HCPCS Codes - Ei K ids

1 1 HCPCS Codes Effective January 2004 *NOTE: This HCPCS listing does not indicate what is or is not considered appropriate assistive technology for First Steps purposes. Please consult Program policy or listserv messages for further guidance. HCPCS CodeDescription A0021 Outside state ambulance serv A0080 Noninterest escort in non er A0090 Interest escort in non er A0100 Nonemergency transport taxi A0110 Nonemergency transport bus A0120 Noner transport mini-bus A0130 Noner transport wheelch van A0140 Nonemergency transport air A0160 Noner transport case worker A0170 Noner transport parking fees A0180 Noner transport lodgng recip A0190 Noner transport meals recip A0200 Noner transport lodgng escrt A0210 Noner transport meals escort A0225 Neonatal emergency

2 Transport A0368 Adv er no serv sep mile&supp A0382 Basic support routine suppls A0384 Bls defibrillation supplies A0392 Als defibrillation supplies A0394 Als IV drug therapy supplies A0396 Als esophageal intub suppls A0398 Als routine disposble suppls A0420 Ambulance waiting 1/2 hr A0422 Ambulance 02 life sustaining A0424 Extra ambulance attendant A0425 Ground mileage A0426 Als 1 A0427 ALS1-emergency A0428 bls A0429 BLS-emergency A0430 Fixed wing air transport A0431 Rotary wing air transport A0432 PI volunteer ambulance co A0433 als 2 A0434 Specialty care transport A0435 Fixed wing air mileage A0436 Rotary wing air mileage A0888 Noncovered ambulance mileage A0999 Unlisted ambulance service A4206 1 CC sterile syringe&needle A4207 2 CC sterile syringe&needle A4208 3 CC sterile syringe&needle A4209 5+ CC sterile syringe&needle 2A4210 Nonneedle injection device A4211 Supp for self-adm injections A4212 Non coring needle or stylet A4213 20+ CC syringe only A4214 30 CC sterile water/saline A4215 Sterile needle A4220 Infusion

3 Pump refill kit A4221 Maint drug infus cath per wk A4222 Drug infusion pump supplies A4230 Infus insulin pump non needl A4231 Infusion insulin pump needle A4232 Syringe w/needle insulin 3cc A4244 Alcohol or peroxide per pint A4245 Alcohol wipes per box A4246 Betadine/phisohex solution A4247 Betadine/iodine swabs/wipes A4250 Urine reagent strips/tablets A4253 Blood glucose/reagent strips A4254 Battery for glucose monitor A4255 Glucose monitor platforms A4256 Calibrator solution/chips A4258 Lancet device each A4259 Lancets per box A4260 Levonorgestrel implant A4261 Cervical cap contraceptive A4262 Temporary tear duct plug A4263 Permanent tear duct plug A4265 Paraffin A4270 Disposable endoscope sheath A4280 Brst prsths adhsv attchmnt A4290 Sacral nerve stim test lead A4300 Cath impl vasc access portal A4301 Implantable access syst perc A4305 Drug delivery system >=50 ML A4306 Drug delivery system <=5 ML A4310 Insert tray w/o bag/cath A4311 Catheter w/o bag 2-way latex A4312 Cath w/o bag 2-way silicone A4313 Catheter w/bag 3-way A4314

4 Cath w/drainage 2-way latex A4315 Cath w/drainage 2-way silcne A4316 Cath w/drainage 3-way A4319 Sterile H2O irrigation solut A4320 Irrigation tray A4321 Cath therapeutic irrig agent A4322 Irrigation syringe A4323 Saline irrigation solution A4324 Male ext cath w/adh coating A4325 Male ext cath w/adh strip A4326 Male external catheter A4327 Fem urinary collect dev cup A4328 Fem urinary collect pouch 3A4329 External catheter start set A4330 Stool collection pouch A4331 Extension drainage tubing A4332 Lubricant for cath insertion A4333 Urinary cath anchor device A4334 Urinary cath leg strap A4335 Incontinence supply A4338 Indwelling catheter latex A4340 Indwelling catheter special A4344 Cath indw foley 2 way silicn A4346 Cath indw foley 3 way A4347 Male external catheter A4348 Male ext cath extended wear A4351 Straight tip urine catheter A4352 Coude tip urinary catheter A4353 Intermittent urinary cath A4354 Cath insertion tray w/bag A4355 Bladder irrigation tubing A4356 Ext ureth clmp or compr dvc A4357 Bedside drainage bag A4358

5 Urinary leg bag A4359 Urinary suspensory w/o leg b A4361 Ostomy face plate A4362 Solid skin barrier A4364 Liq adhes for facial prosth A4365 Adhesive remover wipes A4367 Ostomy belt A4368 Ostomy filter A4369 Skin barrier liquid per oz A4370 Skin barrier paste per oz A4371 Skin barrier powder per oz A4372 Skin barrier solid 4x4 equiv A4373 Skin barrier with flange A4374 Skin barrier extended wear A4375 Drainable plastic pch w fcpl A4376 Drainable rubber pch w fcplt A4377 Drainable plstic pch w/o fp A4378 Drainable rubber pch w/o fp A4379 Urinary plastic pouch w fcpl A4380 Urinary rubber pouch w fcplt A4381 Urinary plastic pouch w/o fp A4382 Urinary hvy plstc pch w/o fp A4383 Urinary rubber pouch w/o fp A4384 Ostomy faceplt/silicone ring A4385 Ost skn barrier sld ext wear A4386 Ost skn barrier w flng ex wr A4387 Ost clsd pouch w att st barr A4388 Drainable pch w ex wear barr A4389 Drainable pch w st wear barr A4390 Drainable pch ex wear convex A4391 Urinary pouch w ex wear barr A4392 Urinary pouch w st wear barr 4A4393 Urine pch w ex

6 Wear bar conv A4394 Ostomy pouch liq deodorant A4395 Ostomy pouch solid deodorant A4396 Peristomal hernia supprt blt A4397 Irrigation supply sleeve A4398 Ostomy irrigation bag A4399 Ostomy irrig cone/cath w brs A4400 Ostomy irrigation set A4402 Lubricant per ounce A4404 Ostomy ring each A4421 Ostomy supply misc A4454 Tape all types all sizes A4455 Adhesive remover per ounce A4460 Elastic compression bandage A4462 Abdmnl drssng holder/binder A4464 Joint support device/garment A4465 Non-elastic extremity binder A4470 Gravlee jet washer A4480 Vabra aspirator A4481 Tracheostoma filter A4483 Moisture exchanger A4490 Above knee surgical stocking A4495 Thigh length surg stocking A4500 Below knee surgical stocking A4510 Full length surg stocking A4550 Surgical trays A4554 Disposable underpads A4556 Electrodes, pair A4557 Lead wires, pair A4558 Conductive paste or gel A4561 Pessary rubber, any type A4562 Pessary, non rubber.

7 Any type A4565 Slings A4570 Splint A4572 Rib belt A4575 Hyperbaric o2 chamber disps A4580 Cast supplies (plaster) A4590 Special casting material A4595 TENS suppl 2 lead per month A4608 Transtracheal oxygen cath A4611 Heavy duty battery A4612 Battery cables A4613 Battery charger A4614 Hand-held PEFR meter A4615 Cannula nasal A4616 Tubing (oxygen) per foot A4617 Mouth piece A4618 Breathing circuits A4619 Face tent A4620 Variable concentration mask A4621 Tracheotomy mask or collar A4622 Tracheostomy or larngectomy 5A4623 Tracheostomy inner cannula A4624 Tracheal suction tube A4625 Trach care kit for new trach A4626 Tracheostomy cleaning brush A4627 Spacer bag/reservoir A4628 Oropharyngeal suction cath A4629 Tracheostomy care kit A4630 Repl bat own by pt A4631 Wheelchair battery A4635 Underarm crutch pad A4636 Handgrip for cane etc A4637 Repl tip

8 Cane/crutch/walker A4640 Alternating pressure pad A4641 Diagnostic imaging agent A4642 Satumomab pendetide per dose A4643 High dose contrast MRI A4644 Contrast 100-199 MGs iodine A4645 Contrast 200-299 MGs iodine A4646 Contrast 300-399 MGs iodine A4647 Supp- paramagnetic contr mat A4649 Surgical supplies A4650 Supp esrd centrifuge A4655 Esrd syringe/needle A4660 Esrd blood pressure device A4663 Esrd blood pressure cuff A4670 Auto blood pressure monitor A4680 Activated carbon filters A4690 Dialyzers A4700 Standard dialysate solution A4705 Bicarb dialysate solution A4712 Sterile water A4714 Treated water for dialysis A4730 Fistula cannulation set dial A4735 Local/topical anesthetics A4740 Esrd shunt accessory A4750 Arterial or venous tubing A4755 Arterial and venous tubing A4760 Standard testing solution A4765 Dialysate concentrate A4770 Blood testing supplies A4771 Blood clotting time tube A4772 Dextrostick/glucose strips A4773 Hemostix A4774 Ammonia test paper A4780 Esrd sterilizing agent A4790 Esrd cleansing agents A4800

9 Heparin/antidote dialysis A4820 Supplies hemodialysis kit A4850 Rubber tipped hemostats A4860