DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

A4221 1 1 Line Edit Code Descriptor / CPT Instruction

A4234 3 1 Line Edit Clinical: Data

A4235 2 1 Line Edit Clinical: Data

A4236 2 1 Line Edit Clinical: Data

A4253 1 1 Line Edit Nature of Equipment

A4255 1 1 Line Edit Nature of Equipment

A4258 1 1 Line Edit Published Contractor Policy

A4259 1 1 Line Edit Nature of Equipment

A4356 1 1 Line Edit Published Contractor Policy

A4396 3 1 Line Edit Clinical: Data

A4399 2 1 Line Edit Published Contractor Policy

A4463 3 1 Line Edit Clinical: Data

A4470 1 1 Line Edit Anatomic Consideration

A4480 1 1 Line Edit Anatomic Consideration

A4555 0 3 Date of Service Edit: Clinical CMS Policy

A4557 2 1 Line Edit Published Contractor Policy

A4561 1 1 Line Edit Clinical: Data

A4562 1 1 Line Edit Clinical: Data

A4604 1 1 Line Edit Published Contractor Policy

A4611 2 1 Line Edit Clinical: Data

A4612 2 1 Line Edit Clinical: CMS Workgroup

A4613 1 1 Line Edit Clinical: Data

A4614 1 1 Line Edit Clinical: Data

A4623 200 3 Date of Service Edit: Clinical Published Contractor Policy

A4625 100 3 Date of Service Edit: Clinical Published Contractor Policy

A4635 2 1 Line Edit Clinical: Data

A4636 2 1 Line Edit Clinical: Data

A4638 2 1 Line Edit Clinical: Data

A4640 1 1 Line Edit Nature of Equipment

A4642 1 1 Line Edit Code Descriptor / CPT Instruction

A4650 3 1 Line Edit Clinical: Data

A5056 120 3 Date of Service Edit: Clinical Published Contractor Policy

A5057 120 3 Date of Service Edit: Clinical Published Contractor Policy

A5102 1 1 Line Edit Published Contractor Policy

A5120 450 3 Date of Service Edit: Clinical Published Contractor Policy

A5500 2 2 Date of Service Edit: Policy Published Contractor Policy

A5501 2 2 Date of Service Edit: Policy Published Contractor Policy

A5503 2 2 Date of Service Edit: Policy Published Contractor Policy

Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2014 American

Medical Association. All rights reserved.

CPT® is a registered trademark of the American Medical Association.

Applicable FARS\DFARS Restrictions Apply to Government Use.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the

AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly

practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not

contained herein.

Page 1 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

A5504 2 2 Date of Service Edit: Policy Published Contractor Policy

A5505 2 2 Date of Service Edit: Policy Published Contractor Policy

A5506 2 2 Date of Service Edit: Policy Published Contractor Policy

A5507 2 3 Date of Service Edit: Clinical Published Contractor Policy

A5508 0 3 Date of Service Edit: Clinical Published Contractor Policy

A5510 0 3 Date of Service Edit: Clinical Published Contractor Policy

A5512 6 2 Date of Service Edit: Policy Published Contractor Policy

A5513 6 2 Date of Service Edit: Policy Published Contractor Policy

A6501 2 1 Line Edit Nature of Equipment

A6502 2 1 Line Edit Nature of Equipment

A6503 2 1 Line Edit Nature of Equipment

A6504 4 1 Line Edit Nature of Equipment

A6505 4 1 Line Edit Nature of Equipment

A6506 4 1 Line Edit Nature of Equipment

A6507 4 1 Line Edit Nature of Equipment

A6508 4 1 Line Edit Nature of Equipment

A6509 2 1 Line Edit Nature of Equipment

A6510 2 1 Line Edit Nature of Equipment

A6511 2 1 Line Edit Nature of Equipment

A6513 2 1 Line Edit Nature of Equipment

A6545 2 1 Line Edit Clinical: CMS Workgroup

A7005 1 1 Line Edit Published Contractor Policy

A7010 2 1 Line Edit Published Contractor Policy

A7014 1 1 Line Edit Published Contractor Policy

A7017 1 1 Line Edit Published Contractor Policy

A7020 1 1 Line Edit Nature of Equipment

A7025 1 1 Line Edit Clinical: Data

A7026 1 1 Line Edit Clinical: Data

A7027 1 1 Line Edit Published Contractor Policy

A7030 1 1 Line Edit Published Contractor Policy

A7031 3 1 Line Edit Published Contractor Policy

A7034 1 1 Line Edit Published Contractor Policy

A7035 1 1 Line Edit Published Contractor Policy

A7036 1 1 Line Edit Published Contractor Policy

A7039 1 1 Line Edit Code Descriptor / CPT Instruction

A7040 2 1 Line Edit Clinical: Data

A7041 2 1 Line Edit Clinical: Data

A7044 1 1 Line Edit Clinical: Data

A7045 1 1 Line Edit Clinical: Data

A7046 1 1 Line Edit Published Contractor Policy

A7047 0 3 Date of Service Edit: Clinical CMS Policy

A7502 3 1 Line Edit Published Contractor Policy

A7503 1 1 Line Edit Published Contractor Policy

A7504 200 3 Date of Service Edit: Clinical Published Contractor Policy

A7506 200 3 Date of Service Edit: Clinical Published Contractor Policy

A7507 200 3 Date of Service Edit: Clinical Published Contractor Policy

A7508 200 3 Date of Service Edit: Clinical Published Contractor Policy

Page 2 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

A7509 200 3 Date of Service Edit: Clinical Published Contractor Policy

A7522 1 2 Date of Service Edit: Policy Published Contractor Policy

A7524 1 1 Line Edit Published Contractor Policy

A7526 100 3 Date of Service Edit: Clinical Published Contractor Policy

A9284 1 1 Line Edit Nature of Equipment

A9500 3 1 Line Edit Code Descriptor / CPT Instruction

A9501 3 1 Line Edit Code Descriptor / CPT Instruction

A9502 3 1 Line Edit Code Descriptor / CPT Instruction

A9503 1 1 Line Edit Code Descriptor / CPT Instruction

A9504 1 1 Line Edit Code Descriptor / CPT Instruction

A9507 1 1 Line Edit Code Descriptor / CPT Instruction

A9510 1 1 Line Edit Code Descriptor / CPT Instruction

A9521 2 1 Line Edit Code Descriptor / CPT Instruction

A9526 2 1 Line Edit Code Descriptor / CPT Instruction

A9536 1 1 Line Edit Code Descriptor / CPT Instruction

A9537 1 1 Line Edit Code Descriptor / CPT Instruction

A9538 1 1 Line Edit Code Descriptor / CPT Instruction

A9539 2 1 Line Edit Code Descriptor / CPT Instruction

A9540 2 1 Line Edit Code Descriptor / CPT Instruction

A9541 1 1 Line Edit Code Descriptor / CPT Instruction

A9542 1 1 Line Edit Code Descriptor / CPT Instruction

A9543 1 1 Line Edit Code Descriptor / CPT Instruction

A9544 1 1 Line Edit Code Descriptor / CPT Instruction

A9545 1 1 Line Edit Code Descriptor / CPT Instruction

A9546 1 1 Line Edit Code Descriptor / CPT Instruction

A9550 1 1 Line Edit Code Descriptor / CPT Instruction

A9551 1 1 Line Edit Code Descriptor / CPT Instruction

A9552 1 1 Line Edit Code Descriptor / CPT Instruction

A9553 1 1 Line Edit Code Descriptor / CPT Instruction

A9554 1 1 Line Edit Code Descriptor / CPT Instruction

A9555 3 1 Line Edit Code Descriptor / CPT Instruction

A9557 2 1 Line Edit Code Descriptor / CPT Instruction

A9559 1 1 Line Edit Code Descriptor / CPT Instruction

A9560 2 1 Line Edit Code Descriptor / CPT Instruction

A9561 1 1 Line Edit Code Descriptor / CPT Instruction

A9562 2 1 Line Edit Code Descriptor / CPT Instruction

A9566 1 1 Line Edit Code Descriptor / CPT Instruction

A9567 2 1 Line Edit Code Descriptor / CPT Instruction

A9569 1 1 Line Edit Code Descriptor / CPT Instruction

A9570 1 1 Line Edit Code Descriptor / CPT Instruction

A9571 1 1 Line Edit Code Descriptor / CPT Instruction

A9580 1 1 Line Edit Nature of Service/Procedure

A9700 2 1 Line Edit Nature of Service/Procedure

B4034 1 1 Line Edit Code Descriptor / CPT Instruction

B4035 1 1 Line Edit Code Descriptor / CPT Instruction

B4036 1 1 Line Edit Code Descriptor / CPT Instruction

B4087 1 1 Line Edit Clinical: CMS Workgroup

Page 3 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

B4088 1 1 Line Edit Nature of Equipment

B4193 1 1 Line Edit Published Contractor Policy

B4197 1 1 Line Edit Published Contractor Policy

B4216 1 1 Line Edit Code Descriptor / CPT Instruction

B4220 1 1 Line Edit Code Descriptor / CPT Instruction

B4222 1 1 Line Edit Code Descriptor / CPT Instruction

B4224 1 1 Line Edit Code Descriptor / CPT Instruction

B5000 1 1 Line Edit Published Contractor Policy

B5100 1 1 Line Edit Published Contractor Policy

B9000 1 1 Line Edit Nature of Equipment

B9002 1 1 Line Edit Nature of Equipment

B9004 1 1 Line Edit Nature of Equipment

B9006 1 1 Line Edit Nature of Equipment

E0100 1 3 Date of Service Edit: Clinical Nature of Equipment

E0105 1 3 Date of Service Edit: Clinical Nature of Equipment

E0110 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0111 2 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0112 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0113 2 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0114 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0116 2 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0117 2 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0118 1 2 Date of Service Edit: Policy Nature of Equipment

E0130 1 2 Date of Service Edit: Policy Nature of Equipment

E0135 1 2 Date of Service Edit: Policy Nature of Equipment

E0140 1 2 Date of Service Edit: Policy Nature of Equipment

E0141 1 2 Date of Service Edit: Policy Nature of Equipment

E0143 1 2 Date of Service Edit: Policy Nature of Equipment

E0144 1 2 Date of Service Edit: Policy Nature of Equipment

E0147 1 2 Date of Service Edit: Policy Nature of Equipment

E0148 1 2 Date of Service Edit: Policy Nature of Equipment

E0149 1 2 Date of Service Edit: Policy Nature of Equipment

E0153 2 2 Date of Service Edit: Policy Anatomic Consideration

E0154 2 2 Date of Service Edit: Policy Nature of Equipment

E0155 1 3 Date of Service Edit: Clinical Nature of Equipment

E0156 1 2 Date of Service Edit: Policy Nature of Equipment

E0157 2 2 Date of Service Edit: Policy Nature of Equipment

E0158 1 2 Date of Service Edit: Policy Nature of Equipment

E0159 2 2 Date of Service Edit: Policy Nature of Equipment

E0160 1 2 Date of Service Edit: Policy Nature of Equipment

E0161 1 2 Date of Service Edit: Policy Nature of Equipment

E0162 1 2 Date of Service Edit: Policy Nature of Equipment

E0163 1 2 Date of Service Edit: Policy Nature of Equipment

E0165 1 2 Date of Service Edit: Policy Nature of Equipment

E0167 1 2 Date of Service Edit: Policy Nature of Equipment

E0168 1 2 Date of Service Edit: Policy Nature of Equipment

E0170 1 2 Date of Service Edit: Policy Nature of Equipment

Page 4 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E0171 1 2 Date of Service Edit: Policy Nature of Equipment

E0172 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0175 2 2 Date of Service Edit: Policy Nature of Equipment

E0181 1 2 Date of Service Edit: Policy Nature of Equipment

E0182 1 2 Date of Service Edit: Policy Nature of Equipment

E0184 1 2 Date of Service Edit: Policy Nature of Equipment

E0185 1 2 Date of Service Edit: Policy Nature of Equipment

E0186 1 2 Date of Service Edit: Policy Nature of Equipment

E0187 1 2 Date of Service Edit: Policy Nature of Equipment

E0188 1 3 Date of Service Edit: Clinical Nature of Equipment

E0189 1 3 Date of Service Edit: Clinical Nature of Equipment

E0190 0 3 Date of Service Edit: Clinical CMS Policy

E0191 0 3 Date of Service Edit: Clinical CMS Policy

E0193 1 2 Date of Service Edit: Policy Nature of Equipment

E0194 1 2 Date of Service Edit: Policy Nature of Equipment

E0196 1 2 Date of Service Edit: Policy Nature of Equipment

E0197 1 2 Date of Service Edit: Policy Nature of Equipment

E0198 1 2 Date of Service Edit: Policy Nature of Equipment

E0199 1 2 Date of Service Edit: Policy Nature of Equipment

E0200 0 3 Date of Service Edit: Clinical CMS Policy

E0202 1 2 Date of Service Edit: Policy Nature of Equipment

E0203 0 3 Date of Service Edit: Clinical CMS Policy

E0205 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0210 1 2 Date of Service Edit: Policy Nature of Equipment

E0215 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0217 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0218 1 2 Date of Service Edit: Policy Nature of Equipment

E0221 0 3 Date of Service Edit: Clinical CMS Policy

E0225 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0231 0 3 Date of Service Edit: Clinical CMS Policy

E0232 0 3 Date of Service Edit: Clinical CMS Policy

E0235 1 2 Date of Service Edit: Policy Nature of Equipment

E0236 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0239 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0240 0 3 Date of Service Edit: Clinical CMS Policy

E0241 0 3 Date of Service Edit: Clinical CMS Policy

E0242 0 3 Date of Service Edit: Clinical CMS Policy

E0243 0 3 Date of Service Edit: Clinical CMS Policy

E0244 0 3 Date of Service Edit: Clinical CMS Policy

E0245 0 3 Date of Service Edit: Clinical CMS Policy

E0246 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0247 0 3 Date of Service Edit: Clinical CMS Policy

E0248 0 3 Date of Service Edit: Clinical CMS Policy

E0249 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0250 1 2 Date of Service Edit: Policy Nature of Equipment

E0251 1 2 Date of Service Edit: Policy Nature of Equipment

E0255 1 2 Date of Service Edit: Policy Nature of Equipment

Page 5 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E0256 1 2 Date of Service Edit: Policy Nature of Equipment

E0260 1 2 Date of Service Edit: Policy Nature of Equipment

E0261 1 2 Date of Service Edit: Policy Nature of Equipment

E0265 1 2 Date of Service Edit: Policy Nature of Equipment

E0266 1 2 Date of Service Edit: Policy Nature of Equipment

E0270 1 2 Date of Service Edit: Policy Nature of Equipment

E0271 1 2 Date of Service Edit: Policy Nature of Equipment

E0272 1 2 Date of Service Edit: Policy Nature of Equipment

E0273 0 3 Date of Service Edit: Clinical CMS Policy

E0274 0 3 Date of Service Edit: Clinical CMS Policy

E0275 1 2 Date of Service Edit: Policy Nature of Equipment

E0276 1 2 Date of Service Edit: Policy Nature of Equipment

E0277 1 2 Date of Service Edit: Policy Nature of Equipment

E0280 1 2 Date of Service Edit: Policy Nature of Equipment

E0290 1 2 Date of Service Edit: Policy Nature of Equipment

E0291 1 2 Date of Service Edit: Policy Nature of Equipment

E0292 1 2 Date of Service Edit: Policy Nature of Equipment

E0293 1 2 Date of Service Edit: Policy Nature of Equipment

E0294 1 2 Date of Service Edit: Policy Nature of Equipment

E0295 1 2 Date of Service Edit: Policy Nature of Equipment

E0296 1 2 Date of Service Edit: Policy Nature of Equipment

E0297 1 2 Date of Service Edit: Policy Nature of Equipment

E0300 1 2 Date of Service Edit: Policy Nature of Equipment

E0301 1 2 Date of Service Edit: Policy Nature of Equipment

E0302 1 2 Date of Service Edit: Policy Nature of Equipment

E0303 1 2 Date of Service Edit: Policy Nature of Equipment

E0304 1 2 Date of Service Edit: Policy Nature of Equipment

E0305 2 3 Date of Service Edit: Clinical Clinical: Data

E0310 2 2 Date of Service Edit: Policy Nature of Equipment

E0315 0 3 Date of Service Edit: Clinical CMS Policy

E0316 1 2 Date of Service Edit: Policy Nature of Equipment

E0325 1 2 Date of Service Edit: Policy Nature of Equipment

E0326 1 2 Date of Service Edit: Policy Nature of Equipment

E0328 1 2 Date of Service Edit: Policy Nature of Equipment

E0329 1 2 Date of Service Edit: Policy Nature of Equipment

E0350 1 2 Date of Service Edit: Policy Nature of Equipment

E0352 30 3 Date of Service Edit: Clinical Clinical: Data

E0370 0 3 Date of Service Edit: Clinical CMS Policy

E0371 1 2 Date of Service Edit: Policy Nature of Equipment

E0372 1 2 Date of Service Edit: Policy Nature of Equipment

E0373 1 2 Date of Service Edit: Policy Nature of Equipment

E0424 1 2 Date of Service Edit: Policy Nature of Equipment

E0425 0 3 Date of Service Edit: Clinical CMS Policy

E0430 0 3 Date of Service Edit: Clinical CMS Policy

E0431 1 2 Date of Service Edit: Policy Nature of Equipment

E0433 1 2 Date of Service Edit: Policy Nature of Equipment

E0434 1 2 Date of Service Edit: Policy Nature of Equipment

Page 6 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E0435 0 3 Date of Service Edit: Clinical CMS Policy

E0439 1 2 Date of Service Edit: Policy Nature of Equipment

E0440 0 3 Date of Service Edit: Clinical CMS Policy

E0441 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0442 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0443 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0444 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E0445 0 3 Date of Service Edit: Clinical CMS Policy

E0446 0 3 Date of Service Edit: Clinical CMS Policy

E0450 2 3 Date of Service Edit: Clinical Nature of Equipment

E0455 0 3 Date of Service Edit: Clinical CMS Policy

E0457 1 3 Date of Service Edit: Clinical Nature of Equipment

E0459 1 3 Date of Service Edit: Clinical Nature of Equipment

E0460 1 3 Date of Service Edit: Clinical Nature of Equipment

E0461 2 3 Date of Service Edit: Clinical Clinical: Data

E0462 1 2 Date of Service Edit: Policy Nature of Equipment

E0463 2 3 Date of Service Edit: Clinical Clinical: Data

E0464 2 3 Date of Service Edit: Clinical Clinical: Data

E0470 1 3 Date of Service Edit: Clinical Nature of Equipment

E0471 1 3 Date of Service Edit: Clinical Nature of Equipment

E0472 1 3 Date of Service Edit: Clinical Nature of Equipment

E0480 1 2 Date of Service Edit: Policy Nature of Equipment

E0481 1 2 Date of Service Edit: Policy Nature of Equipment

E0482 1 2 Date of Service Edit: Policy Nature of Equipment

E0483 1 2 Date of Service Edit: Policy Nature of Equipment

E0484 1 2 Date of Service Edit: Policy Nature of Equipment

E0485 1 2 Date of Service Edit: Policy Nature of Equipment

E0486 1 2 Date of Service Edit: Policy Nature of Equipment

E0487 0 3 Date of Service Edit: Clinical CMS Policy

E0500 1 2 Date of Service Edit: Policy Nature of Equipment

E0550 1 2 Date of Service Edit: Policy Nature of Equipment

E0555 1 2 Date of Service Edit: Policy Nature of Equipment

E0560 1 2 Date of Service Edit: Policy Nature of Equipment

E0561 1 3 Date of Service Edit: Clinical Nature of Equipment

E0562 1 3 Date of Service Edit: Clinical Nature of Equipment

E0565 1 3 Date of Service Edit: Clinical Nature of Equipment

E0570 1 3 Date of Service Edit: Clinical Nature of Equipment

E0572 1 3 Date of Service Edit: Clinical Nature of Equipment

E0574 1 3 Date of Service Edit: Clinical Nature of Equipment

E0575 1 3 Date of Service Edit: Clinical Nature of Equipment

E0580 1 3 Date of Service Edit: Clinical Nature of Equipment

E0585 1 3 Date of Service Edit: Clinical Nature of Equipment

E0600 1 2 Date of Service Edit: Policy Nature of Equipment

E0601 1 3 Date of Service Edit: Clinical Nature of Equipment

E0602 1 2 Date of Service Edit: Policy Nature of Equipment

E0603 1 2 Date of Service Edit: Policy Nature of Equipment

E0604 1 2 Date of Service Edit: Policy Nature of Equipment

Page 7 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E0605 1 2 Date of Service Edit: Policy Nature of Equipment

E0606 1 2 Date of Service Edit: Policy Nature of Equipment

E0607 1 2 Date of Service Edit: Policy Nature of Equipment

E0610 1 2 Date of Service Edit: Policy Nature of Equipment

E0615 1 2 Date of Service Edit: Policy Nature of Equipment

E0616 0 3 Date of Service Edit: Clinical CMS Policy

E0617 1 2 Date of Service Edit: Policy Nature of Equipment

E0618 1 2 Date of Service Edit: Policy Nature of Equipment

E0619 1 2 Date of Service Edit: Policy Nature of Equipment

E0620 1 2 Date of Service Edit: Policy Nature of Equipment

E0621 1 2 Date of Service Edit: Policy Nature of Equipment

E0625 0 3 Date of Service Edit: Clinical CMS Policy

E0627 1 2 Date of Service Edit: Policy Nature of Equipment

E0628 1 2 Date of Service Edit: Policy Nature of Equipment

E0629 1 2 Date of Service Edit: Policy Nature of Equipment

E0630 1 2 Date of Service Edit: Policy Nature of Equipment

E0635 1 2 Date of Service Edit: Policy Nature of Equipment

E0636 1 2 Date of Service Edit: Policy Nature of Equipment

E0637 1 2 Date of Service Edit: Policy Nature of Equipment

E0638 0 3 Date of Service Edit: Clinical CMS Policy

E0639 1 2 Date of Service Edit: Policy Nature of Equipment

E0640 1 2 Date of Service Edit: Policy Nature of Equipment

E0641 0 3 Date of Service Edit: Clinical CMS Policy

E0642 0 3 Date of Service Edit: Clinical CMS Policy

E0650 1 3 Date of Service Edit: Clinical Nature of Equipment

E0651 1 3 Date of Service Edit: Clinical Nature of Equipment

E0652 1 3 Date of Service Edit: Clinical Nature of Equipment

E0655 2 2 Date of Service Edit: Policy Anatomic Consideration

E0656 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0657 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0660 2 2 Date of Service Edit: Policy Anatomic Consideration

E0665 2 2 Date of Service Edit: Policy Anatomic Consideration

E0666 2 2 Date of Service Edit: Policy Anatomic Consideration

E0667 2 2 Date of Service Edit: Policy Anatomic Consideration

E0668 2 2 Date of Service Edit: Policy Anatomic Consideration

E0669 2 2 Date of Service Edit: Policy Anatomic Consideration

E0670 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0671 2 2 Date of Service Edit: Policy Anatomic Consideration

E0672 2 2 Date of Service Edit: Policy Anatomic Consideration

E0673 2 2 Date of Service Edit: Policy Anatomic Consideration

E0675 1 2 Date of Service Edit: Policy Nature of Equipment

E0676 1 3 Date of Service Edit: Clinical Nature of Equipment

E0691 1 2 Date of Service Edit: Policy Nature of Equipment

E0692 1 2 Date of Service Edit: Policy Nature of Equipment

E0693 1 2 Date of Service Edit: Policy Nature of Equipment

E0694 1 2 Date of Service Edit: Policy Nature of Equipment

E0700 0 3 Date of Service Edit: Clinical Published Contractor Policy

Page 8 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E0705 1 2 Date of Service Edit: Policy Nature of Equipment

E0710 0 3 Date of Service Edit: Clinical Published Contractor Policy

E0720 1 2 Date of Service Edit: Policy Nature of Equipment

E0730 1 2 Date of Service Edit: Policy Nature of Equipment

E0731 1 3 Date of Service Edit: Clinical Nature of Equipment

E0740 1 2 Date of Service Edit: Policy Nature of Equipment

E0744 1 2 Date of Service Edit: Policy Nature of Equipment

E0745 1 3 Date of Service Edit: Clinical Nature of Equipment

E0746 0 3 Date of Service Edit: Clinical CMS Policy

E0747 1 3 Date of Service Edit: Clinical Nature of Equipment

E0748 1 3 Date of Service Edit: Clinical Nature of Equipment

E0749 0 3 Date of Service Edit: Clinical CMS Policy

E0755 1 2 Date of Service Edit: Policy Nature of Equipment

E0760 1 3 Date of Service Edit: Clinical Nature of Equipment

E0761 0 3 Date of Service Edit: Clinical CMS Policy

E0762 1 3 Date of Service Edit: Clinical Nature of Equipment

E0764 1 2 Date of Service Edit: Policy Nature of Equipment

E0765 1 2 Date of Service Edit: Policy Nature of Equipment

E0766 1 3 Date of Service Edit: Clinical Nature of Equipment

E0769 0 3 Date of Service Edit: Clinical CMS Policy

E0770 1 3 Date of Service Edit: Clinical Nature of Equipment

E0776 1 3 Date of Service Edit: Clinical Nature of Equipment

E0779 1 3 Date of Service Edit: Clinical Nature of Equipment

E0780 1 3 Date of Service Edit: Clinical Nature of Equipment

E0781 1 2 Date of Service Edit: Policy Nature of Equipment

E0782 0 3 Date of Service Edit: Clinical CMS Policy

E0783 0 3 Date of Service Edit: Clinical CMS Policy

E0784 1 2 Date of Service Edit: Policy Nature of Equipment

E0785 0 3 Date of Service Edit: Clinical CMS Policy

E0786 0 3 Date of Service Edit: Clinical CMS Policy

E0791 1 2 Date of Service Edit: Policy Nature of Equipment

E0830 0 3 Date of Service Edit: Clinical CMS Policy

E0840 1 2 Date of Service Edit: Policy Nature of Equipment

E0849 1 2 Date of Service Edit: Policy Nature of Equipment

E0850 1 2 Date of Service Edit: Policy Nature of Equipment

E0855 1 2 Date of Service Edit: Policy Nature of Equipment

E0856 1 2 Date of Service Edit: Policy Nature of Equipment

E0860 1 2 Date of Service Edit: Policy Nature of Equipment

E0870 1 2 Date of Service Edit: Policy Nature of Equipment

E0880 1 2 Date of Service Edit: Policy Nature of Equipment

E0890 1 2 Date of Service Edit: Policy Nature of Equipment

E0900 1 2 Date of Service Edit: Policy Nature of Equipment

E0910 1 2 Date of Service Edit: Policy Nature of Equipment

E0911 1 2 Date of Service Edit: Policy Nature of Equipment

E0912 1 2 Date of Service Edit: Policy Nature of Equipment

E0920 1 2 Date of Service Edit: Policy Nature of Equipment

E0930 1 2 Date of Service Edit: Policy Nature of Equipment

Page 9 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E0935 21 3 Date of Service Edit: Clinical CMS Policy

E0936 0 3 Date of Service Edit: Clinical CMS Policy

E0940 1 2 Date of Service Edit: Policy Nature of Equipment

E0941 1 2 Date of Service Edit: Policy Nature of Equipment

E0942 1 2 Date of Service Edit: Policy Nature of Equipment

E0944 1 3 Date of Service Edit: Clinical Nature of Equipment

E0945 2 3 Date of Service Edit: Clinical Anatomic Consideration

E0946 1 2 Date of Service Edit: Policy Nature of Equipment

E0947 1 2 Date of Service Edit: Policy Nature of Equipment

E0948 1 2 Date of Service Edit: Policy Nature of Equipment

E0950 1 2 Date of Service Edit: Policy Nature of Equipment

E0951 2 2 Date of Service Edit: Policy Anatomic Consideration

E0952 2 2 Date of Service Edit: Policy Nature of Equipment

E0955 1 2 Date of Service Edit: Policy Nature of Equipment

E0956 4 3 Date of Service Edit: Clinical Nature of Equipment

E0957 2 3 Date of Service Edit: Clinical Anatomic Consideration

E0958 1 3 Date of Service Edit: Clinical Nature of Equipment

E0959 2 2 Date of Service Edit: Policy Nature of Equipment

E0960 2 2 Date of Service Edit: Policy Nature of Equipment

E0961 2 2 Date of Service Edit: Policy Nature of Equipment

E0966 1 2 Date of Service Edit: Policy Nature of Equipment

E0967 2 2 Date of Service Edit: Policy Anatomic Consideration

E0968 1 2 Date of Service Edit: Policy Nature of Equipment

E0970 2 2 Date of Service Edit: Policy Anatomic Consideration

E0971 2 3 Date of Service Edit: Clinical Nature of Equipment

E0973 2 2 Date of Service Edit: Policy Nature of Equipment

E0974 2 2 Date of Service Edit: Policy Nature of Equipment

E0978 1 3 Date of Service Edit: Clinical Nature of Equipment

E0981 1 2 Date of Service Edit: Policy Nature of Equipment

E0982 1 2 Date of Service Edit: Policy Nature of Equipment

E0983 0 3 Date of Service Edit: Clinical CMS Policy

E0984 0 3 Date of Service Edit: Clinical CMS Policy

E0985 1 2 Date of Service Edit: Policy Nature of Equipment

E0986 1 2 Date of Service Edit: Policy Nature of Equipment

E0988 1 2 Date of Service Edit: Policy Nature of Equipment

E0990 2 2 Date of Service Edit: Policy Anatomic Consideration

E0992 1 2 Date of Service Edit: Policy Nature of Equipment

E0994 2 2 Date of Service Edit: Policy Anatomic Consideration

E0995 2 2 Date of Service Edit: Policy Anatomic Consideration

E1002 1 2 Date of Service Edit: Policy Nature of Equipment

E1003 1 2 Date of Service Edit: Policy Nature of Equipment

E1004 1 2 Date of Service Edit: Policy Nature of Equipment

E1005 1 2 Date of Service Edit: Policy Nature of Equipment

E1006 1 2 Date of Service Edit: Policy Nature of Equipment

E1007 1 2 Date of Service Edit: Policy Nature of Equipment

E1008 1 2 Date of Service Edit: Policy Nature of Equipment

E1009 2 2 Date of Service Edit: Policy Clinical: Data

Page 10 of 41

DMESupplierSvcEff-01-01-2015

HCPCS/C

PT Code

DME Supplier

Services MUE

Values MUE Adjudication Indicator MUE Rationale

E1010 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E1011 1 2 Date of Service Edit: Policy Nature of Equipment

E1014 1 2 Date of Service Edit: Policy Nature of Equipment

E1015 2 3 Date of Service Edit: Clinical Nature of Equipment

E1016 2 3 Date of Service Edit: Clinical Nature of Equipment

E1017 2 3 Date of Service Edit: Clinical Nature of Equipment

E1018 2 3 Date of Service Edit: Clinical Nature of Equipment

E1020 2 2 Date of Service Edit: Policy Nature of Equipment

E1028 4 3 Date of Service Edit: Clinical Clinical: Data

E1029 1 2 Date of Service Edit: Policy Nature of Equipment

E1030 1 2 Date of Service Edit: Policy Nature of Equipment

E1031 1 2 Date of Service Edit: Policy Nature of Equipment

E1035 1 1 Line Edit Nature of Equipment

E1036 1 1 Line Edit Nature of Equipment

E1037 1 2 Date of Service Edit: Policy Nature of Equipment

E1038 1 2 Date of Service Edit: Policy Nature of Equipment

E1039 1 2 Date of Service Edit: Policy Nature of Equipment

E1050 1 2 Date of Service Edit: Policy Nature of Equipment

E1060 1 2 Date of Service Edit: Policy Nature of Equipment

E1070 1 2 Date of Service Edit: Policy Nature of Equipment

E1083 1 2 Date of Service Edit: Policy Nature of Equipment

E1084 1 2 Date of Service Edit: Policy Nature of Equipment

E1085 1 2 Date of Service Edit: Policy Nature of Equipment

E1086 1 2 Date of Service Edit: Policy Nature of Equipment

E1087 1 2 Date of Service Edit: Policy Nature of Equipment

E1088 1 2 Date of Service Edit: Policy Nature of Equipment

E1089 1 2 Date of Service Edit: Policy Nature of Equipment

E1090 1 2 Date of Service Edit: Policy Nature of Equipment

E1092 1 2 Date of Service Edit: Policy Nature of Equipment

E1093 1 2 Date of Service Edit: Policy Nature of Equipment

E1100 1 2 Date of Service Edit: Policy Nature of Equipment

E1110 1 2 Date of Service Edit: Policy Nature of Equipment

E1130 1 2 Date of Service Edit: Policy Nature of Equipment

E1140 1 2 Date of Service Edit: Policy Nature of Equipment

E1150 1 2 Date of Service Edit: Policy Nature of Equipment

E1160 1 2 Date of Service Edit: Policy Nature of Equipment

E1161 1 2 Date of Service Edit: Policy Nature of Equipment

E1170 1 2 Date of Service Edit: Policy Nature of Equipment

E1171 1 2 Date of Service Edit: Policy Nature of Equipment

E1172 1 2 Date of Service Edit: Policy Nature of Equipment

E1180 1 2 Date of Service Edit: Policy Nature of Equipment

E1190 1 2 Date of Service Edit: Policy Nature of Equipment

E1195 1 2 Date of Service Edit: Policy Nature of Equipment

E1200 1 2 Date of Service Edit: Policy Nature of Equipment

E1220 1 2 Date of Service Edit: Policy Nature of Equipment

E1221 1 2 Date of Service Edit: Policy Nature of Equipment

E1222 1 2 Date of Service Edit: Policy Nature of Equipment

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E1223 1 2 Date of Service Edit: Policy Nature of Equipment

E1224 1 2 Date of Service Edit: Policy Nature of Equipment

E1225 1 2 Date of Service Edit: Policy Nature of Equipment

E1226 1 2 Date of Service Edit: Policy Nature of Equipment

E1228 1 2 Date of Service Edit: Policy Nature of Equipment

E1229 1 2 Date of Service Edit: Policy Nature of Equipment

E1230 1 2 Date of Service Edit: Policy Nature of Equipment

E1231 1 2 Date of Service Edit: Policy Nature of Equipment

E1232 1 2 Date of Service Edit: Policy Nature of Equipment

E1233 1 2 Date of Service Edit: Policy Nature of Equipment

E1234 1 2 Date of Service Edit: Policy Nature of Equipment

E1235 1 2 Date of Service Edit: Policy Nature of Equipment

E1236 1 2 Date of Service Edit: Policy Nature of Equipment

E1237 1 2 Date of Service Edit: Policy Nature of Equipment

E1238 1 2 Date of Service Edit: Policy Nature of Equipment

E1239 1 2 Date of Service Edit: Policy Nature of Equipment

E1240 1 2 Date of Service Edit: Policy Nature of Equipment

E1250 1 2 Date of Service Edit: Policy Nature of Equipment

E1260 1 2 Date of Service Edit: Policy Nature of Equipment

E1270 1 2 Date of Service Edit: Policy Nature of Equipment

E1280 1 2 Date of Service Edit: Policy Nature of Equipment

E1285 1 2 Date of Service Edit: Policy Nature of Equipment

E1290 1 2 Date of Service Edit: Policy Nature of Equipment

E1295 1 2 Date of Service Edit: Policy Nature of Equipment

E1300 0 3 Date of Service Edit: Clinical CMS Policy

E1310 1 2 Date of Service Edit: Policy Nature of Equipment

E1352 0 3 Date of Service Edit: Clinical CMS Policy

E1353 0 3 Date of Service Edit: Clinical CMS Policy

E1354 0 3 Date of Service Edit: Clinical CMS Policy

E1355 0 3 Date of Service Edit: Clinical CMS Policy

E1356 0 3 Date of Service Edit: Clinical CMS Policy

E1357 0 3 Date of Service Edit: Clinical CMS Policy

E1358 0 3 Date of Service Edit: Clinical CMS Policy

E1372 1 3 Date of Service Edit: Clinical Nature of Equipment

E1390 1 2 Date of Service Edit: Policy Nature of Equipment

E1391 1 2 Date of Service Edit: Policy Nature of Equipment

E1392 1 2 Date of Service Edit: Policy Nature of Service/Procedure

E1405 1 2 Date of Service Edit: Policy Nature of Equipment

E1406 1 2 Date of Service Edit: Policy Nature of Equipment

E1500 0 3 Date of Service Edit: Clinical CMS Policy

E1510 0 3 Date of Service Edit: Clinical CMS Policy

E1520 0 3 Date of Service Edit: Clinical CMS Policy

E1530 0 3 Date of Service Edit: Clinical CMS Policy

E1540 0 3 Date of Service Edit: Clinical CMS Policy

E1550 0 3 Date of Service Edit: Clinical CMS Policy

E1560 0 3 Date of Service Edit: Clinical CMS Policy

E1570 0 3 Date of Service Edit: Clinical CMS Policy

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E1575 0 3 Date of Service Edit: Clinical CMS Policy

E1580 0 3 Date of Service Edit: Clinical CMS Policy

E1590 0 3 Date of Service Edit: Clinical CMS Policy

E1592 0 3 Date of Service Edit: Clinical CMS Policy

E1594 0 3 Date of Service Edit: Clinical CMS Policy

E1600 0 3 Date of Service Edit: Clinical CMS Policy

E1610 0 3 Date of Service Edit: Clinical CMS Policy

E1615 0 3 Date of Service Edit: Clinical CMS Policy

E1620 0 3 Date of Service Edit: Clinical CMS Policy

E1625 0 3 Date of Service Edit: Clinical CMS Policy

E1630 0 3 Date of Service Edit: Clinical CMS Policy

E1632 0 3 Date of Service Edit: Clinical CMS Policy

E1634 0 3 Date of Service Edit: Clinical CMS Policy

E1635 0 3 Date of Service Edit: Clinical CMS Policy

E1636 0 3 Date of Service Edit: Clinical CMS Policy

E1637 0 3 Date of Service Edit: Clinical CMS Policy

E1639 0 3 Date of Service Edit: Clinical CMS Policy

E1700 1 2 Date of Service Edit: Policy Nature of Equipment

E1701 3 3 Date of Service Edit: Clinical Clinical: Data

E1702 0 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

E1800 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1801 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1802 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1805 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1806 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1810 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1811 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1812 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1815 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1816 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1818 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1820 2 3 Date of Service Edit: Clinical Clinical: Data

E1821 1 3 Date of Service Edit: Clinical Clinical: Data

E1825 3 3 Date of Service Edit: Clinical Clinical: Data

E1830 2 3 Date of Service Edit: Clinical Nature of Equipment

E1831 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1840 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1841 2 3 Date of Service Edit: Clinical Anatomic Consideration

E1902 1 3 Date of Service Edit: Clinical Nature of Equipment

E2000 1 2 Date of Service Edit: Policy Nature of Equipment

E2100 1 2 Date of Service Edit: Policy Nature of Equipment

E2101 1 2 Date of Service Edit: Policy Nature of Equipment

E2120 1 2 Date of Service Edit: Policy Nature of Equipment

E2201 1 2 Date of Service Edit: Policy Nature of Equipment

E2202 1 2 Date of Service Edit: Policy Nature of Equipment

E2203 1 2 Date of Service Edit: Policy Nature of Equipment

E2204 1 2 Date of Service Edit: Policy Nature of Equipment

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E2205 2 2 Date of Service Edit: Policy Nature of Equipment

E2206 2 2 Date of Service Edit: Policy Nature of Equipment

E2207 2 2 Date of Service Edit: Policy Nature of Equipment

E2208 1 3 Date of Service Edit: Clinical Nature of Equipment

E2209 2 2 Date of Service Edit: Policy Anatomic Consideration

E2210 12 3 Date of Service Edit: Clinical Clinical: Data

E2211 2 2 Date of Service Edit: Policy Nature of Equipment

E2212 2 2 Date of Service Edit: Policy Nature of Equipment

E2213 2 2 Date of Service Edit: Policy Nature of Equipment

E2214 2 3 Date of Service Edit: Clinical Nature of Equipment

E2215 2 3 Date of Service Edit: Clinical Nature of Equipment

E2216 2 2 Date of Service Edit: Policy Nature of Equipment

E2217 2 3 Date of Service Edit: Clinical Nature of Equipment

E2218 2 2 Date of Service Edit: Policy Nature of Equipment

E2219 2 3 Date of Service Edit: Clinical Nature of Equipment

E2220 2 2 Date of Service Edit: Policy Nature of Equipment

E2221 2 3 Date of Service Edit: Clinical Nature of Equipment

E2222 2 3 Date of Service Edit: Clinical Nature of Equipment

E2224 2 2 Date of Service Edit: Policy Nature of Equipment

E2225 2 3 Date of Service Edit: Clinical Nature of Equipment

E2226 2 3 Date of Service Edit: Clinical Nature of Equipment

E2227 2 2 Date of Service Edit: Policy Nature of Equipment

E2228 2 2 Date of Service Edit: Policy Nature of Equipment

E2231 1 2 Date of Service Edit: Policy Nature of Equipment

E2291 1 2 Date of Service Edit: Policy Nature of Equipment

E2292 1 2 Date of Service Edit: Policy Nature of Equipment

E2293 1 2 Date of Service Edit: Policy Nature of Equipment

E2294 1 2 Date of Service Edit: Policy Nature of Equipment

E2295 1 2 Date of Service Edit: Policy Nature of Equipment

E2300 1 2 Date of Service Edit: Policy Nature of Equipment

E2301 1 2 Date of Service Edit: Policy Nature of Equipment

E2310 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E2311 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

E2312 1 2 Date of Service Edit: Policy Nature of Equipment

E2313 1 2 Date of Service Edit: Policy Nature of Equipment

E2321 1 2 Date of Service Edit: Policy Nature of Equipment

E2322 1 3 Date of Service Edit: Clinical Nature of Equipment

E2323 1 2 Date of Service Edit: Policy Nature of Equipment

E2324 1 2 Date of Service Edit: Policy Nature of Equipment

E2325 1 2 Date of Service Edit: Policy Nature of Equipment

E2326 1 3 Date of Service Edit: Clinical Nature of Equipment

E2327 1 2 Date of Service Edit: Policy Nature of Equipment

E2328 1 2 Date of Service Edit: Policy Nature of Equipment

E2329 1 2 Date of Service Edit: Policy Nature of Equipment

E2330 1 2 Date of Service Edit: Policy Nature of Equipment

E2331 1 2 Date of Service Edit: Policy Nature of Equipment

E2340 1 2 Date of Service Edit: Policy Nature of Equipment

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E2341 1 2 Date of Service Edit: Policy Nature of Equipment

E2342 1 2 Date of Service Edit: Policy Nature of Equipment

E2343 1 2 Date of Service Edit: Policy Nature of Equipment

E2351 1 2 Date of Service Edit: Policy Nature of Equipment

E2358 2 2 Date of Service Edit: Policy Nature of Equipment

E2359 2 2 Date of Service Edit: Policy Nature of Equipment

E2361 2 2 Date of Service Edit: Policy Nature of Equipment

E2363 2 2 Date of Service Edit: Policy Nature of Equipment

E2365 2 2 Date of Service Edit: Policy Nature of Equipment

E2366 1 2 Date of Service Edit: Policy Nature of Equipment

E2367 1 2 Date of Service Edit: Policy Nature of Equipment

E2368 2 2 Date of Service Edit: Policy Nature of Equipment

E2369 2 2 Date of Service Edit: Policy Nature of Equipment

E2370 2 2 Date of Service Edit: Policy Nature of Equipment

E2371 2 2 Date of Service Edit: Policy Nature of Equipment

E2373 1 2 Date of Service Edit: Policy Nature of Equipment

E2374 1 2 Date of Service Edit: Policy Nature of Equipment

E2375 1 2 Date of Service Edit: Policy Nature of Equipment

E2376 1 2 Date of Service Edit: Policy Nature of Equipment

E2377 1 2 Date of Service Edit: Policy Nature of Equipment

E2378 2 1 Line Edit Nature of Equipment

E2381 2 2 Date of Service Edit: Policy Nature of Equipment

E2382 2 2 Date of Service Edit: Policy Nature of Equipment

E2383 2 2 Date of Service Edit: Policy Nature of Equipment

E2384 4 2 Date of Service Edit: Policy Nature of Equipment

E2385 4 2 Date of Service Edit: Policy Nature of Equipment

E2386 2 2 Date of Service Edit: Policy Nature of Equipment

E2387 4 2 Date of Service Edit: Policy Nature of Equipment

E2388 2 2 Date of Service Edit: Policy Nature of Equipment

E2389 4 2 Date of Service Edit: Policy Nature of Equipment

E2390 2 2 Date of Service Edit: Policy Nature of Equipment

E2391 4 2 Date of Service Edit: Policy Nature of Equipment

E2392 4 2 Date of Service Edit: Policy Nature of Equipment

E2394 2 2 Date of Service Edit: Policy Nature of Equipment

E2395 4 2 Date of Service Edit: Policy Nature of Equipment

E2396 4 2 Date of Service Edit: Policy Nature of Equipment

E2397 1 3 Date of Service Edit: Clinical Nature of Equipment

E2402 1 2 Date of Service Edit: Policy Nature of Equipment

E2500 1 2 Date of Service Edit: Policy Nature of Equipment

E2502 1 2 Date of Service Edit: Policy Nature of Equipment

E2504 1 2 Date of Service Edit: Policy Nature of Equipment

E2506 1 2 Date of Service Edit: Policy Nature of Equipment

E2508 1 2 Date of Service Edit: Policy Nature of Equipment

E2510 1 2 Date of Service Edit: Policy Nature of Equipment

E2511 1 2 Date of Service Edit: Policy Nature of Equipment

E2512 1 3 Date of Service Edit: Clinical Nature of Equipment

E2601 1 2 Date of Service Edit: Policy Nature of Equipment

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

E2602 1 2 Date of Service Edit: Policy Nature of Equipment

E2603 1 2 Date of Service Edit: Policy Nature of Equipment

E2604 1 2 Date of Service Edit: Policy Nature of Equipment

E2605 1 2 Date of Service Edit: Policy Nature of Equipment

E2606 1 2 Date of Service Edit: Policy Nature of Equipment

E2607 1 2 Date of Service Edit: Policy Nature of Equipment

E2608 1 2 Date of Service Edit: Policy Nature of Equipment

E2609 1 2 Date of Service Edit: Policy Nature of Equipment

E2611 1 2 Date of Service Edit: Policy Nature of Equipment

E2612 1 2 Date of Service Edit: Policy Nature of Equipment

E2613 1 2 Date of Service Edit: Policy Nature of Equipment

E2614 1 2 Date of Service Edit: Policy Nature of Equipment

E2615 1 2 Date of Service Edit: Policy Nature of Equipment

E2616 1 2 Date of Service Edit: Policy Nature of Equipment

E2617 1 2 Date of Service Edit: Policy Nature of Equipment

E2619 2 2 Date of Service Edit: Policy Nature of Equipment

E2620 1 2 Date of Service Edit: Policy Nature of Equipment

E2621 1 2 Date of Service Edit: Policy Nature of Equipment

E2622 1 2 Date of Service Edit: Policy Nature of Equipment

E2623 1 2 Date of Service Edit: Policy Nature of Equipment

E2624 1 2 Date of Service Edit: Policy Nature of Equipment

E2625 1 2 Date of Service Edit: Policy Nature of Equipment

E2626 2 2 Date of Service Edit: Policy Anatomic Consideration

E2627 2 2 Date of Service Edit: Policy Anatomic Consideration

E2628 2 2 Date of Service Edit: Policy Anatomic Consideration

E2629 2 2 Date of Service Edit: Policy Anatomic Consideration

E2630 2 2 Date of Service Edit: Policy Anatomic Consideration

E2631 2 2 Date of Service Edit: Policy Anatomic Consideration

E2632 2 2 Date of Service Edit: Policy Anatomic Consideration

E2633 2 2 Date of Service Edit: Policy Anatomic Consideration

G0333 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

J0133 3600 3 Date of Service Edit: Clinical Clinical: Data

J0289 150 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

J1556 300 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

J1557 300 3 Date of Service Edit: Clinical Prescribing Information

J1561 300 3 Date of Service Edit: Clinical Prescribing Information

J1568 300 3 Date of Service Edit: Clinical Prescribing Information

J1569 300 3 Date of Service Edit: Clinical Prescribing Information

J1572 300 3 Date of Service Edit: Clinical Prescribing Information

J3010 700 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

J3285 400 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

J7504 0 1 Line Edit Published Contractor Policy

J7527 720 3 Date of Service Edit: Clinical Clinical: Data

J7604 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7607 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7609 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7610 0 3 Date of Service Edit: Clinical Compounded Drug Policy

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J7615 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7622 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7624 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7627 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7628 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7629 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7632 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7634 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7635 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7636 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7637 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7638 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7640 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7641 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7642 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7643 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7645 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7647 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7650 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7657 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7660 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7667 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7670 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7676 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7680 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7681 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7683 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7684 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J7685 0 3 Date of Service Edit: Clinical Compounded Drug Policy

J8510 0 3 Date of Service Edit: Clinical Published Contractor Policy

K0001 1 2 Date of Service Edit: Policy Nature of Equipment

K0002 1 2 Date of Service Edit: Policy Nature of Equipment

K0003 1 2 Date of Service Edit: Policy Nature of Equipment

K0004 1 2 Date of Service Edit: Policy Nature of Equipment

K0005 1 2 Date of Service Edit: Policy Nature of Equipment

K0006 1 2 Date of Service Edit: Policy Nature of Equipment

K0007 1 2 Date of Service Edit: Policy Nature of Equipment

K0008 1 2 Date of Service Edit: Policy Nature of Equipment

K0009 1 2 Date of Service Edit: Policy Nature of Equipment

K0013 1 2 Date of Service Edit: Policy Nature of Equipment

K0015 2 2 Date of Service Edit: Policy Anatomic Consideration

K0017 2 2 Date of Service Edit: Policy Anatomic Consideration

K0018 2 2 Date of Service Edit: Policy Anatomic Consideration

K0019 2 2 Date of Service Edit: Policy Anatomic Consideration

K0020 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

K0037 2 2 Date of Service Edit: Policy Anatomic Consideration

K0038 2 3 Date of Service Edit: Clinical Anatomic Consideration

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Values MUE Adjudication Indicator MUE Rationale

K0039 2 3 Date of Service Edit: Clinical Anatomic Consideration

K0040 2 2 Date of Service Edit: Policy Anatomic Consideration

K0041 2 2 Date of Service Edit: Policy Anatomic Consideration

K0042 2 2 Date of Service Edit: Policy Anatomic Consideration

K0043 2 2 Date of Service Edit: Policy Anatomic Consideration

K0044 2 2 Date of Service Edit: Policy Anatomic Consideration

K0045 2 2 Date of Service Edit: Policy Anatomic Consideration

K0046 2 2 Date of Service Edit: Policy Anatomic Consideration

K0047 2 2 Date of Service Edit: Policy Anatomic Consideration

K0050 2 2 Date of Service Edit: Policy Nature of Equipment

K0051 2 2 Date of Service Edit: Policy Nature of Equipment

K0052 2 2 Date of Service Edit: Policy Anatomic Consideration

K0053 2 2 Date of Service Edit: Policy Anatomic Consideration

K0056 1 2 Date of Service Edit: Policy Nature of Equipment

K0065 2 2 Date of Service Edit: Policy Nature of Equipment

K0069 2 2 Date of Service Edit: Policy Nature of Equipment

K0070 2 2 Date of Service Edit: Policy Nature of Equipment

K0071 2 2 Date of Service Edit: Policy Nature of Equipment

K0072 2 2 Date of Service Edit: Policy Nature of Equipment

K0073 2 2 Date of Service Edit: Policy Nature of Equipment

K0077 2 2 Date of Service Edit: Policy Nature of Equipment

K0105 1 2 Date of Service Edit: Policy Nature of Equipment

K0195 1 3 Date of Service Edit: Clinical Code Descriptor / CPT Instruction

K0455 1 2 Date of Service Edit: Policy Nature of Equipment

K0462 1 1 Line Edit Clinical: Data

K0606 1 2 Date of Service Edit: Policy Nature of Equipment

K0607 1 1 Line Edit Nature of Equipment

K0608 1 1 Line Edit Nature of Equipment

K0609 1 1 Line Edit Nature of Equipment

K0672 4 3 Date of Service Edit: Clinical Nature of Equipment

K0730 1 3 Date of Service Edit: Clinical Nature of Equipment

K0733 2 2 Date of Service Edit: Policy Nature of Equipment

K0738 1 2 Date of Service Edit: Policy Nature of Equipment

K0743 1 2 Date of Service Edit: Policy Nature of Equipment

K0800 1 2 Date of Service Edit: Policy Nature of Equipment

K0801 1 2 Date of Service Edit: Policy Nature of Equipment

K0802 1 2 Date of Service Edit: Policy Nature of Equipment

K0806 1 2 Date of Service Edit: Policy Nature of Equipment

K0807 1 2 Date of Service Edit: Policy Nature of Equipment

K0808 1 2 Date of Service Edit: Policy Nature of Equipment

K0812 1 2 Date of Service Edit: Policy Nature of Equipment

K0813 1 2 Date of Service Edit: Policy Nature of Equipment

K0814 1 2 Date of Service Edit: Policy Nature of Equipment

K0815 1 2 Date of Service Edit: Policy Nature of Equipment

K0816 1 2 Date of Service Edit: Policy Nature of Equipment

K0820 1 2 Date of Service Edit: Policy Nature of Equipment

K0821 1 2 Date of Service Edit: Policy Nature of Equipment

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Values MUE Adjudication Indicator MUE Rationale

K0822 1 2 Date of Service Edit: Policy Nature of Equipment

K0823 1 2 Date of Service Edit: Policy Nature of Equipment

K0824 1 2 Date of Service Edit: Policy Nature of Equipment

K0825 1 2 Date of Service Edit: Policy Nature of Equipment

K0826 1 2 Date of Service Edit: Policy Nature of Equipment

K0827 1 2 Date of Service Edit: Policy Nature of Equipment

K0828 1 2 Date of Service Edit: Policy Nature of Equipment

K0829 1 2 Date of Service Edit: Policy Nature of Equipment

K0830 1 2 Date of Service Edit: Policy Nature of Equipment

K0831 1 2 Date of Service Edit: Policy Nature of Equipment

K0835 1 2 Date of Service Edit: Policy Nature of Equipment

K0836 1 2 Date of Service Edit: Policy Nature of Equipment

K0837 1 2 Date of Service Edit: Policy Nature of Equipment

K0838 1 2 Date of Service Edit: Policy Nature of Equipment

K0839 1 2 Date of Service Edit: Policy Nature of Equipment

K0840 1 2 Date of Service Edit: Policy Nature of Equipment

K0841 1 2 Date of Service Edit: Policy Nature of Equipment

K0842 1 2 Date of Service Edit: Policy Nature of Equipment

K0843 1 2 Date of Service Edit: Policy Nature of Equipment

K0848 1 2 Date of Service Edit: Policy Nature of Equipment

K0849 1 2 Date of Service Edit: Policy Nature of Equipment

K0850 1 2 Date of Service Edit: Policy Nature of Equipment

K0851 1 2 Date of Service Edit: Policy Nature of Equipment

K0852 1 2 Date of Service Edit: Policy Nature of Equipment

K0853 1 2 Date of Service Edit: Policy Nature of Equipment

K0854 1 2 Date of Service Edit: Policy Nature of Equipment

K0855 1 2 Date of Service Edit: Policy Nature of Equipment

K0856 1 2 Date of Service Edit: Policy Nature of Equipment

K0857 1 2 Date of Service Edit: Policy Nature of Equipment

K0858 1 2 Date of Service Edit: Policy Nature of Equipment

K0859 1 2 Date of Service Edit: Policy Nature of Equipment

K0860 1 2 Date of Service Edit: Policy Nature of Equipment

K0861 1 2 Date of Service Edit: Policy Nature of Equipment

K0862 1 2 Date of Service Edit: Policy Nature of Equipment

K0863 1 2 Date of Service Edit: Policy Nature of Equipment

K0864 1 2 Date of Service Edit: Policy Nature of Equipment

K0868 1 2 Date of Service Edit: Policy Nature of Equipment

K0869 1 2 Date of Service Edit: Policy Nature of Equipment

K0870 1 2 Date of Service Edit: Policy Nature of Equipment

K0871 1 2 Date of Service Edit: Policy Nature of Equipment

K0877 1 2 Date of Service Edit: Policy Nature of Equipment

K0878 1 2 Date of Service Edit: Policy Nature of Equipment

K0879 1 2 Date of Service Edit: Policy Nature of Equipment

K0880 1 2 Date of Service Edit: Policy Nature of Equipment

K0884 1 2 Date of Service Edit: Policy Nature of Equipment

K0885 1 2 Date of Service Edit: Policy Nature of Equipment

K0886 1 2 Date of Service Edit: Policy Nature of Equipment

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Values MUE Adjudication Indicator MUE Rationale

K0890 1 2 Date of Service Edit: Policy Nature of Equipment

K0891 1 2 Date of Service Edit: Policy Nature of Equipment

K0898 1 2 Date of Service Edit: Policy Nature of Equipment

K0900 1 3 Date of Service Edit: Clinical Nature of Equipment

L0112 1 2 Date of Service Edit: Policy Anatomic Consideration

L0113 1 2 Date of Service Edit: Policy Anatomic Consideration

L0120 1 2 Date of Service Edit: Policy Anatomic Consideration

L0130 1 2 Date of Service Edit: Policy Anatomic Consideration

L0140 1 2 Date of Service Edit: Policy Anatomic Consideration

L0150 1 2 Date of Service Edit: Policy Anatomic Consideration

L0160 1 2 Date of Service Edit: Policy Anatomic Consideration

L0170 1 2 Date of Service Edit: Policy Anatomic Consideration

L0172 1 2 Date of Service Edit: Policy Anatomic Consideration

L0174 1 2 Date of Service Edit: Policy Anatomic Consideration

L0180 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L0190 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L0200 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L0220 1 3 Date of Service Edit: Clinical Anatomic Consideration

L0450 1 2 Date of Service Edit: Policy Anatomic Consideration

L0452 1 2 Date of Service Edit: Policy Anatomic Consideration

L0454 1 2 Date of Service Edit: Policy Anatomic Consideration

L0455 1 2 Date of Service Edit: Policy Anatomic Consideration

L0456 1 2 Date of Service Edit: Policy Anatomic Consideration

L0457 1 2 Date of Service Edit: Policy Anatomic Consideration

L0458 1 2 Date of Service Edit: Policy Anatomic Consideration

L0460 1 2 Date of Service Edit: Policy Anatomic Consideration

L0462 1 2 Date of Service Edit: Policy Anatomic Consideration

L0464 1 2 Date of Service Edit: Policy Anatomic Consideration

L0466 1 2 Date of Service Edit: Policy Anatomic Consideration

L0467 1 2 Date of Service Edit: Policy Anatomic Consideration

L0468 1 2 Date of Service Edit: Policy Anatomic Consideration

L0469 1 2 Date of Service Edit: Policy Anatomic Consideration

L0470 1 2 Date of Service Edit: Policy Anatomic Consideration

L0472 1 2 Date of Service Edit: Policy Anatomic Consideration

L0480 1 2 Date of Service Edit: Policy Anatomic Consideration

L0482 1 2 Date of Service Edit: Policy Anatomic Consideration

L0484 1 2 Date of Service Edit: Policy Anatomic Consideration

L0486 1 2 Date of Service Edit: Policy Anatomic Consideration

L0488 1 2 Date of Service Edit: Policy Anatomic Consideration

L0490 1 2 Date of Service Edit: Policy Anatomic Consideration

L0491 1 2 Date of Service Edit: Policy Anatomic Consideration

L0492 1 2 Date of Service Edit: Policy Anatomic Consideration

L0621 1 2 Date of Service Edit: Policy Anatomic Consideration

L0622 1 2 Date of Service Edit: Policy Anatomic Consideration

L0623 1 2 Date of Service Edit: Policy Anatomic Consideration

L0624 1 2 Date of Service Edit: Policy Anatomic Consideration

L0625 1 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L0626 1 2 Date of Service Edit: Policy Anatomic Consideration

L0627 1 2 Date of Service Edit: Policy Anatomic Consideration

L0628 1 2 Date of Service Edit: Policy Anatomic Consideration

L0629 1 2 Date of Service Edit: Policy Anatomic Consideration

L0630 1 2 Date of Service Edit: Policy Anatomic Consideration

L0631 1 2 Date of Service Edit: Policy Anatomic Consideration

L0632 1 2 Date of Service Edit: Policy Anatomic Consideration

L0633 1 2 Date of Service Edit: Policy Anatomic Consideration

L0634 1 2 Date of Service Edit: Policy Anatomic Consideration

L0635 1 2 Date of Service Edit: Policy Anatomic Consideration

L0636 1 2 Date of Service Edit: Policy Anatomic Consideration

L0637 1 2 Date of Service Edit: Policy Anatomic Consideration

L0638 1 2 Date of Service Edit: Policy Anatomic Consideration

L0639 1 2 Date of Service Edit: Policy Anatomic Consideration

L0640 1 2 Date of Service Edit: Policy Anatomic Consideration

L0641 1 2 Date of Service Edit: Policy Anatomic Consideration

L0642 1 2 Date of Service Edit: Policy Anatomic Consideration

L0643 1 2 Date of Service Edit: Policy Anatomic Consideration

L0648 1 2 Date of Service Edit: Policy Anatomic Consideration

L0649 1 2 Date of Service Edit: Policy Anatomic Consideration

L0650 1 2 Date of Service Edit: Policy Anatomic Consideration

L0651 1 2 Date of Service Edit: Policy Anatomic Consideration

L0700 1 2 Date of Service Edit: Policy Anatomic Consideration

L0710 1 2 Date of Service Edit: Policy Anatomic Consideration

L0810 1 2 Date of Service Edit: Policy Anatomic Consideration

L0820 1 2 Date of Service Edit: Policy Anatomic Consideration

L0830 1 2 Date of Service Edit: Policy Anatomic Consideration

L0859 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L0861 1 2 Date of Service Edit: Policy Nature of Equipment

L0970 1 2 Date of Service Edit: Policy Anatomic Consideration

L0972 1 2 Date of Service Edit: Policy Anatomic Consideration

L0974 1 2 Date of Service Edit: Policy Anatomic Consideration

L0976 1 2 Date of Service Edit: Policy Anatomic Consideration

L0978 2 3 Date of Service Edit: Clinical Anatomic Consideration

L0980 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L0982 1 3 Date of Service Edit: Clinical Nature of Equipment

L0984 0 3 Date of Service Edit: Clinical CMS Policy

L1000 1 2 Date of Service Edit: Policy Anatomic Consideration

L1001 1 2 Date of Service Edit: Policy Anatomic Consideration

L1005 1 2 Date of Service Edit: Policy Anatomic Consideration

L1010 2 2 Date of Service Edit: Policy Anatomic Consideration

L1020 2 3 Date of Service Edit: Clinical Nature of Equipment

L1025 1 3 Date of Service Edit: Clinical Nature of Equipment

L1030 1 3 Date of Service Edit: Clinical Nature of Equipment

L1040 1 3 Date of Service Edit: Clinical Nature of Equipment

L1050 1 3 Date of Service Edit: Clinical Nature of Equipment

L1060 1 3 Date of Service Edit: Clinical Nature of Equipment

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L1070 2 2 Date of Service Edit: Policy Nature of Equipment

L1080 2 2 Date of Service Edit: Policy Nature of Equipment

L1085 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1090 1 3 Date of Service Edit: Clinical Anatomic Consideration

L1100 2 2 Date of Service Edit: Policy Nature of Equipment

L1110 2 2 Date of Service Edit: Policy Nature of Equipment

L1120 3 3 Date of Service Edit: Clinical Nature of Equipment

L1200 1 2 Date of Service Edit: Policy Anatomic Consideration

L1210 2 3 Date of Service Edit: Clinical Nature of Equipment

L1220 1 3 Date of Service Edit: Clinical Nature of Equipment

L1230 1 2 Date of Service Edit: Policy Nature of Equipment

L1240 1 3 Date of Service Edit: Clinical Nature of Equipment

L1250 2 3 Date of Service Edit: Clinical Nature of Equipment

L1260 1 3 Date of Service Edit: Clinical Nature of Equipment

L1270 3 3 Date of Service Edit: Clinical Nature of Equipment

L1280 2 3 Date of Service Edit: Clinical Nature of Equipment

L1290 2 3 Date of Service Edit: Clinical Nature of Equipment

L1300 1 2 Date of Service Edit: Policy Anatomic Consideration

L1310 1 2 Date of Service Edit: Policy Anatomic Consideration

L1499 1 3 Date of Service Edit: Clinical Nature of Equipment

L1600 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1610 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1620 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1630 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1640 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1650 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1652 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1660 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1680 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1685 1 2 Date of Service Edit: Policy Nature of Equipment

L1686 1 3 Date of Service Edit: Clinical Nature of Equipment

L1690 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L1700 1 2 Date of Service Edit: Policy Nature of Equipment

L1710 1 2 Date of Service Edit: Policy Nature of Equipment

L1720 2 2 Date of Service Edit: Policy Anatomic Consideration

L1730 1 2 Date of Service Edit: Policy Nature of Equipment

L1755 2 2 Date of Service Edit: Policy Anatomic Consideration

L1810 2 2 Date of Service Edit: Policy Anatomic Consideration

L1812 2 2 Date of Service Edit: Policy Anatomic Consideration

L1820 2 2 Date of Service Edit: Policy Anatomic Consideration

L1830 2 2 Date of Service Edit: Policy Anatomic Consideration

L1831 2 2 Date of Service Edit: Policy Anatomic Consideration

L1832 2 2 Date of Service Edit: Policy Anatomic Consideration

L1833 2 2 Date of Service Edit: Policy Anatomic Consideration

L1834 2 2 Date of Service Edit: Policy Anatomic Consideration

L1836 2 2 Date of Service Edit: Policy Anatomic Consideration

L1840 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L1843 2 2 Date of Service Edit: Policy Anatomic Consideration

L1844 2 2 Date of Service Edit: Policy Anatomic Consideration

L1845 2 2 Date of Service Edit: Policy Anatomic Consideration

L1846 2 2 Date of Service Edit: Policy Anatomic Consideration

L1847 2 2 Date of Service Edit: Policy Anatomic Consideration

L1848 2 2 Date of Service Edit: Policy Anatomic Consideration

L1850 2 2 Date of Service Edit: Policy Anatomic Consideration

L1860 2 2 Date of Service Edit: Policy Anatomic Consideration

L1900 2 2 Date of Service Edit: Policy Anatomic Consideration

L1902 2 2 Date of Service Edit: Policy Anatomic Consideration

L1904 2 2 Date of Service Edit: Policy Anatomic Consideration

L1906 2 2 Date of Service Edit: Policy Anatomic Consideration

L1907 2 2 Date of Service Edit: Policy Anatomic Consideration

L1910 2 2 Date of Service Edit: Policy Anatomic Consideration

L1920 2 2 Date of Service Edit: Policy Anatomic Consideration

L1930 2 2 Date of Service Edit: Policy Anatomic Consideration

L1932 2 2 Date of Service Edit: Policy Anatomic Consideration

L1940 2 2 Date of Service Edit: Policy Anatomic Consideration

L1945 2 2 Date of Service Edit: Policy Anatomic Consideration

L1950 2 2 Date of Service Edit: Policy Anatomic Consideration

L1951 2 2 Date of Service Edit: Policy Anatomic Consideration

L1960 2 2 Date of Service Edit: Policy Anatomic Consideration

L1970 2 2 Date of Service Edit: Policy Anatomic Consideration

L1971 2 2 Date of Service Edit: Policy Anatomic Consideration

L1980 2 2 Date of Service Edit: Policy Anatomic Consideration

L1990 2 2 Date of Service Edit: Policy Anatomic Consideration

L2000 2 2 Date of Service Edit: Policy Anatomic Consideration

L2005 2 2 Date of Service Edit: Policy Anatomic Consideration

L2010 2 2 Date of Service Edit: Policy Anatomic Consideration

L2020 2 2 Date of Service Edit: Policy Anatomic Consideration

L2030 2 2 Date of Service Edit: Policy Anatomic Consideration

L2034 2 2 Date of Service Edit: Policy Anatomic Consideration

L2035 2 2 Date of Service Edit: Policy Anatomic Consideration

L2036 2 2 Date of Service Edit: Policy Anatomic Consideration

L2037 2 2 Date of Service Edit: Policy Anatomic Consideration

L2038 2 2 Date of Service Edit: Policy Anatomic Consideration

L2040 1 2 Date of Service Edit: Policy Nature of Equipment

L2050 1 2 Date of Service Edit: Policy Nature of Equipment

L2060 1 2 Date of Service Edit: Policy Nature of Equipment

L2070 1 2 Date of Service Edit: Policy Nature of Equipment

L2080 1 2 Date of Service Edit: Policy Nature of Equipment

L2090 1 2 Date of Service Edit: Policy Nature of Equipment

L2106 2 2 Date of Service Edit: Policy Anatomic Consideration

L2108 2 2 Date of Service Edit: Policy Anatomic Consideration

L2112 2 2 Date of Service Edit: Policy Anatomic Consideration

L2114 2 2 Date of Service Edit: Policy Anatomic Consideration

L2116 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L2126 2 2 Date of Service Edit: Policy Anatomic Consideration

L2128 2 2 Date of Service Edit: Policy Anatomic Consideration

L2132 2 2 Date of Service Edit: Policy Anatomic Consideration

L2134 2 2 Date of Service Edit: Policy Anatomic Consideration

L2136 2 2 Date of Service Edit: Policy Anatomic Consideration

L2180 2 2 Date of Service Edit: Policy Anatomic Consideration

L2182 4 2 Date of Service Edit: Policy Nature of Equipment

L2184 4 2 Date of Service Edit: Policy Nature of Equipment

L2186 4 2 Date of Service Edit: Policy Nature of Equipment

L2188 2 2 Date of Service Edit: Policy Anatomic Consideration

L2190 2 2 Date of Service Edit: Policy Anatomic Consideration

L2192 2 2 Date of Service Edit: Policy Anatomic Consideration

L2200 4 2 Date of Service Edit: Policy Anatomic Consideration

L2210 4 2 Date of Service Edit: Policy Anatomic Consideration

L2220 4 2 Date of Service Edit: Policy Anatomic Consideration

L2230 2 2 Date of Service Edit: Policy Anatomic Consideration

L2232 2 2 Date of Service Edit: Policy Anatomic Consideration

L2240 2 2 Date of Service Edit: Policy Anatomic Consideration

L2250 2 2 Date of Service Edit: Policy Anatomic Consideration

L2260 2 2 Date of Service Edit: Policy Anatomic Consideration

L2265 2 2 Date of Service Edit: Policy Anatomic Consideration

L2270 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2275 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2280 2 2 Date of Service Edit: Policy Anatomic Consideration

L2300 1 2 Date of Service Edit: Policy Nature of Equipment

L2310 1 2 Date of Service Edit: Policy Nature of Equipment

L2320 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2330 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2335 2 2 Date of Service Edit: Policy Anatomic Consideration

L2340 2 2 Date of Service Edit: Policy Anatomic Consideration

L2350 2 2 Date of Service Edit: Policy Anatomic Consideration

L2360 2 2 Date of Service Edit: Policy Anatomic Consideration

L2370 2 2 Date of Service Edit: Policy Anatomic Consideration

L2375 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2380 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2385 4 2 Date of Service Edit: Policy Anatomic Consideration

L2387 4 2 Date of Service Edit: Policy Anatomic Consideration

L2390 4 2 Date of Service Edit: Policy Anatomic Consideration

L2395 4 2 Date of Service Edit: Policy Anatomic Consideration

L2397 4 3 Date of Service Edit: Clinical Anatomic Consideration

L2405 4 2 Date of Service Edit: Policy Anatomic Consideration

L2415 4 2 Date of Service Edit: Policy Anatomic Consideration

L2425 4 2 Date of Service Edit: Policy Anatomic Consideration

L2430 4 2 Date of Service Edit: Policy Anatomic Consideration

L2492 4 2 Date of Service Edit: Policy Anatomic Consideration

L2500 2 2 Date of Service Edit: Policy Anatomic Consideration

L2510 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L2520 2 2 Date of Service Edit: Policy Anatomic Consideration

L2525 2 2 Date of Service Edit: Policy Anatomic Consideration

L2526 2 2 Date of Service Edit: Policy Anatomic Consideration

L2530 2 2 Date of Service Edit: Policy Anatomic Consideration

L2540 2 2 Date of Service Edit: Policy Anatomic Consideration

L2550 2 2 Date of Service Edit: Policy Anatomic Consideration

L2570 2 2 Date of Service Edit: Policy Anatomic Consideration

L2580 2 2 Date of Service Edit: Policy Anatomic Consideration

L2600 2 2 Date of Service Edit: Policy Anatomic Consideration

L2610 2 2 Date of Service Edit: Policy Anatomic Consideration

L2620 2 2 Date of Service Edit: Policy Anatomic Consideration

L2622 2 2 Date of Service Edit: Policy Anatomic Consideration

L2624 2 2 Date of Service Edit: Policy Anatomic Consideration

L2627 1 3 Date of Service Edit: Clinical Nature of Equipment

L2628 1 3 Date of Service Edit: Clinical Nature of Equipment

L2630 1 2 Date of Service Edit: Policy Anatomic Consideration

L2640 1 2 Date of Service Edit: Policy Anatomic Consideration

L2650 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2660 1 3 Date of Service Edit: Clinical Nature of Equipment

L2670 2 3 Date of Service Edit: Clinical Nature of Equipment

L2680 2 3 Date of Service Edit: Clinical Nature of Equipment

L2750 8 3 Date of Service Edit: Clinical Clinical: Data

L2755 8 3 Date of Service Edit: Clinical Clinical: Data

L2760 8 2 Date of Service Edit: Policy Nature of Equipment

L2768 4 2 Date of Service Edit: Policy Nature of Equipment

L2780 8 3 Date of Service Edit: Clinical Clinical: Data

L2785 4 2 Date of Service Edit: Policy Nature of Equipment

L2795 2 2 Date of Service Edit: Policy Anatomic Consideration

L2800 2 2 Date of Service Edit: Policy Anatomic Consideration

L2810 4 2 Date of Service Edit: Policy Anatomic Consideration

L2820 2 3 Date of Service Edit: Clinical Anatomic Consideration

L2830 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3000 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3001 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3002 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3003 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3010 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3020 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3030 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3031 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3040 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3050 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3060 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3070 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3080 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3090 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3100 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L3140 1 2 Date of Service Edit: Policy Nature of Equipment

L3150 1 2 Date of Service Edit: Policy Nature of Equipment

L3160 2 2 Date of Service Edit: Policy Anatomic Consideration

L3170 2 2 Date of Service Edit: Policy Anatomic Consideration

L3215 0 3 Date of Service Edit: Clinical Published Contractor Policy

L3216 2 2 Date of Service Edit: Policy Anatomic Consideration

L3217 2 2 Date of Service Edit: Policy Anatomic Consideration

L3219 0 3 Date of Service Edit: Clinical Published Contractor Policy

L3221 2 2 Date of Service Edit: Policy Anatomic Consideration

L3222 2 2 Date of Service Edit: Policy Anatomic Consideration

L3224 2 2 Date of Service Edit: Policy Anatomic Consideration

L3225 2 2 Date of Service Edit: Policy Anatomic Consideration

L3230 2 2 Date of Service Edit: Policy Anatomic Consideration

L3250 2 2 Date of Service Edit: Policy Anatomic Consideration

L3251 2 2 Date of Service Edit: Policy Anatomic Consideration

L3252 2 2 Date of Service Edit: Policy Anatomic Consideration

L3253 2 2 Date of Service Edit: Policy Anatomic Consideration

L3300 4 3 Date of Service Edit: Clinical Clinical: Data

L3310 4 3 Date of Service Edit: Clinical Clinical: Data

L3330 2 2 Date of Service Edit: Policy Anatomic Consideration

L3332 2 2 Date of Service Edit: Policy Anatomic Consideration

L3334 4 3 Date of Service Edit: Clinical Clinical: Data

L3340 2 2 Date of Service Edit: Policy Anatomic Consideration

L3350 2 2 Date of Service Edit: Policy Anatomic Consideration

L3360 2 2 Date of Service Edit: Policy Anatomic Consideration

L3370 2 2 Date of Service Edit: Policy Anatomic Consideration

L3380 2 2 Date of Service Edit: Policy Anatomic Consideration

L3390 2 2 Date of Service Edit: Policy Anatomic Consideration

L3400 2 2 Date of Service Edit: Policy Anatomic Consideration

L3410 2 2 Date of Service Edit: Policy Anatomic Consideration

L3420 2 2 Date of Service Edit: Policy Anatomic Consideration

L3430 2 2 Date of Service Edit: Policy Anatomic Consideration

L3440 2 2 Date of Service Edit: Policy Anatomic Consideration

L3450 2 2 Date of Service Edit: Policy Anatomic Consideration

L3455 2 2 Date of Service Edit: Policy Anatomic Consideration

L3460 2 2 Date of Service Edit: Policy Anatomic Consideration

L3465 2 2 Date of Service Edit: Policy Anatomic Consideration

L3470 2 2 Date of Service Edit: Policy Anatomic Consideration

L3480 2 2 Date of Service Edit: Policy Anatomic Consideration

L3485 2 2 Date of Service Edit: Policy Anatomic Consideration

L3500 2 2 Date of Service Edit: Policy Anatomic Consideration

L3510 2 2 Date of Service Edit: Policy Anatomic Consideration

L3520 2 2 Date of Service Edit: Policy Anatomic Consideration

L3530 2 2 Date of Service Edit: Policy Anatomic Consideration

L3540 2 2 Date of Service Edit: Policy Anatomic Consideration

L3550 2 2 Date of Service Edit: Policy Anatomic Consideration

L3560 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L3570 2 2 Date of Service Edit: Policy Anatomic Consideration

L3580 2 2 Date of Service Edit: Policy Anatomic Consideration

L3590 2 2 Date of Service Edit: Policy Anatomic Consideration

L3595 2 2 Date of Service Edit: Policy Anatomic Consideration

L3600 2 2 Date of Service Edit: Policy Nature of Service/Procedure

L3610 2 2 Date of Service Edit: Policy Nature of Service/Procedure

L3620 2 2 Date of Service Edit: Policy Nature of Service/Procedure

L3630 2 2 Date of Service Edit: Policy Nature of Service/Procedure

L3640 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L3650 1 2 Date of Service Edit: Policy Nature of Equipment

L3660 1 2 Date of Service Edit: Policy Nature of Equipment

L3670 1 3 Date of Service Edit: Clinical Nature of Equipment

L3671 1 3 Date of Service Edit: Clinical Nature of Equipment

L3674 1 3 Date of Service Edit: Clinical Clinical: Data

L3675 1 2 Date of Service Edit: Policy Nature of Equipment

L3677 1 2 Date of Service Edit: Policy Nature of Equipment

L3678 1 2 Date of Service Edit: Policy Nature of Equipment

L3702 2 2 Date of Service Edit: Policy Anatomic Consideration

L3710 2 2 Date of Service Edit: Policy Anatomic Consideration

L3720 2 2 Date of Service Edit: Policy Anatomic Consideration

L3730 2 2 Date of Service Edit: Policy Anatomic Consideration

L3740 2 2 Date of Service Edit: Policy Anatomic Consideration

L3760 2 2 Date of Service Edit: Policy Anatomic Consideration

L3762 2 2 Date of Service Edit: Policy Anatomic Consideration

L3763 2 2 Date of Service Edit: Policy Anatomic Consideration

L3764 2 2 Date of Service Edit: Policy Anatomic Consideration

L3765 2 2 Date of Service Edit: Policy Anatomic Consideration

L3766 2 2 Date of Service Edit: Policy Anatomic Consideration

L3806 2 2 Date of Service Edit: Policy Anatomic Consideration

L3807 2 2 Date of Service Edit: Policy Anatomic Consideration

L3808 2 2 Date of Service Edit: Policy Anatomic Consideration

L3809 2 2 Date of Service Edit: Policy Anatomic Consideration

L3900 2 2 Date of Service Edit: Policy Anatomic Consideration

L3901 2 2 Date of Service Edit: Policy Anatomic Consideration

L3904 2 2 Date of Service Edit: Policy Anatomic Consideration

L3905 2 2 Date of Service Edit: Policy Anatomic Consideration

L3906 2 2 Date of Service Edit: Policy Anatomic Consideration

L3908 2 2 Date of Service Edit: Policy Anatomic Consideration

L3912 2 3 Date of Service Edit: Clinical Anatomic Consideration

L3913 2 2 Date of Service Edit: Policy Anatomic Consideration

L3915 2 2 Date of Service Edit: Policy Anatomic Consideration

L3916 2 2 Date of Service Edit: Policy Anatomic Consideration

L3917 2 2 Date of Service Edit: Policy Anatomic Consideration

L3918 2 2 Date of Service Edit: Policy Anatomic Consideration

L3919 2 2 Date of Service Edit: Policy Anatomic Consideration

L3921 2 2 Date of Service Edit: Policy Anatomic Consideration

L3923 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L3924 2 2 Date of Service Edit: Policy Anatomic Consideration

L3925 4 3 Date of Service Edit: Clinical Code Descriptor / CPT Instruction

L3927 4 3 Date of Service Edit: Clinical Clinical: Data

L3929 2 2 Date of Service Edit: Policy Anatomic Consideration

L3930 2 2 Date of Service Edit: Policy Anatomic Consideration

L3931 2 2 Date of Service Edit: Policy Anatomic Consideration

L3933 3 3 Date of Service Edit: Clinical Clinical: Data

L3935 3 3 Date of Service Edit: Clinical Clinical: Data

L3956 4 3 Date of Service Edit: Clinical Clinical: Data

L3960 1 3 Date of Service Edit: Clinical Nature of Equipment

L3961 1 3 Date of Service Edit: Clinical Nature of Equipment

L3962 1 3 Date of Service Edit: Clinical Nature of Equipment

L3967 1 3 Date of Service Edit: Clinical Nature of Equipment

L3971 1 3 Date of Service Edit: Clinical Nature of Equipment

L3973 1 3 Date of Service Edit: Clinical Nature of Equipment

L3975 1 3 Date of Service Edit: Clinical Nature of Equipment

L3976 1 3 Date of Service Edit: Clinical Nature of Equipment

L3977 1 3 Date of Service Edit: Clinical Nature of Equipment

L3978 1 3 Date of Service Edit: Clinical Nature of Equipment

L3980 2 2 Date of Service Edit: Policy Anatomic Consideration

L3982 2 2 Date of Service Edit: Policy Anatomic Consideration

L3984 2 2 Date of Service Edit: Policy Anatomic Consideration

L4000 1 2 Date of Service Edit: Policy Anatomic Consideration

L4002 8 3 Date of Service Edit: Clinical Clinical: Data

L4010 2 2 Date of Service Edit: Policy Anatomic Consideration

L4020 2 2 Date of Service Edit: Policy Anatomic Consideration

L4030 2 2 Date of Service Edit: Policy Anatomic Consideration

L4040 2 2 Date of Service Edit: Policy Anatomic Consideration

L4045 2 2 Date of Service Edit: Policy Anatomic Consideration

L4050 2 2 Date of Service Edit: Policy Anatomic Consideration

L4055 2 2 Date of Service Edit: Policy Anatomic Consideration

L4060 2 2 Date of Service Edit: Policy Anatomic Consideration

L4070 2 3 Date of Service Edit: Clinical Clinical: Data

L4080 2 2 Date of Service Edit: Policy Anatomic Consideration

L4090 4 2 Date of Service Edit: Policy Clinical: Data

L4100 2 2 Date of Service Edit: Policy Anatomic Consideration

L4110 4 2 Date of Service Edit: Policy Clinical: Data

L4130 2 2 Date of Service Edit: Policy Anatomic Consideration

L4205 8 3 Date of Service Edit: Clinical Clinical: Data

L4210 4 3 Date of Service Edit: Clinical Clinical: Data

L4350 2 2 Date of Service Edit: Policy Anatomic Consideration

L4360 2 2 Date of Service Edit: Policy Anatomic Consideration

L4361 2 2 Date of Service Edit: Policy Anatomic Consideration

L4370 2 2 Date of Service Edit: Policy Anatomic Consideration

L4386 2 2 Date of Service Edit: Policy Anatomic Consideration

L4387 2 2 Date of Service Edit: Policy Anatomic Consideration

L4392 2 3 Date of Service Edit: Clinical Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L4394 2 3 Date of Service Edit: Clinical Anatomic Consideration

L4396 2 2 Date of Service Edit: Policy Anatomic Consideration

L4397 2 2 Date of Service Edit: Policy Anatomic Consideration

L4398 2 2 Date of Service Edit: Policy Anatomic Consideration

L4631 2 2 Date of Service Edit: Policy Anatomic Consideration

L5000 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5010 2 2 Date of Service Edit: Policy Anatomic Consideration

L5020 2 2 Date of Service Edit: Policy Anatomic Consideration

L5050 2 2 Date of Service Edit: Policy Anatomic Consideration

L5060 2 2 Date of Service Edit: Policy Anatomic Consideration

L5100 2 2 Date of Service Edit: Policy Anatomic Consideration

L5105 2 2 Date of Service Edit: Policy Anatomic Consideration

L5150 2 2 Date of Service Edit: Policy Anatomic Consideration

L5160 2 2 Date of Service Edit: Policy Anatomic Consideration

L5200 2 2 Date of Service Edit: Policy Anatomic Consideration

L5210 2 2 Date of Service Edit: Policy Anatomic Consideration

L5220 2 2 Date of Service Edit: Policy Anatomic Consideration

L5230 2 2 Date of Service Edit: Policy Anatomic Consideration

L5250 2 2 Date of Service Edit: Policy Anatomic Consideration

L5270 2 2 Date of Service Edit: Policy Anatomic Consideration

L5280 2 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L5301 2 2 Date of Service Edit: Policy Anatomic Consideration

L5312 2 2 Date of Service Edit: Policy Anatomic Consideration

L5321 2 2 Date of Service Edit: Policy Anatomic Consideration

L5331 2 2 Date of Service Edit: Policy Anatomic Consideration

L5341 2 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

L5400 2 2 Date of Service Edit: Policy Anatomic Consideration

L5410 2 2 Date of Service Edit: Policy Clinical: Data

L5420 2 2 Date of Service Edit: Policy Anatomic Consideration

L5430 2 2 Date of Service Edit: Policy Clinical: Data

L5450 2 2 Date of Service Edit: Policy Anatomic Consideration

L5460 2 2 Date of Service Edit: Policy Anatomic Consideration

L5500 2 2 Date of Service Edit: Policy Anatomic Consideration

L5505 2 2 Date of Service Edit: Policy Anatomic Consideration

L5510 2 2 Date of Service Edit: Policy Anatomic Consideration

L5520 2 2 Date of Service Edit: Policy Anatomic Consideration

L5530 2 2 Date of Service Edit: Policy Anatomic Consideration

L5535 2 2 Date of Service Edit: Policy Anatomic Consideration

L5540 2 2 Date of Service Edit: Policy Anatomic Consideration

L5560 2 2 Date of Service Edit: Policy Anatomic Consideration

L5570 2 2 Date of Service Edit: Policy Anatomic Consideration

L5580 2 2 Date of Service Edit: Policy Anatomic Consideration

L5585 2 2 Date of Service Edit: Policy Anatomic Consideration

L5590 2 2 Date of Service Edit: Policy Anatomic Consideration

L5595 2 2 Date of Service Edit: Policy Anatomic Consideration

L5600 2 2 Date of Service Edit: Policy Anatomic Consideration

L5610 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L5611 2 2 Date of Service Edit: Policy Anatomic Consideration

L5613 2 2 Date of Service Edit: Policy Anatomic Consideration

L5614 2 2 Date of Service Edit: Policy Anatomic Consideration

L5616 2 2 Date of Service Edit: Policy Anatomic Consideration

L5617 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5618 4 3 Date of Service Edit: Clinical Nature of Equipment

L5620 4 3 Date of Service Edit: Clinical Nature of Equipment

L5622 4 3 Date of Service Edit: Clinical Nature of Equipment

L5624 4 3 Date of Service Edit: Clinical Nature of Equipment

L5626 4 3 Date of Service Edit: Clinical Nature of Equipment

L5628 2 3 Date of Service Edit: Clinical Nature of Equipment

L5629 2 2 Date of Service Edit: Policy Anatomic Consideration

L5630 2 2 Date of Service Edit: Policy Anatomic Consideration

L5631 2 2 Date of Service Edit: Policy Anatomic Consideration

L5632 2 2 Date of Service Edit: Policy Anatomic Consideration

L5634 2 2 Date of Service Edit: Policy Anatomic Consideration

L5636 2 2 Date of Service Edit: Policy Anatomic Consideration

L5637 2 2 Date of Service Edit: Policy Anatomic Consideration

L5638 2 2 Date of Service Edit: Policy Anatomic Consideration

L5639 2 2 Date of Service Edit: Policy Anatomic Consideration

L5640 2 2 Date of Service Edit: Policy Anatomic Consideration

L5642 2 2 Date of Service Edit: Policy Anatomic Consideration

L5643 2 2 Date of Service Edit: Policy Anatomic Consideration

L5644 2 2 Date of Service Edit: Policy Anatomic Consideration

L5645 2 2 Date of Service Edit: Policy Anatomic Consideration

L5646 2 2 Date of Service Edit: Policy Anatomic Consideration

L5647 2 2 Date of Service Edit: Policy Anatomic Consideration

L5648 2 2 Date of Service Edit: Policy Anatomic Consideration

L5649 2 2 Date of Service Edit: Policy Anatomic Consideration

L5650 2 2 Date of Service Edit: Policy Anatomic Consideration

L5651 2 2 Date of Service Edit: Policy Anatomic Consideration

L5652 2 2 Date of Service Edit: Policy Anatomic Consideration

L5653 2 2 Date of Service Edit: Policy Anatomic Consideration

L5654 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5655 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5656 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5658 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5661 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5665 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5666 2 2 Date of Service Edit: Policy Anatomic Consideration

L5668 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5670 2 2 Date of Service Edit: Policy Anatomic Consideration

L5671 2 2 Date of Service Edit: Policy Anatomic Consideration

L5672 2 2 Date of Service Edit: Policy Anatomic Consideration

L5673 4 3 Date of Service Edit: Clinical Nature of Equipment

L5676 2 2 Date of Service Edit: Policy Anatomic Consideration

L5677 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L5678 2 2 Date of Service Edit: Policy Anatomic Consideration

L5679 4 3 Date of Service Edit: Clinical Nature of Equipment

L5680 2 2 Date of Service Edit: Policy Anatomic Consideration

L5681 2 2 Date of Service Edit: Policy Anatomic Consideration

L5682 2 2 Date of Service Edit: Policy Anatomic Consideration

L5683 2 2 Date of Service Edit: Policy Anatomic Consideration

L5684 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5685 4 3 Date of Service Edit: Clinical Anatomic Consideration

L5686 2 2 Date of Service Edit: Policy Anatomic Consideration

L5688 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5690 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5692 2 2 Date of Service Edit: Policy Anatomic Consideration

L5694 2 2 Date of Service Edit: Policy Anatomic Consideration

L5695 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5696 2 2 Date of Service Edit: Policy Anatomic Consideration

L5697 2 2 Date of Service Edit: Policy Anatomic Consideration

L5698 2 2 Date of Service Edit: Policy Anatomic Consideration

L5699 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5700 2 2 Date of Service Edit: Policy Anatomic Consideration

L5701 2 2 Date of Service Edit: Policy Anatomic Consideration

L5702 2 2 Date of Service Edit: Policy Anatomic Consideration

L5703 2 2 Date of Service Edit: Policy Anatomic Consideration

L5704 2 2 Date of Service Edit: Policy Anatomic Consideration

L5705 2 2 Date of Service Edit: Policy Anatomic Consideration

L5706 2 2 Date of Service Edit: Policy Anatomic Consideration

L5707 2 2 Date of Service Edit: Policy Anatomic Consideration

L5710 2 2 Date of Service Edit: Policy Anatomic Consideration

L5711 2 2 Date of Service Edit: Policy Anatomic Consideration

L5712 2 2 Date of Service Edit: Policy Anatomic Consideration

L5714 2 2 Date of Service Edit: Policy Anatomic Consideration

L5716 2 2 Date of Service Edit: Policy Anatomic Consideration

L5718 2 2 Date of Service Edit: Policy Anatomic Consideration

L5722 2 2 Date of Service Edit: Policy Anatomic Consideration

L5724 2 2 Date of Service Edit: Policy Anatomic Consideration

L5726 2 2 Date of Service Edit: Policy Anatomic Consideration

L5728 2 2 Date of Service Edit: Policy Anatomic Consideration

L5780 2 2 Date of Service Edit: Policy Anatomic Consideration

L5781 2 2 Date of Service Edit: Policy Anatomic Consideration

L5782 2 2 Date of Service Edit: Policy Anatomic Consideration

L5785 2 2 Date of Service Edit: Policy Anatomic Consideration

L5790 2 2 Date of Service Edit: Policy Anatomic Consideration

L5795 2 2 Date of Service Edit: Policy Anatomic Consideration

L5810 2 2 Date of Service Edit: Policy Anatomic Consideration

L5811 2 2 Date of Service Edit: Policy Anatomic Consideration

L5812 2 2 Date of Service Edit: Policy Anatomic Consideration

L5814 2 2 Date of Service Edit: Policy Anatomic Consideration

L5816 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L5818 2 2 Date of Service Edit: Policy Anatomic Consideration

L5822 2 2 Date of Service Edit: Policy Anatomic Consideration

L5824 2 2 Date of Service Edit: Policy Anatomic Consideration

L5826 2 2 Date of Service Edit: Policy Anatomic Consideration

L5828 2 2 Date of Service Edit: Policy Anatomic Consideration

L5830 2 2 Date of Service Edit: Policy Anatomic Consideration

L5840 2 2 Date of Service Edit: Policy Anatomic Consideration

L5845 2 2 Date of Service Edit: Policy Anatomic Consideration

L5848 2 2 Date of Service Edit: Policy Anatomic Consideration

L5850 2 2 Date of Service Edit: Policy Anatomic Consideration

L5855 2 2 Date of Service Edit: Policy Anatomic Consideration

L5856 2 2 Date of Service Edit: Policy Anatomic Consideration

L5857 2 2 Date of Service Edit: Policy Anatomic Consideration

L5858 2 2 Date of Service Edit: Policy Anatomic Consideration

L5859 2 1 Line Edit Anatomic Consideration

L5910 2 2 Date of Service Edit: Policy Anatomic Consideration

L5920 2 2 Date of Service Edit: Policy Anatomic Consideration

L5925 2 3 Date of Service Edit: Clinical Anatomic Consideration

L5930 2 2 Date of Service Edit: Policy Anatomic Consideration

L5940 2 2 Date of Service Edit: Policy Anatomic Consideration

L5950 2 2 Date of Service Edit: Policy Anatomic Consideration

L5960 2 2 Date of Service Edit: Policy Anatomic Consideration

L5961 1 3 Date of Service Edit: Clinical Anatomic Consideration

L5962 2 2 Date of Service Edit: Policy Anatomic Consideration

L5964 2 2 Date of Service Edit: Policy Anatomic Consideration

L5966 2 2 Date of Service Edit: Policy Anatomic Consideration

L5968 2 2 Date of Service Edit: Policy Anatomic Consideration

L5969 2 2 Date of Service Edit: Policy Anatomic Consideration

L5970 2 2 Date of Service Edit: Policy Anatomic Consideration

L5971 2 2 Date of Service Edit: Policy Anatomic Consideration

L5972 2 2 Date of Service Edit: Policy Anatomic Consideration

L5973 2 2 Date of Service Edit: Policy Anatomic Consideration

L5974 2 2 Date of Service Edit: Policy Anatomic Consideration

L5975 2 2 Date of Service Edit: Policy Anatomic Consideration

L5976 2 2 Date of Service Edit: Policy Anatomic Consideration

L5978 2 2 Date of Service Edit: Policy Anatomic Consideration

L5979 2 2 Date of Service Edit: Policy Anatomic Consideration

L5980 2 2 Date of Service Edit: Policy Anatomic Consideration

L5981 2 2 Date of Service Edit: Policy Anatomic Consideration

L5982 2 2 Date of Service Edit: Policy Anatomic Consideration

L5984 2 2 Date of Service Edit: Policy Anatomic Consideration

L5985 2 2 Date of Service Edit: Policy Anatomic Consideration

L5986 2 2 Date of Service Edit: Policy Anatomic Consideration

L5987 2 2 Date of Service Edit: Policy Anatomic Consideration

L5988 2 2 Date of Service Edit: Policy Anatomic Consideration

L5990 2 2 Date of Service Edit: Policy Anatomic Consideration

L6000 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L6010 2 2 Date of Service Edit: Policy Anatomic Consideration

L6020 2 2 Date of Service Edit: Policy Anatomic Consideration

L6050 2 2 Date of Service Edit: Policy Anatomic Consideration

L6055 2 2 Date of Service Edit: Policy Anatomic Consideration

L6100 2 2 Date of Service Edit: Policy Anatomic Consideration

L6110 2 2 Date of Service Edit: Policy Anatomic Consideration

L6120 2 2 Date of Service Edit: Policy Anatomic Consideration

L6130 2 2 Date of Service Edit: Policy Anatomic Consideration

L6200 2 2 Date of Service Edit: Policy Anatomic Consideration

L6205 2 2 Date of Service Edit: Policy Anatomic Consideration

L6250 2 2 Date of Service Edit: Policy Anatomic Consideration

L6300 2 2 Date of Service Edit: Policy Anatomic Consideration

L6310 2 2 Date of Service Edit: Policy Anatomic Consideration

L6320 2 2 Date of Service Edit: Policy Anatomic Consideration

L6350 2 2 Date of Service Edit: Policy Anatomic Consideration

L6360 2 2 Date of Service Edit: Policy Anatomic Consideration

L6370 2 2 Date of Service Edit: Policy Anatomic Consideration

L6380 2 2 Date of Service Edit: Policy Anatomic Consideration

L6382 2 2 Date of Service Edit: Policy Anatomic Consideration

L6384 2 2 Date of Service Edit: Policy Anatomic Consideration

L6386 2 2 Date of Service Edit: Policy Clinical: Data

L6388 2 2 Date of Service Edit: Policy Anatomic Consideration

L6400 2 2 Date of Service Edit: Policy Anatomic Consideration

L6450 2 2 Date of Service Edit: Policy Anatomic Consideration

L6500 2 2 Date of Service Edit: Policy Anatomic Consideration

L6550 2 2 Date of Service Edit: Policy Anatomic Consideration

L6570 2 2 Date of Service Edit: Policy Anatomic Consideration

L6580 2 2 Date of Service Edit: Policy Anatomic Consideration

L6582 2 2 Date of Service Edit: Policy Anatomic Consideration

L6584 2 2 Date of Service Edit: Policy Anatomic Consideration

L6586 2 2 Date of Service Edit: Policy Anatomic Consideration

L6588 2 2 Date of Service Edit: Policy Anatomic Consideration

L6590 2 2 Date of Service Edit: Policy Anatomic Consideration

L6600 2 2 Date of Service Edit: Policy Anatomic Consideration

L6605 2 2 Date of Service Edit: Policy Anatomic Consideration

L6610 2 2 Date of Service Edit: Policy Anatomic Consideration

L6611 2 3 Date of Service Edit: Clinical Anatomic Consideration

L6615 2 2 Date of Service Edit: Policy Anatomic Consideration

L6616 2 2 Date of Service Edit: Policy Anatomic Consideration

L6620 2 2 Date of Service Edit: Policy Anatomic Consideration

L6621 2 2 Date of Service Edit: Policy Anatomic Consideration

L6623 2 2 Date of Service Edit: Policy Anatomic Consideration

L6624 2 2 Date of Service Edit: Policy Anatomic Consideration

L6625 2 2 Date of Service Edit: Policy Anatomic Consideration

L6628 2 2 Date of Service Edit: Policy Anatomic Consideration

L6629 2 2 Date of Service Edit: Policy Anatomic Consideration

L6630 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L6632 4 3 Date of Service Edit: Clinical Clinical: Data

L6635 2 2 Date of Service Edit: Policy Anatomic Consideration

L6637 2 2 Date of Service Edit: Policy Anatomic Consideration

L6638 2 2 Date of Service Edit: Policy Anatomic Consideration

L6640 2 2 Date of Service Edit: Policy Anatomic Consideration

L6641 2 3 Date of Service Edit: Clinical Anatomic Consideration

L6642 2 3 Date of Service Edit: Clinical Anatomic Consideration

L6645 2 2 Date of Service Edit: Policy Anatomic Consideration

L6646 2 2 Date of Service Edit: Policy Anatomic Consideration

L6647 2 2 Date of Service Edit: Policy Anatomic Consideration

L6648 2 2 Date of Service Edit: Policy Anatomic Consideration

L6650 2 2 Date of Service Edit: Policy Anatomic Consideration

L6655 4 3 Date of Service Edit: Clinical Clinical: Data

L6660 4 3 Date of Service Edit: Clinical Clinical: Data

L6665 4 3 Date of Service Edit: Clinical Clinical: Data

L6670 2 2 Date of Service Edit: Policy Anatomic Consideration

L6672 2 2 Date of Service Edit: Policy Anatomic Consideration

L6675 2 2 Date of Service Edit: Policy Anatomic Consideration

L6676 2 2 Date of Service Edit: Policy Anatomic Consideration

L6677 2 2 Date of Service Edit: Policy Anatomic Consideration

L6680 4 3 Date of Service Edit: Clinical Nature of Equipment

L6682 4 3 Date of Service Edit: Clinical Nature of Equipment

L6684 4 3 Date of Service Edit: Clinical Nature of Equipment

L6686 2 2 Date of Service Edit: Policy Anatomic Consideration

L6687 2 2 Date of Service Edit: Policy Anatomic Consideration

L6688 2 2 Date of Service Edit: Policy Anatomic Consideration

L6689 2 2 Date of Service Edit: Policy Anatomic Consideration

L6690 2 2 Date of Service Edit: Policy Anatomic Consideration

L6691 4 3 Date of Service Edit: Clinical Clinical: Data

L6692 4 3 Date of Service Edit: Clinical Clinical: Data

L6693 2 2 Date of Service Edit: Policy Anatomic Consideration

L6694 2 3 Date of Service Edit: Clinical Nature of Equipment

L6695 2 3 Date of Service Edit: Clinical Nature of Equipment

L6696 2 2 Date of Service Edit: Policy Anatomic Consideration

L6697 2 2 Date of Service Edit: Policy Anatomic Consideration

L6698 2 2 Date of Service Edit: Policy Anatomic Consideration

L6703 2 2 Date of Service Edit: Policy Anatomic Consideration

L6704 2 2 Date of Service Edit: Policy Anatomic Consideration

L6706 2 2 Date of Service Edit: Policy Anatomic Consideration

L6707 2 2 Date of Service Edit: Policy Anatomic Consideration

L6708 2 2 Date of Service Edit: Policy Anatomic Consideration

L6709 2 2 Date of Service Edit: Policy Anatomic Consideration

L6711 2 2 Date of Service Edit: Policy Anatomic Consideration

L6712 2 2 Date of Service Edit: Policy Anatomic Consideration

L6713 2 2 Date of Service Edit: Policy Anatomic Consideration

L6714 2 2 Date of Service Edit: Policy Anatomic Consideration

L6715 4 3 Date of Service Edit: Clinical Clinical: CMS Workgroup

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Values MUE Adjudication Indicator MUE Rationale

L6721 2 2 Date of Service Edit: Policy Anatomic Consideration

L6722 2 2 Date of Service Edit: Policy Anatomic Consideration

L6805 2 2 Date of Service Edit: Policy Anatomic Consideration

L6810 2 3 Date of Service Edit: Clinical Anatomic Consideration

L6880 2 2 Date of Service Edit: Policy Anatomic Consideration

L6881 2 2 Date of Service Edit: Policy Anatomic Consideration

L6882 2 2 Date of Service Edit: Policy Anatomic Consideration

L6883 2 2 Date of Service Edit: Policy Anatomic Consideration

L6884 2 2 Date of Service Edit: Policy Anatomic Consideration

L6885 2 2 Date of Service Edit: Policy Anatomic Consideration

L6890 2 3 Date of Service Edit: Clinical Anatomic Consideration

L6895 2 3 Date of Service Edit: Clinical Anatomic Consideration

L6900 2 2 Date of Service Edit: Policy Anatomic Consideration

L6905 2 2 Date of Service Edit: Policy Anatomic Consideration

L6910 2 2 Date of Service Edit: Policy Anatomic Consideration

L6915 2 2 Date of Service Edit: Policy Anatomic Consideration

L6920 2 2 Date of Service Edit: Policy Anatomic Consideration

L6925 2 2 Date of Service Edit: Policy Anatomic Consideration

L6930 2 2 Date of Service Edit: Policy Anatomic Consideration

L6935 2 2 Date of Service Edit: Policy Anatomic Consideration

L6940 2 2 Date of Service Edit: Policy Anatomic Consideration

L6945 2 2 Date of Service Edit: Policy Anatomic Consideration

L6950 2 2 Date of Service Edit: Policy Anatomic Consideration

L6955 2 2 Date of Service Edit: Policy Anatomic Consideration

L6960 2 2 Date of Service Edit: Policy Anatomic Consideration

L6965 2 2 Date of Service Edit: Policy Anatomic Consideration

L6970 2 2 Date of Service Edit: Policy Anatomic Consideration

L6975 2 2 Date of Service Edit: Policy Anatomic Consideration

L7007 2 2 Date of Service Edit: Policy Anatomic Consideration

L7008 2 2 Date of Service Edit: Policy Anatomic Consideration

L7009 2 2 Date of Service Edit: Policy Anatomic Consideration

L7040 2 2 Date of Service Edit: Policy Anatomic Consideration

L7045 2 2 Date of Service Edit: Policy Anatomic Consideration

L7170 2 2 Date of Service Edit: Policy Anatomic Consideration

L7180 2 2 Date of Service Edit: Policy Anatomic Consideration

L7181 2 2 Date of Service Edit: Policy Anatomic Consideration

L7185 2 2 Date of Service Edit: Policy Anatomic Consideration

L7186 2 2 Date of Service Edit: Policy Anatomic Consideration

L7190 2 2 Date of Service Edit: Policy Anatomic Consideration

L7191 2 2 Date of Service Edit: Policy Anatomic Consideration

L7360 4 3 Date of Service Edit: Clinical Clinical: Data

L7362 1 2 Date of Service Edit: Policy Nature of Equipment

L7364 4 3 Date of Service Edit: Clinical Clinical: Data

L7366 1 2 Date of Service Edit: Policy Nature of Equipment

L7367 4 3 Date of Service Edit: Clinical Clinical: Data

L7368 1 2 Date of Service Edit: Policy Nature of Equipment

L7400 2 2 Date of Service Edit: Policy Anatomic Consideration

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Services MUE

Values MUE Adjudication Indicator MUE Rationale

L7401 2 2 Date of Service Edit: Policy Anatomic Consideration

L7402 2 2 Date of Service Edit: Policy Anatomic Consideration

L7403 2 2 Date of Service Edit: Policy Anatomic Consideration

L7404 2 2 Date of Service Edit: Policy Anatomic Consideration

L7405 2 2 Date of Service Edit: Policy Anatomic Consideration

L7510 4 3 Date of Service Edit: Clinical Clinical: Data

L7520 12 3 Date of Service Edit: Clinical Clinical: Data

L7900 1 1 Line Edit Nature of Equipment

L7902 1 1 Line Edit Nature of Equipment

L8030 2 1 Line Edit Anatomic Consideration

L8031 2 1 Line Edit Anatomic Consideration

L8032 2 1 Line Edit Anatomic Consideration

L8035 2 1 Line Edit Anatomic Consideration

L8039 2 1 Line Edit Anatomic Consideration

L8040 1 1 Line Edit Anatomic Consideration

L8041 1 1 Line Edit Anatomic Consideration

L8042 2 1 Line Edit Anatomic Consideration

L8043 1 1 Line Edit Anatomic Consideration

L8044 1 1 Line Edit Anatomic Consideration

L8045 2 1 Line Edit Anatomic Consideration

L8046 1 1 Line Edit Anatomic Consideration

L8047 1 1 Line Edit Anatomic Consideration

L8048 1 3 Date of Service Edit: Clinical Nature of Equipment

L8300 1 1 Line Edit Nature of Equipment

L8310 1 1 Line Edit Nature of Equipment

L8320 2 1 Line Edit Nature of Equipment

L8330 2 1 Line Edit Nature of Equipment

L8400 12 3 Date of Service Edit: Clinical Clinical: Data

L8410 12 3 Date of Service Edit: Clinical Clinical: Data

L8415 6 3 Date of Service Edit: Clinical Clinical: Data

L8417 12 3 Date of Service Edit: Clinical Clinical: Data

L8420 24 3 Date of Service Edit: Clinical Clinical: Data

L8430 24 3 Date of Service Edit: Clinical Clinical: Data

L8435 12 3 Date of Service Edit: Clinical Clinical: Data

L8440 4 3 Date of Service Edit: Clinical Clinical: Data

L8460 4 3 Date of Service Edit: Clinical Clinical: Data

L8465 4 3 Date of Service Edit: Clinical Clinical: Data

L8470 24 3 Date of Service Edit: Clinical Clinical: Data

L8480 24 3 Date of Service Edit: Clinical Clinical: Data

L8485 12 3 Date of Service Edit: Clinical Clinical: Data

L8500 1 1 Line Edit Anatomic Consideration

L8501 2 1 Line Edit Nature of Equipment

L8507 3 1 Line Edit Nature of Equipment

L8509 1 1 Line Edit Anatomic Consideration

L8510 1 1 Line Edit Anatomic Consideration

L8511 1 1 Line Edit Nature of Equipment

L8514 1 1 Line Edit Clinical: Data

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Values MUE Adjudication Indicator MUE Rationale

L8515 1 1 Line Edit Clinical: Data

L8600 2 1 Line Edit Anatomic Consideration

L8609 1 1 Line Edit Clinical: Data

L8610 2 1 Line Edit Anatomic Consideration

L8612 2 1 Line Edit Anatomic Consideration

L8613 2 1 Line Edit Anatomic Consideration

L8614 2 1 Line Edit Nature of Equipment

L8615 2 1 Line Edit Nature of Equipment

L8616 2 1 Line Edit Nature of Equipment

L8617 2 1 Line Edit Nature of Equipment

L8618 2 1 Line Edit Nature of Equipment

L8619 2 1 Line Edit Nature of Equipment

L8622 2 1 Line Edit Nature of Equipment

L8631 4 1 Line Edit Clinical: Data

L8641 4 1 Line Edit Clinical: Data

L8642 2 1 Line Edit Anatomic Consideration

L8658 4 1 Line Edit Clinical: Data

L8659 4 1 Line Edit Clinical: Data

L8670 4 1 Line Edit Clinical: Data

L8681 1 1 Line Edit Nature of Equipment

L8682 2 1 Line Edit Nature of Equipment

L8683 1 1 Line Edit Nature of Equipment

L8684 1 1 Line Edit Nature of Equipment

L8685 1 1 Line Edit Nature of Equipment

L8686 2 1 Line Edit Nature of Equipment

L8687 1 1 Line Edit Nature of Equipment

L8688 1 1 Line Edit Nature of Equipment

L8689 1 1 Line Edit Nature of Equipment

L8690 2 2 Date of Service Edit: Policy Nature of Equipment

L8691 1 3 Date of Service Edit: Clinical Nature of Equipment

L8692 0 3 Date of Service Edit: Clinical CMS Policy

L8693 1 3 Date of Service Edit: Clinical Nature of Equipment

L8695 1 1 Line Edit Nature of Equipment

Q0035 1 1 Line Edit Code Descriptor / CPT Instruction

Q0091 1 1 Line Edit Anatomic Consideration

Q0111 2 1 Line Edit Clinical: Data

Q0112 3 1 Line Edit Clinical: Data

Q0113 2 1 Line Edit Nature of Service/Procedure

Q0114 1 1 Line Edit Nature of Analyte

Q0115 1 1 Line Edit Clinical: Data

Q0161 66 3 Date of Service Edit: Clinical Prescribing Information

Q0478 1 1 Line Edit Nature of Equipment

Q0479 1 1 Line Edit Code Descriptor / CPT Instruction

Q0480 1 1 Line Edit Clinical: Data

Q0481 1 2 Date of Service Edit: Policy Clinical: Data

Q0482 1 1 Line Edit Clinical: Data

Q0483 1 1 Line Edit Clinical: Data

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Q0484 1 1 Line Edit Clinical: Data

Q0485 1 1 Line Edit Clinical: Data

Q0486 1 1 Line Edit Clinical: Data

Q0487 1 1 Line Edit Clinical: Data

Q0488 1 1 Line Edit Nature of Equipment

Q0489 1 1 Line Edit Clinical: Data

Q0490 1 1 Line Edit Clinical: Data

Q0491 1 1 Line Edit Clinical: Data

Q0492 1 1 Line Edit Clinical: Data

Q0493 1 1 Line Edit Clinical: Data

Q0494 1 1 Line Edit Clinical: Data

Q0495 1 1 Line Edit Clinical: Data

Q0497 2 1 Line Edit Clinical: Data

Q0498 1 1 Line Edit Clinical: Data

Q0499 1 1 Line Edit Clinical: Data

Q0501 1 1 Line Edit Clinical: Data

Q0502 1 1 Line Edit Clinical: Data

Q0503 3 1 Line Edit Clinical: Data

Q0504 1 1 Line Edit Clinical: Data

Q0510 1 2 Date of Service Edit: Policy CMS Policy

Q0511 1 2 Date of Service Edit: Policy CMS Policy

Q0512 4 3 Date of Service Edit: Clinical Clinical: Data

Q0513 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

Q0514 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction

Q1004 2 1 Line Edit Anatomic Consideration

Q1005 2 1 Line Edit Anatomic Consideration

Q4001 1 1 Line Edit Anatomic Consideration

Q4002 1 1 Line Edit Anatomic Consideration

Q4003 2 1 Line Edit Anatomic Consideration

Q4004 2 1 Line Edit Anatomic Consideration

Q4025 1 1 Line Edit Anatomic Consideration

Q4026 1 1 Line Edit Anatomic Consideration

Q4027 1 1 Line Edit Anatomic Consideration

Q4028 1 1 Line Edit Anatomic Consideration

Q4074 279 3 Date of Service Edit: Clinical Clinical: Data

V2020 1 1 Line Edit Clinical: Data

V2101 2 1 Line Edit Anatomic Consideration

V2102 2 1 Line Edit Anatomic Consideration

V2104 2 1 Line Edit Anatomic Consideration

V2105 2 1 Line Edit Anatomic Consideration

V2106 2 1 Line Edit Anatomic Consideration

V2107 2 1 Line Edit Anatomic Consideration

V2108 2 1 Line Edit Anatomic Consideration

V2109 2 1 Line Edit Anatomic Consideration

V2110 2 1 Line Edit Anatomic Consideration

V2111 2 1 Line Edit Anatomic Consideration

V2112 2 1 Line Edit Anatomic Consideration

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Values MUE Adjudication Indicator MUE Rationale

V2113 2 1 Line Edit Anatomic Consideration

V2114 2 1 Line Edit Anatomic Consideration

V2115 2 1 Line Edit Anatomic Consideration

V2118 2 1 Line Edit Anatomic Consideration

V2121 2 1 Line Edit Anatomic Consideration

V2199 2 3 Date of Service Edit: Clinical Nature of Equipment

V2200 2 1 Line Edit Anatomic Consideration

V2201 2 1 Line Edit Anatomic Consideration

V2202 2 1 Line Edit Anatomic Consideration

V2203 2 1 Line Edit Anatomic Consideration

V2204 2 1 Line Edit Anatomic Consideration

V2205 2 1 Line Edit Anatomic Consideration

V2206 2 1 Line Edit Anatomic Consideration

V2207 2 1 Line Edit Anatomic Consideration

V2208 2 1 Line Edit Anatomic Consideration

V2209 2 1 Line Edit Anatomic Consideration

V2210 2 1 Line Edit Anatomic Consideration

V2211 2 1 Line Edit Anatomic Consideration

V2212 2 1 Line Edit Anatomic Consideration

V2213 2 1 Line Edit Anatomic Consideration

V2214 2 1 Line Edit Anatomic Consideration

V2215 2 1 Line Edit Anatomic Consideration

V2218 2 1 Line Edit Anatomic Consideration

V2219 2 1 Line Edit Anatomic Consideration

V2220 2 1 Line Edit Anatomic Consideration

V2221 2 1 Line Edit Anatomic Consideration

V2299 2 1 Line Edit Nature of Equipment

V2300 2 1 Line Edit Anatomic Consideration

V2301 2 1 Line Edit Anatomic Consideration

V2302 2 1 Line Edit Anatomic Consideration

V2303 2 1 Line Edit Anatomic Consideration

V2304 2 1 Line Edit Anatomic Consideration

V2305 2 1 Line Edit Anatomic Consideration

V2306 2 1 Line Edit Anatomic Consideration

V2307 2 1 Line Edit Anatomic Consideration

V2308 2 1 Line Edit Anatomic Consideration

V2309 2 1 Line Edit Anatomic Consideration

V2310 2 1 Line Edit Anatomic Consideration

V2311 2 1 Line Edit Anatomic Consideration

V2312 2 1 Line Edit Anatomic Consideration

V2313 2 1 Line Edit Anatomic Consideration

V2314 2 1 Line Edit Anatomic Consideration

V2315 2 1 Line Edit Anatomic Consideration

V2318 2 1 Line Edit Anatomic Consideration

V2319 2 1 Line Edit Anatomic Consideration

V2320 2 1 Line Edit Anatomic Consideration

V2321 2 1 Line Edit Anatomic Consideration

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V2399 2 1 Line Edit Nature of Equipment

V2410 2 1 Line Edit Anatomic Consideration

V2430 2 1 Line Edit Anatomic Consideration

V2499 2 3 Date of Service Edit: Clinical Nature of Equipment

V2500 2 1 Line Edit Anatomic Consideration

V2501 2 1 Line Edit Anatomic Consideration

V2502 2 1 Line Edit Anatomic Consideration

V2503 2 1 Line Edit Anatomic Consideration

V2510 2 1 Line Edit Anatomic Consideration

V2511 2 1 Line Edit Anatomic Consideration

V2512 2 1 Line Edit Anatomic Consideration

V2513 2 1 Line Edit Anatomic Consideration

V2520 2 1 Line Edit Anatomic Consideration

V2521 2 1 Line Edit Anatomic Consideration

V2522 2 1 Line Edit Anatomic Consideration

V2523 2 1 Line Edit Anatomic Consideration

V2530 2 1 Line Edit Anatomic Consideration

V2531 2 1 Line Edit Anatomic Consideration

V2599 2 3 Date of Service Edit: Clinical Nature of Equipment

V2600 1 1 Line Edit Code Descriptor / CPT Instruction

V2610 1 1 Line Edit Anatomic Consideration

V2615 2 1 Line Edit Nature of Service/Procedure

V2623 2 1 Line Edit Anatomic Consideration

V2624 2 1 Line Edit Anatomic Consideration

V2625 2 1 Line Edit Anatomic Consideration

V2626 2 1 Line Edit Anatomic Consideration

V2627 2 1 Line Edit Anatomic Consideration

V2628 2 1 Line Edit Nature of Service/Procedure

V2629 2 1 Line Edit Anatomic Consideration

V2630 2 1 Line Edit Anatomic Consideration

V2631 2 1 Line Edit Anatomic Consideration

V2632 2 1 Line Edit Anatomic Consideration

V2700 2 1 Line Edit Anatomic Consideration

V2710 2 1 Line Edit Anatomic Consideration

V2718 2 1 Line Edit Anatomic Consideration

V2730 2 1 Line Edit Anatomic Consideration

V2761 2 1 Line Edit Anatomic Consideration

V2770 2 1 Line Edit Anatomic Consideration

V2780 2 1 Line Edit Anatomic Consideration

V2781 2 1 Line Edit Anatomic Consideration

V2782 2 1 Line Edit Anatomic Consideration

V2783 2 1 Line Edit Anatomic Consideration

V2785 2 1 Line Edit Anatomic Consideration

V2790 1 1 Line Edit Code Descriptor / CPT Instruction

V2797 1 1 Line Edit Clinical: Data

V5008 0 1 Line Edit CMS Policy

V5010 0 1 Line Edit CMS Policy

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V5011 0 1 Line Edit CMS Policy

V5274 0 3 Date of Service Edit: Clinical CMS Policy

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