K0672 |
Soft Interface for orthosis |
DME MAC |
|
K0730 |
Inhalation drug delivery system |
DME MAC |
|
K0733 |
Power wheelchair accessory |
DME MAC |
|
K0738 |
Oxygen equipment |
DME MAC |
|
K0739 |
Repair or nonroutine service for DME |
Part B MAC if implanted DME. If other, DME MAC |
|
K0740 |
Repair or nonroutine service for oxygen equipment |
DME MAC |
|
K0743 - K0746 |
Suction pump and dressings |
DME MAC |
|
K0800 - K0899 |
Power mobility devices |
DME MAC |
|
K0900 |
Custom DME, other than wheelchair |
DME MAC |
|
K1004 |
Devices |
DME MAC when the supplier considers the item DMEPOS. Part B MAC if the supplier considers the item something other than DMEPOS (e.g., supplies furnished incident to the professional service of a physician). |
|
K1007 |
Devices |
DME MAC |
|
K1027 |
Devices |
DME MAC when the supplier considers the item DMEPOS. Part B MAC if the supplier considers the item something other than DMEPOS (e.g., supplies furnished incident to the professional service of a physician). |
|
K1035 - K1037 |
Devices |
DME MAC |
|
L0112 - L4631 |
Orthotics & devices |
DME MAC |
|
L5000 - L5999 |
Lower limb prosthetics |
DME MAC |
|
L6000 - L7499 |
Upper limb prosthetics |
DME MAC |
|
L7510 - L7520 |
Repair of prosthetic device |
Part B MAC if repair of implanted prosthetic device. If other, DME MAC. |
|
L7600 - L8485 |
Prosthetics |
DME MAC |
|
L8499 |
Unlisted procedure for miscellaneous prosthetic services |
Part B MAC if implanted prosthetic device. If other, DME MAC. |
|
L8500 - L8501 |
Artificial larynx; tracheostomy speaking valve |
DME MAC |
|
L8505 |
Artificial larynx accessory |
DME MAC |
|
L8507 |
Voice prosthesis, patient inserted |
DME MAC |
|
L8509 |
Voice prosthesis, inserted by a licensed health care provider |
Part B MAC |
|
L8510 |
Voice prosthesis |
DME MAC |
|
L8511 - L8515 |
Voice prosthesis |
Part B MAC if used with tracheoesophageal voice prostheses inserted by a licensed health care provider. If other, DME MAC. |
|
L8701 - L8702 |
Assist device |
DME MAC |
|
L9900 |
Miscellaneous orthotic or prosthetic component or accessory |
Part B MAC if used with implanted prosthetic device. If other, DME MAC. |
|
Q0144 |
Azithromycin Dihydrate |
Part B MAC if incident to a physician's service. If other, DME MAC. |
|
Q0161 - Q0181 |
Anti-emetic |
DME MAC |
|
Q0510 - Q0514 |
Drug dispensing fees |
DME MAC |
|
Q2049 - Q2050 |
Doxorubicin |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
Q2052 |
IVIG demonstration |
DME MAC |
|
Q4074 |
Inhalation drug |
Part B MAC if incident to a physician's service. If other, DME MAC. |
|
Q5101 - Q5134 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
Q5137 - Q5138 |
Injection |
Part B MAC if incident to a physician’s service If other, DME MAC. |
|
Q9991 - Q9992 |
Injection |
Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
|
V2020 - V2025 |
Frames |
DME MAC |
|
V2100 - V2513 |
Lenses |
DME MAC |
|
V2520 - V2523 |
Hydrophilic contact lenses |
Part B MAC if incident to a physician's service. If other, DME MAC. |
|
V2524 - V2526 |
Hydrophilic Contact Lenses |
DME MAC |
|
V2530 - V2531 |
Contact lenses, Scleral |
DME MAC |
|
V2599 |
Contact lens, other type |
Part B MAC if incident to a physician's service. If other, DME MAC. |
|
V2600 - V2615 |
Low vision aids |
DME MAC |
|
V2623 - V2629 |
Prosthetic eyes |
DME MAC |
|
V2700 - V2780 |
Miscellaneous vision service |
DME MAC |
|
V2781 |
Progressive lens |
DME MAC |
|
V2782 - V2784 |
Lenses |
DME MAC |
|
V2786 |
Lens |
DME MAC |
|
V2797 |
Vision supply |
DME MAC |
|
V2799 |
Miscellaneous vision service |
Part B MAC if supply for an implanted prosthetic device. If other, DME MAC. |
|
V5336 |
Repair/modification of augmentative communicative system or device |
DME MAC |