ICD-10-CM/PCS MS-DRG v40.1 Definitions Manual
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ICD-10-CM/PCS MS-DRG v40.1 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 61 of 75 |
| A000 B302 C577 C8442 D309 E093393 E1344 F19280 G9761 H21341 H52203 I369 I70221 J682 K7031 L89200 M06812 M23203 M4841XS M71811 M84529D M87842 N468 O1214 O336XX3 O368234 O714 P913 R062 S0092XA S0303XA S069X2A S14106D S21312S S25809S S31811D S32499S S37012A S42123D S42449D S46329S S52045R S52291A S52552B S56112S S60359A S61509A S62321G S62660D S63637S S66529S S72024G S72114B S72326D S72451B S7711XD S82045J S82251P S8261XA S83521A S89309D S92044S S92426G S96802A T20219S T23229S T25739S T391X5S T444X2S T498X3S T602X4S T7801XS T83722D Z309 Z960 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S89309D | 08 | 559-561 | S90829D | 23 | 949-950 | S91222S | 09 | 604-605 | ||
| S89309G | 08 | 559-561 | S90829S | 09 | 604-605 | S91223A | 21 | 913-914 | ||
| S89309K | 08 | 564-566 | S90841A | 09 | 604-605 | S91223A | 24 | 963-965 | ||
| S89309P | 08 | 564-566 | S90841A | 24 | 963-965 | S91223D | 23 | 949-950 | ||
| S89309S | 08 | 559-561 | S90841D | 23 | 949-950 | S91223S | 09 | 604-605 | ||
| S89311A | 08 | 562-563 | S90841S | 09 | 604-605 | S91224A | 21 | 913-914 | ||
| S89311A | 24 | 963-965 | S90842A | 09 | 604-605 | S91224A | 24 | 963-965 | ||
| S89311D | 08 | 559-561 | S90842A | 24 | 963-965 | S91224D | 23 | 949-950 | ||
| S89311G | 08 | 559-561 | S90842D | 23 | 949-950 | S91224S | 09 | 604-605 | ||
| S89311K | 08 | 564-566 | S90842S | 09 | 604-605 | S91225A | 21 | 913-914 | ||
| S89311P | 08 | 564-566 | S90849A | 09 | 604-605 | S91225A | 24 | 963-965 | ||
| S89311S | 08 | 559-561 | S90849A | 24 | 963-965 | S91225D | 23 | 949-950 | ||
| S89312A | 08 | 562-563 | S90849D | 23 | 949-950 | S91225S | 09 | 604-605 | ||
| S89312A | 24 | 963-965 | S90849S | 09 | 604-605 | S91226A | 21 | 913-914 | ||
| S89312D | 08 | 559-561 | S90851A | 09 | 604-605 | S91226A | 24 | 963-965 | ||
| S89312G | 08 | 559-561 | S90851A | 24 | 963-965 | S91226D | 23 | 949-950 | ||
| S89312K | 08 | 564-566 | S90851D | 23 | 949-950 | S91226S | 09 | 604-605 | ||
| S89312P | 08 | 564-566 | S90851S | 09 | 604-605 | S91229A | 21 | 913-914 | ||
| S89312S | 08 | 559-561 | S90852A | 09 | 604-605 | S91229A | 24 | 963-965 | ||
| S89319A | 08 | 562-563 | S90852A | 24 | 963-965 | S91229D | 23 | 949-950 | ||
| S89319A | 24 | 963-965 | S90852D | 23 | 949-950 | S91229S | 09 | 604-605 | ||
| S89319D | 08 | 559-561 | S90852S | 09 | 604-605 | S91231A | 09 | 604-605 | ||
| S89319G | 08 | 559-561 | S90859A | 09 | 604-605 | S91231A | 24 | 963-965 | ||
| S89319K | 08 | 564-566 | S90859A | 24 | 963-965 | S91231D | 23 | 949-950 | ||
| S89319P | 08 | 564-566 | S90859D | 23 | 949-950 | S91231S | 09 | 604-605 | ||
| S89319S | 08 | 559-561 | S90859S | 09 | 604-605 | S91232A | 09 | 604-605 | ||
| S89321A | 08 | 562-563 | S90861A | 09 | 606-607 | S91232A | 24 | 963-965 | ||
| S89321A | 24 | 963-965 | S90861A | 24 | 963-965 | S91232D | 23 | 949-950 | ||
| S89321D | 08 | 559-561 | S90861D | 23 | 949-950 | S91232S | 09 | 604-605 | ||
| S89321G | 08 | 559-561 | S90861S | 09 | 604-605 | S91233A | 09 | 604-605 | ||
| S89321K | 08 | 564-566 | S90862A | 09 | 606-607 | S91233A | 24 | 963-965 | ||
| S89321P | 08 | 564-566 | S90862A | 24 | 963-965 | S91233D | 23 | 949-950 | ||
| S89321S | 08 | 559-561 | S90862D | 23 | 949-950 | S91233S | 09 | 604-605 | ||
| S89322A | 08 | 562-563 | S90862S | 09 | 604-605 | S91234A | 09 | 604-605 | ||
| S89322A | 24 | 963-965 | S90869A | 09 | 606-607 | S91234A | 24 | 963-965 | ||
| S89322D | 08 | 559-561 | S90869A | 24 | 963-965 | S91234D | 23 | 949-950 | ||
| S89322G | 08 | 559-561 | S90869D | 23 | 949-950 | S91234S | 09 | 604-605 | ||
| S89322K | 08 | 564-566 | S90869S | 09 | 604-605 | S91235A | 09 | 604-605 | ||
| S89322P | 08 | 564-566 | S90871A | 09 | 604-605 | S91235A | 24 | 963-965 | ||
| S89322S | 08 | 559-561 | S90871A | 24 | 963-965 | S91235D | 23 | 949-950 | ||
| S89329A | 08 | 562-563 | S90871D | 23 | 949-950 | S91235S | 09 | 604-605 | ||
| S89329A | 24 | 963-965 | S90871S | 09 | 604-605 | S91236A | 09 | 604-605 | ||
| S89329D | 08 | 559-561 | S90872A | 09 | 604-605 | S91236A | 24 | 963-965 | ||
| S89329G | 08 | 559-561 | S90872A | 24 | 963-965 | S91236D | 23 | 949-950 | ||
| S89329K | 08 | 564-566 | S90872D | 23 | 949-950 | S91236S | 09 | 604-605 | ||
| S89329P | 08 | 564-566 | S90872S | 09 | 604-605 | S91239A | 09 | 604-605 | ||
| S89329S | 08 | 559-561 | S90879A | 09 | 604-605 | S91239A | 24 | 963-965 | ||
| S89391A | 08 | 562-563 | S90879A | 24 | 963-965 | S91239D | 23 | 949-950 | ||
| S89391A | 24 | 963-965 | S90879D | 23 | 949-950 | S91239S | 09 | 604-605 | ||
| S89391D | 08 | 559-561 | S90879S | 09 | 604-605 | S91241A | 21 | 913-914 | ||
| S89391G | 08 | 559-561 | S90911A | 09 | 604-605 | S91241A | 24 | 963-965 | ||
| S89391K | 08 | 564-566 | S90911A | 24 | 963-965 | S91241D | 23 | 949-950 | ||
| S89391P | 08 | 564-566 | S90911D | 23 | 949-950 | S91241S | 09 | 604-605 | ||
| S89391S | 08 | 559-561 | S90911S | 09 | 604-605 | S91242A | 21 | 913-914 | ||
| S89392A | 08 | 562-563 | S90912A | 09 | 604-605 | S91242A | 24 | 963-965 | ||
| S89392A | 24 | 963-965 | S90912A | 24 | 963-965 | S91242D | 23 | 949-950 | ||
| S89392D | 08 | 559-561 | S90912D | 23 | 949-950 | S91242S | 09 | 604-605 | ||
| S89392G | 08 | 559-561 | S90912S | 09 | 604-605 | S91243A | 21 | 913-914 | ||
| S89392K | 08 | 564-566 | S90919A | 09 | 604-605 | S91243A | 24 | 963-965 | ||
| S89392P | 08 | 564-566 | S90919A | 24 | 963-965 | S91243D | 23 | 949-950 | ||
| S89392S | 08 | 559-561 | S90919D | 23 | 949-950 | S91243S | 09 | 604-605 | ||
| S89399A | 08 | 562-563 | S90919S | 09 | 604-605 | S91244A | 21 | 913-914 | ||
| S89399A | 24 | 963-965 | S90921A | 09 | 604-605 | S91244A | 24 | 963-965 | ||
| S89399D | 08 | 559-561 | S90921A | 24 | 963-965 | S91244D | 23 | 949-950 | ||
| S89399G | 08 | 559-561 | S90921D | 23 | 949-950 | S91244S | 09 | 604-605 | ||
| S89399K | 08 | 564-566 | S90921S | 09 | 604-605 | S91245A | 21 | 913-914 | ||
| S89399P | 08 | 564-566 | S90922A | 09 | 604-605 | S91245A | 24 | 963-965 | ||
| S89399S | 08 | 559-561 | S90922A | 24 | 963-965 | S91245D | 23 | 949-950 | ||
| S8980XA | 21 | 913-914 | S90922D | 23 | 949-950 | S91245S | 09 | 604-605 | ||
| S8980XA | 24 | 963-965 | S90922S | 09 | 604-605 | S91246A | 21 | 913-914 | ||
| S8980XD | 23 | 949-950 | S90929A | 09 | 604-605 | S91246A | 24 | 963-965 | ||
| S8980XS | 21 | 913-914 | S90929A | 24 | 963-965 | S91246D | 23 | 949-950 | ||
| S8981XA | 21 | 913-914 | S90929D | 23 | 949-950 | S91246S | 09 | 604-605 | ||
| S8981XA | 24 | 963-965 | S90929S | 09 | 604-605 | S91249A | 21 | 913-914 | ||
| S8981XD | 23 | 949-950 | S90931A | 09 | 604-605 | S91249A | 24 | 963-965 | ||
| S8981XS | 21 | 913-914 | S90931A | 24 | 963-965 | S91249D | 23 | 949-950 | ||
| S8982XA | 21 | 913-914 | S90931D | 23 | 949-950 | S91249S | 09 | 604-605 | ||
| S8982XA | 24 | 963-965 | S90931S | 09 | 604-605 | S91251A | 09 | 604-605 | ||
| S8982XD | 23 | 949-950 | S90932A | 09 | 604-605 | S91251A | 24 | 963-965 | ||
| S8982XS | 21 | 913-914 | S90932A | 24 | 963-965 | S91251D | 23 | 949-950 | ||
| S8990XA | 21 | 913-914 | S90932D | 23 | 949-950 | S91251S | 09 | 604-605 | ||
| S8990XA | 24 | 963-965 | S90932S | 09 | 604-605 | S91252A | 09 | 604-605 | ||
| S8990XD | 23 | 949-950 | S90933A | 09 | 604-605 | S91252A | 24 | 963-965 | ||
| S8990XS | 21 | 913-914 | S90933A | 24 | 963-965 | S91252D | 23 | 949-950 | ||
| S8991XA | 21 | 913-914 | S90933D | 23 | 949-950 | S91252S | 09 | 604-605 | ||
| S8991XA | 24 | 963-965 | S90933S | 09 | 604-605 | S91253A | 09 | 604-605 | ||
| S8991XD | 23 | 949-950 | S90934A | 09 | 604-605 | S91253A | 24 | 963-965 | ||
| S8991XS | 21 | 913-914 | S90934A | 24 | 963-965 | S91253D | 23 | 949-950 | ||
| S8992XA | 21 | 913-914 | S90934D | 23 | 949-950 | S91253S | 09 | 604-605 | ||
| S8992XA | 24 | 963-965 | S90934S | 09 | 604-605 | S91254A | 09 | 604-605 | ||
| S8992XD | 23 | 949-950 | S90935A | 09 | 604-605 | S91254A | 24 | 963-965 | ||
| S8992XS | 21 | 913-914 | S90935A | 24 | 963-965 | S91254D | 23 | 949-950 | ||
| S9000XA | 09 | 604-605 | S90935D | 23 | 949-950 | S91254S | 09 | 604-605 | ||
| S9000XA | 24 | 963-965 | S90935S | 09 | 604-605 | S91255A | 09 | 604-605 | ||
| S9000XD | 23 | 949-950 | S90936A | 09 | 604-605 | S91255A | 24 | 963-965 | ||
| S9000XS | 09 | 604-605 | S90936A | 24 | 963-965 | S91255D | 23 | 949-950 | ||
| S9001XA | 09 | 604-605 | S90936D | 23 | 949-950 | S91255S | 09 | 604-605 | ||
| S9001XA | 24 | 963-965 | S90936S | 09 | 604-605 | S91256A | 09 | 604-605 | ||
| S9001XD | 23 | 949-950 | S91001A | 09 | 604-605 | S91256A | 24 | 963-965 | ||
| S9001XS | 09 | 604-605 | S91001A | 24 | 963-965 | S91256D | 23 | 949-950 | ||
| S9002XA | 09 | 604-605 | S91001D | 23 | 949-950 | S91256S | 09 | 604-605 | ||
| S9002XA | 24 | 963-965 | S91001S | 09 | 604-605 | S91259A | 09 | 604-605 | ||
| S9002XD | 23 | 949-950 | S91002A | 09 | 604-605 | S91259A | 24 | 963-965 | ||
| S9002XS | 09 | 604-605 | S91002A | 24 | 963-965 | S91259D | 23 | 949-950 | ||
| S90111A | 09 | 604-605 | S91002D | 23 | 949-950 | S91259S | 09 | 604-605 | ||
| S90111A | 24 | 963-965 | S91002S | 09 | 604-605 | S91301A | 09 | 604-605 | ||
| S90111D | 23 | 949-950 | S91009A | 09 | 604-605 | S91301A | 24 | 963-965 | ||
| S90111S | 09 | 604-605 | S91009A | 24 | 963-965 | S91301D | 23 | 949-950 | ||
| S90112A | 09 | 604-605 | S91009D | 23 | 949-950 | S91301S | 09 | 604-605 | ||
| S90112A | 24 | 963-965 | S91009S | 09 | 604-605 | S91302A | 09 | 604-605 | ||
| S90112D | 23 | 949-950 | S91011A | 09 | 604-605 | S91302A | 24 | 963-965 | ||
| S90112S | 09 | 604-605 | S91011A | 24 | 963-965 | S91302D | 23 | 949-950 | ||
| S90119A | 09 | 604-605 | S91011D | 23 | 949-950 | S91302S | 09 | 604-605 | ||
| S90119A | 24 | 963-965 | S91011S | 09 | 604-605 | S91309A | 09 | 604-605 | ||
| S90119D | 23 | 949-950 | S91012A | 09 | 604-605 | S91309A | 24 | 963-965 | ||
| S90119S | 09 | 604-605 | S91012A | 24 | 963-965 | S91309D | 23 | 949-950 | ||
| S90121A | 09 | 604-605 | S91012D | 23 | 949-950 | S91309S | 09 | 604-605 | ||
| S90121A | 24 | 963-965 | S91012S | 09 | 604-605 | S91311A | 09 | 604-605 | ||
| S90121D | 23 | 949-950 | S91019A | 09 | 604-605 | S91311A | 24 | 963-965 | ||
| S90121S | 09 | 604-605 | S91019A | 24 | 963-965 | S91311D | 23 | 949-950 | ||
| S90122A | 09 | 604-605 | S91019D | 23 | 949-950 | S91311S | 09 | 604-605 | ||
| S90122A | 24 | 963-965 | S91019S | 09 | 604-605 | S91312A | 09 | 604-605 | ||
| S90122D | 23 | 949-950 | S91021A | 21 | 913-914 | S91312A | 24 | 963-965 | ||
| S90122S | 09 | 604-605 | S91021A | 24 | 963-965 | S91312D | 23 | 949-950 | ||
| S90129A | 09 | 604-605 | S91021D | 23 | 949-950 | S91312S | 09 | 604-605 | ||
| S90129A | 24 | 963-965 | S91021S | 09 | 604-605 | S91319A | 09 | 604-605 | ||
| S90129D | 23 | 949-950 | S91022A | 21 | 913-914 | S91319A | 24 | 963-965 | ||
| S90129S | 09 | 604-605 | S91022A | 24 | 963-965 | S91319D | 23 | 949-950 | ||
| S90211A | 09 | 604-605 | S91022D | 23 | 949-950 | S91319S | 09 | 604-605 | ||
| S90211A | 24 | 963-965 | S91022S | 09 | 604-605 | S91321A | 21 | 913-914 | ||
| S90211D | 23 | 949-950 | S91029A | 21 | 913-914 | S91321A | 24 | 963-965 | ||
| S90211S | 09 | 604-605 | S91029A | 24 | 963-965 | S91321D | 23 | 949-950 | ||
| S90212A | 09 | 604-605 | S91029D | 23 | 949-950 | S91321S | 09 | 604-605 | ||
| S90212A | 24 | 963-965 | S91029S | 09 | 604-605 | S91322A | 21 | 913-914 | ||
| S90212D | 23 | 949-950 | S91031A | 09 | 604-605 | S91322A | 24 | 963-965 | ||
| S90212S | 09 | 604-605 | S91031A | 24 | 963-965 | S91322D | 23 | 949-950 | ||
| S90219A | 09 | 604-605 | S91031D | 23 | 949-950 | S91322S | 09 | 604-605 | ||
| S90219A | 24 | 963-965 | S91031S | 09 | 604-605 | S91329A | 21 | 913-914 | ||
| S90219D | 23 | 949-950 | S91032A | 09 | 604-605 | S91329A | 24 | 963-965 | ||
| S90219S | 09 | 604-605 | S91032A | 24 | 963-965 | S91329D | 23 | 949-950 | ||
| S90221A | 09 | 604-605 | S91032D | 23 | 949-950 | S91329S | 09 | 604-605 | ||
| S90221A | 24 | 963-965 | S91032S | 09 | 604-605 | S91331A | 09 | 604-605 | ||
| S90221D | 23 | 949-950 | S91039A | 09 | 604-605 | S91331A | 24 | 963-965 | ||
| S90221S | 09 | 604-605 | S91039A | 24 | 963-965 | S91331D | 23 | 949-950 | ||
| S90222A | 09 | 604-605 | S91039D | 23 | 949-950 | S91331S | 09 | 604-605 | ||
| S90222A | 24 | 963-965 | S91039S | 09 | 604-605 | S91332A | 09 | 604-605 | ||
| S90222D | 23 | 949-950 | S91041A | 21 | 913-914 | S91332A | 24 | 963-965 | ||
| S90222S | 09 | 604-605 | S91041A | 24 | 963-965 | S91332D | 23 | 949-950 | ||
| S90229A | 09 | 604-605 | S91041D | 23 | 949-950 | S91332S | 09 | 604-605 | ||
| S90229A | 24 | 963-965 | S91041S | 09 | 604-605 | S91339A | 09 | 604-605 | ||
| S90229D | 23 | 949-950 | S91042A | 21 | 913-914 | S91339A | 24 | 963-965 | ||
| S90229S | 09 | 604-605 | S91042A | 24 | 963-965 | S91339D | 23 | 949-950 | ||
| S9030XA | 09 | 604-605 | S91042D | 23 | 949-950 | S91339S | 09 | 604-605 | ||
| S9030XA | 24 | 963-965 | S91042S | 09 | 604-605 | S91341A | 21 | 913-914 | ||
| S9030XD | 23 | 949-950 | S91049A | 21 | 913-914 | S91341A | 24 | 963-965 | ||
| S9030XS | 09 | 604-605 | S91049A | 24 | 963-965 | S91341D | 23 | 949-950 | ||
| S9031XA | 09 | 604-605 | S91049D | 23 | 949-950 | S91341S | 09 | 604-605 | ||
| S9031XA | 24 | 963-965 | S91049S | 09 | 604-605 | S91342A | 21 | 913-914 | ||
| S9031XD | 23 | 949-950 | S91051A | 09 | 604-605 | S91342A | 24 | 963-965 | ||
| S9031XS | 09 | 604-605 | S91051A | 24 | 963-965 | S91342D | 23 | 949-950 | ||
| S9032XA | 09 | 604-605 | S91051D | 23 | 949-950 | S91342S | 09 | 604-605 | ||
| S9032XA | 24 | 963-965 | S91051S | 09 | 604-605 | S91349A | 21 | 913-914 | ||
| S9032XD | 23 | 949-950 | S91052A | 09 | 604-605 | S91349A | 24 | 963-965 | ||
| S9032XS | 09 | 604-605 | S91052A | 24 | 963-965 | S91349D | 23 | 949-950 | ||
| S90411A | 09 | 604-605 | S91052D | 23 | 949-950 | S91349S | 09 | 604-605 | ||
| S90411A | 24 | 963-965 | S91052S | 09 | 604-605 | S91351A | 09 | 604-605 | ||
| S90411D | 23 | 949-950 | S91059A | 09 | 604-605 | S91351A | 24 | 963-965 | ||
| S90411S | 09 | 604-605 | S91059A | 24 | 963-965 | S91351D | 23 | 949-950 | ||
| S90412A | 09 | 604-605 | S91059D | 23 | 949-950 | S91351S | 09 | 604-605 | ||
| S90412A | 24 | 963-965 | S91059S | 09 | 604-605 | S91352A | 09 | 604-605 | ||
| S90412D | 23 | 949-950 | S91101A | 09 | 604-605 | S91352A | 24 | 963-965 | ||
| S90412S | 09 | 604-605 | S91101A | 24 | 963-965 | S91352D | 23 | 949-950 | ||
| S90413A | 09 | 604-605 | S91101D | 23 | 949-950 | S91352S | 09 | 604-605 | ||
| S90413A | 24 | 963-965 | S91101S | 09 | 604-605 | S91359A | 09 | 604-605 | ||
| S90413D | 23 | 949-950 | S91102A | 09 | 604-605 | S91359A | 24 | 963-965 | ||
| S90413S | 09 | 604-605 | S91102A | 24 | 963-965 | S91359D | 23 | 949-950 | ||
| S90414A | 09 | 604-605 | S91102D | 23 | 949-950 | S91359S | 09 | 604-605 | ||
| S90414A | 24 | 963-965 | S91102S | 09 | 604-605 | S92001A | 08 | 562-563 | ||
| S90414D | 23 | 949-950 | S91103A | 09 | 604-605 | S92001A | 24 | 963-965 | ||
| S90414S | 09 | 604-605 | S91103A | 24 | 963-965 | S92001B | 08 | 562-563 | ||
| S90415A | 09 | 604-605 | S91103D | 23 | 949-950 | S92001B | 24 | 963-965 | ||
| S90415A | 24 | 963-965 | S91103S | 09 | 604-605 | S92001D | 08 | 559-561 | ||
| S90415D | 23 | 949-950 | S91104A | 09 | 604-605 | S92001G | 08 | 559-561 | ||
| S90415S | 09 | 604-605 | S91104A | 24 | 963-965 | S92001K | 08 | 564-566 | ||
| S90416A | 09 | 604-605 | S91104D | 23 | 949-950 | S92001P | 08 | 564-566 | ||
| S90416A | 24 | 963-965 | S91104S | 09 | 604-605 | S92001S | 08 | 559-561 | ||
| S90416D | 23 | 949-950 | S91105A | 09 | 604-605 | S92002A | 08 | 562-563 | ||
| S90416S | 09 | 604-605 | S91105A | 24 | 963-965 | S92002A | 24 | 963-965 | ||
| S90421A | 09 | 606-607 | S91105D | 23 | 949-950 | S92002B | 08 | 562-563 | ||
| S90421A | 24 | 963-965 | S91105S | 09 | 604-605 | S92002B | 24 | 963-965 | ||
| S90421D | 23 | 949-950 | S91106A | 09 | 604-605 | S92002D | 08 | 559-561 | ||
| S90421S | 09 | 604-605 | S91106A | 24 | 963-965 | S92002G | 08 | 559-561 | ||
| S90422A | 09 | 606-607 | S91106D | 23 | 949-950 | S92002K | 08 | 564-566 | ||
| S90422A | 24 | 963-965 | S91106S | 09 | 604-605 | S92002P | 08 | 564-566 | ||
| S90422D | 23 | 949-950 | S91109A | 09 | 604-605 | S92002S | 08 | 559-561 | ||
| S90422S | 09 | 604-605 | S91109A | 24 | 963-965 | S92009A | 08 | 562-563 | ||
| S90423A | 09 | 606-607 | S91109D | 23 | 949-950 | S92009A | 24 | 963-965 | ||
| S90423A | 24 | 963-965 | S91109S | 09 | 604-605 | S92009B | 08 | 562-563 | ||
| S90423D | 23 | 949-950 | S91111A | 09 | 604-605 | S92009B | 24 | 963-965 | ||
| S90423S | 09 | 604-605 | S91111A | 24 | 963-965 | S92009D | 08 | 559-561 | ||
| S90424A | 09 | 606-607 | S91111D | 23 | 949-950 | S92009G | 08 | 559-561 | ||
| S90424A | 24 | 963-965 | S91111S | 09 | 604-605 | S92009K | 08 | 564-566 | ||
| S90424D | 23 | 949-950 | S91112A | 09 | 604-605 | S92009P | 08 | 564-566 | ||
| S90424S | 09 | 604-605 | S91112A | 24 | 963-965 | S92009S | 08 | 559-561 | ||
| S90425A | 09 | 606-607 | S91112D | 23 | 949-950 | S92011A | 08 | 562-563 | ||
| S90425A | 24 | 963-965 | S91112S | 09 | 604-605 | S92011A | 24 | 963-965 | ||
| S90425D | 23 | 949-950 | S91113A | 09 | 604-605 | S92011B | 08 | 562-563 | ||
| S90425S | 09 | 604-605 | S91113A | 24 | 963-965 | S92011B | 24 | 963-965 | ||
| S90426A | 09 | 606-607 | S91113D | 23 | 949-950 | S92011D | 08 | 559-561 | ||
| S90426A | 24 | 963-965 | S91113S | 09 | 604-605 | S92011G | 08 | 559-561 | ||
| S90426D | 23 | 949-950 | S91114A | 09 | 604-605 | S92011K | 08 | 564-566 | ||
| S90426S | 09 | 604-605 | S91114A | 24 | 963-965 | S92011P | 08 | 564-566 | ||
| S90441A | 09 | 604-605 | S91114D | 23 | 949-950 | S92011S | 08 | 559-561 | ||
| S90441A | 24 | 963-965 | S91114S | 09 | 604-605 | S92012A | 08 | 562-563 | ||
| S90441D | 23 | 949-950 | S91115A | 09 | 604-605 | S92012A | 24 | 963-965 | ||
| S90441S | 09 | 604-605 | S91115A | 24 | 963-965 | S92012B | 08 | 562-563 | ||
| S90442A | 09 | 604-605 | S91115D | 23 | 949-950 | S92012B | 24 | 963-965 | ||
| S90442A | 24 | 963-965 | S91115S | 09 | 604-605 | S92012D | 08 | 559-561 | ||
| S90442D | 23 | 949-950 | S91116A | 09 | 604-605 | S92012G | 08 | 559-561 | ||
| S90442S | 09 | 604-605 | S91116A | 24 | 963-965 | S92012K | 08 | 564-566 | ||
| S90443A | 09 | 604-605 | S91116D | 23 | 949-950 | S92012P | 08 | 564-566 | ||
| S90443A | 24 | 963-965 | S91116S | 09 | 604-605 | S92012S | 08 | 559-561 | ||
| S90443D | 23 | 949-950 | S91119A | 09 | 604-605 | S92013A | 08 | 562-563 | ||
| S90443S | 09 | 604-605 | S91119A | 24 | 963-965 | S92013A | 24 | 963-965 | ||
| S90444A | 09 | 604-605 | S91119D | 23 | 949-950 | S92013B | 08 | 562-563 | ||
| S90444A | 24 | 963-965 | S91119S | 09 | 604-605 | S92013B | 24 | 963-965 | ||
| S90444D | 23 | 949-950 | S91121A | 21 | 913-914 | S92013D | 08 | 559-561 | ||
| S90444S | 09 | 604-605 | S91121A | 24 | 963-965 | S92013G | 08 | 559-561 | ||
| S90445A | 09 | 604-605 | S91121D | 23 | 949-950 | S92013K | 08 | 564-566 | ||
| S90445A | 24 | 963-965 | S91121S | 09 | 604-605 | S92013P | 08 | 564-566 | ||
| S90445D | 23 | 949-950 | S91122A | 21 | 913-914 | S92013S | 08 | 559-561 | ||
| S90445S | 09 | 604-605 | S91122A | 24 | 963-965 | S92014A | 08 | 562-563 | ||
| S90446A | 09 | 604-605 | S91122D | 23 | 949-950 | S92014A | 24 | 963-965 | ||
| S90446A | 24 | 963-965 | S91122S | 09 | 604-605 | S92014B | 08 | 562-563 | ||
| S90446D | 23 | 949-950 | S91123A | 21 | 913-914 | S92014B | 24 | 963-965 | ||
| S90446S | 09 | 604-605 | S91123A | 24 | 963-965 | S92014D | 08 | 559-561 | ||
| S90451A | 09 | 604-605 | S91123D | 23 | 949-950 | S92014G | 08 | 559-561 | ||
| S90451A | 24 | 963-965 | S91123S | 09 | 604-605 | S92014K | 08 | 564-566 | ||
| S90451D | 23 | 949-950 | S91124A | 21 | 913-914 | S92014P | 08 | 564-566 | ||
| S90451S | 09 | 604-605 | S91124A | 24 | 963-965 | S92014S | 08 | 559-561 | ||
| S90452A | 09 | 604-605 | S91124D | 23 | 949-950 | S92015A | 08 | 562-563 | ||
| S90452A | 24 | 963-965 | S91124S | 09 | 604-605 | S92015A | 24 | 963-965 | ||
| S90452D | 23 | 949-950 | S91125A | 21 | 913-914 | S92015B | 08 | 562-563 | ||
| S90452S | 09 | 604-605 | S91125A | 24 | 963-965 | S92015B | 24 | 963-965 | ||
| S90453A | 09 | 604-605 | S91125D | 23 | 949-950 | S92015D | 08 | 559-561 | ||
| S90453A | 24 | 963-965 | S91125S | 09 | 604-605 | S92015G | 08 | 559-561 | ||
| S90453D | 23 | 949-950 | S91126A | 21 | 913-914 | S92015K | 08 | 564-566 | ||
| S90453S | 09 | 604-605 | S91126A | 24 | 963-965 | S92015P | 08 | 564-566 | ||
| S90454A | 09 | 604-605 | S91126D | 23 | 949-950 | S92015S | 08 | 559-561 | ||
| S90454A | 24 | 963-965 | S91126S | 09 | 604-605 | S92016A | 08 | 562-563 | ||
| S90454D | 23 | 949-950 | S91129A | 21 | 913-914 | S92016A | 24 | 963-965 | ||
| S90454S | 09 | 604-605 | S91129A | 24 | 963-965 | S92016B | 08 | 562-563 | ||
| S90455A | 09 | 604-605 | S91129D | 23 | 949-950 | S92016B | 24 | 963-965 | ||
| S90455A | 24 | 963-965 | S91129S | 09 | 604-605 | S92016D | 08 | 559-561 | ||
| S90455D | 23 | 949-950 | S91131A | 09 | 604-605 | S92016G | 08 | 559-561 | ||
| S90455S | 09 | 604-605 | S91131A | 24 | 963-965 | S92016K | 08 | 564-566 | ||
| S90456A | 09 | 604-605 | S91131D | 23 | 949-950 | S92016P | 08 | 564-566 | ||
| S90456A | 24 | 963-965 | S91131S | 09 | 604-605 | S92016S | 08 | 559-561 | ||
| S90456D | 23 | 949-950 | S91132A | 09 | 604-605 | S92021A | 08 | 562-563 | ||
| S90456S | 09 | 604-605 | S91132A | 24 | 963-965 | S92021A | 24 | 963-965 | ||
| S90461A | 09 | 606-607 | S91132D | 23 | 949-950 | S92021B | 08 | 562-563 | ||
| S90461A | 24 | 963-965 | S91132S | 09 | 604-605 | S92021B | 24 | 963-965 | ||
| S90461D | 23 | 949-950 | S91133A | 09 | 604-605 | S92021D | 08 | 559-561 | ||
| S90461S | 09 | 604-605 | S91133A | 24 | 963-965 | S92021G | 08 | 559-561 | ||
| S90462A | 09 | 606-607 | S91133D | 23 | 949-950 | S92021K | 08 | 564-566 | ||
| S90462A | 24 | 963-965 | S91133S | 09 | 604-605 | S92021P | 08 | 564-566 | ||
| S90462D | 23 | 949-950 | S91134A | 09 | 604-605 | S92021S | 08 | 559-561 | ||
| S90462S | 09 | 604-605 | S91134A | 24 | 963-965 | S92022A | 08 | 562-563 | ||
| S90463A | 09 | 606-607 | S91134D | 23 | 949-950 | S92022A | 24 | 963-965 | ||
| S90463A | 24 | 963-965 | S91134S | 09 | 604-605 | S92022B | 08 | 562-563 | ||
| S90463D | 23 | 949-950 | S91135A | 09 | 604-605 | S92022B | 24 | 963-965 | ||
| S90463S | 09 | 604-605 | S91135A | 24 | 963-965 | S92022D | 08 | 559-561 | ||
| S90464A | 09 | 606-607 | S91135D | 23 | 949-950 | S92022G | 08 | 559-561 | ||
| S90464A | 24 | 963-965 | S91135S | 09 | 604-605 | S92022K | 08 | 564-566 | ||
| S90464D | 23 | 949-950 | S91136A | 09 | 604-605 | S92022P | 08 | 564-566 | ||
| S90464S | 09 | 604-605 | S91136A | 24 | 963-965 | S92022S | 08 | 559-561 | ||
| S90465A | 09 | 606-607 | S91136D | 23 | 949-950 | S92023A | 08 | 562-563 | ||
| S90465A | 24 | 963-965 | S91136S | 09 | 604-605 | S92023A | 24 | 963-965 | ||
| S90465D | 23 | 949-950 | S91139A | 09 | 604-605 | S92023B | 08 | 562-563 | ||
| S90465S | 09 | 604-605 | S91139A | 24 | 963-965 | S92023B | 24 | 963-965 | ||
| S90466A | 09 | 606-607 | S91139D | 23 | 949-950 | S92023D | 08 | 559-561 | ||
| S90466A | 24 | 963-965 | S91139S | 09 | 604-605 | S92023G | 08 | 559-561 | ||
| S90466D | 23 | 949-950 | S91141A | 21 | 913-914 | S92023K | 08 | 564-566 | ||
| S90466S | 09 | 604-605 | S91141A | 24 | 963-965 | S92023P | 08 | 564-566 | ||
| S90471A | 09 | 604-605 | S91141D | 23 | 949-950 | S92023S | 08 | 559-561 | ||
| S90471A | 24 | 963-965 | S91141S | 09 | 604-605 | S92024A | 08 | 562-563 | ||
| S90471D | 23 | 949-950 | S91142A | 21 | 913-914 | S92024A | 24 | 963-965 | ||
| S90471S | 09 | 604-605 | S91142A | 24 | 963-965 | S92024B | 08 | 562-563 | ||
| S90472A | 09 | 604-605 | S91142D | 23 | 949-950 | S92024B | 24 | 963-965 | ||
| S90472A | 24 | 963-965 | S91142S | 09 | 604-605 | S92024D | 08 | 559-561 | ||
| S90472D | 23 | 949-950 | S91143A | 21 | 913-914 | S92024G | 08 | 559-561 | ||
| S90472S | 09 | 604-605 | S91143A | 24 | 963-965 | S92024K | 08 | 564-566 | ||
| S90473A | 09 | 604-605 | S91143D | 23 | 949-950 | S92024P | 08 | 564-566 | ||
| S90473A | 24 | 963-965 | S91143S | 09 | 604-605 | S92024S | 08 | 559-561 | ||
| S90473D | 23 | 949-950 | S91144A | 21 | 913-914 | S92025A | 08 | 562-563 | ||
| S90473S | 09 | 604-605 | S91144A | 24 | 963-965 | S92025A | 24 | 963-965 | ||
| S90474A | 09 | 604-605 | S91144D | 23 | 949-950 | S92025B | 08 | 562-563 | ||
| S90474A | 24 | 963-965 | S91144S | 09 | 604-605 | S92025B | 24 | 963-965 | ||
| S90474D | 23 | 949-950 | S91145A | 21 | 913-914 | S92025D | 08 | 559-561 | ||
| S90474S | 09 | 604-605 | S91145A | 24 | 963-965 | S92025G | 08 | 559-561 | ||
| S90475A | 09 | 604-605 | S91145D | 23 | 949-950 | S92025K | 08 | 564-566 | ||
| S90475A | 24 | 963-965 | S91145S | 09 | 604-605 | S92025P | 08 | 564-566 | ||
| S90475D | 23 | 949-950 | S91146A | 21 | 913-914 | S92025S | 08 | 559-561 | ||
| S90475S | 09 | 604-605 | S91146A | 24 | 963-965 | S92026A | 08 | 562-563 | ||
| S90476A | 09 | 604-605 | S91146D | 23 | 949-950 | S92026A | 24 | 963-965 | ||
| S90476A | 24 | 963-965 | S91146S | 09 | 604-605 | S92026B | 08 | 562-563 | ||
| S90476D | 23 | 949-950 | S91149A | 21 | 913-914 | S92026B | 24 | 963-965 | ||
| S90476S | 09 | 604-605 | S91149A | 24 | 963-965 | S92026D | 08 | 559-561 | ||
| S90511A | 09 | 604-605 | S91149D | 23 | 949-950 | S92026G | 08 | 559-561 | ||
| S90511A | 24 | 963-965 | S91149S | 09 | 604-605 | S92026K | 08 | 564-566 | ||
| S90511D | 23 | 949-950 | S91151A | 09 | 604-605 | S92026P | 08 | 564-566 | ||
| S90511S | 09 | 604-605 | S91151A | 24 | 963-965 | S92026S | 08 | 559-561 | ||
| S90512A | 09 | 604-605 | S91151D | 23 | 949-950 | S92031A | 08 | 562-563 | ||
| S90512A | 24 | 963-965 | S91151S | 09 | 604-605 | S92031A | 24 | 963-965 | ||
| S90512D | 23 | 949-950 | S91152A | 09 | 604-605 | S92031B | 08 | 562-563 | ||
| S90512S | 09 | 604-605 | S91152A | 24 | 963-965 | S92031B | 24 | 963-965 | ||
| S90519A | 09 | 604-605 | S91152D | 23 | 949-950 | S92031D | 08 | 559-561 | ||
| S90519A | 24 | 963-965 | S91152S | 09 | 604-605 | S92031G | 08 | 559-561 | ||
| S90519D | 23 | 949-950 | S91153A | 09 | 604-605 | S92031K | 08 | 564-566 | ||
| S90519S | 09 | 604-605 | S91153A | 24 | 963-965 | S92031P | 08 | 564-566 | ||
| S90521A | 09 | 606-607 | S91153D | 23 | 949-950 | S92031S | 08 | 559-561 | ||
| S90521A | 24 | 963-965 | S91153S | 09 | 604-605 | S92032A | 08 | 562-563 | ||
| S90521D | 23 | 949-950 | S91154A | 09 | 604-605 | S92032A | 24 | 963-965 | ||
| S90521S | 09 | 604-605 | S91154A | 24 | 963-965 | S92032B | 08 | 562-563 | ||
| S90522A | 09 | 606-607 | S91154D | 23 | 949-950 | S92032B | 24 | 963-965 | ||
| S90522A | 24 | 963-965 | S91154S | 09 | 604-605 | S92032D | 08 | 559-561 | ||
| S90522D | 23 | 949-950 | S91155A | 09 | 604-605 | S92032G | 08 | 559-561 | ||
| S90522S | 09 | 604-605 | S91155A | 24 | 963-965 | S92032K | 08 | 564-566 | ||
| S90529A | 09 | 606-607 | S91155D | 23 | 949-950 | S92032P | 08 | 564-566 | ||
| S90529A | 24 | 963-965 | S91155S | 09 | 604-605 | S92032S | 08 | 559-561 | ||
| S90529D | 23 | 949-950 | S91156A | 09 | 604-605 | S92033A | 08 | 562-563 | ||
| S90529S | 09 | 604-605 | S91156A | 24 | 963-965 | S92033A | 24 | 963-965 | ||
| S90541A | 09 | 604-605 | S91156D | 23 | 949-950 | S92033B | 08 | 562-563 | ||
| S90541A | 24 | 963-965 | S91156S | 09 | 604-605 | S92033B | 24 | 963-965 | ||
| S90541D | 23 | 949-950 | S91159A | 09 | 604-605 | S92033D | 08 | 559-561 | ||
| S90541S | 09 | 604-605 | S91159A | 24 | 963-965 | S92033G | 08 | 559-561 | ||
| S90542A | 09 | 604-605 | S91159D | 23 | 949-950 | S92033K | 08 | 564-566 | ||
| S90542A | 24 | 963-965 | S91159S | 09 | 604-605 | S92033P | 08 | 564-566 | ||
| S90542D | 23 | 949-950 | S91201A | 09 | 604-605 | S92033S | 08 | 559-561 | ||
| S90542S | 09 | 604-605 | S91201A | 24 | 963-965 | S92034A | 08 | 562-563 | ||
| S90549A | 09 | 604-605 | S91201D | 23 | 949-950 | S92034A | 24 | 963-965 | ||
| S90549A | 24 | 963-965 | S91201S | 09 | 604-605 | S92034B | 08 | 562-563 | ||
| S90549D | 23 | 949-950 | S91202A | 09 | 604-605 | S92034B | 24 | 963-965 | ||
| S90549S | 09 | 604-605 | S91202A | 24 | 963-965 | S92034D | 08 | 559-561 | ||
| S90551A | 09 | 604-605 | S91202D | 23 | 949-950 | S92034G | 08 | 559-561 | ||
| S90551A | 24 | 963-965 | S91202S | 09 | 604-605 | S92034K | 08 | 564-566 | ||
| S90551D | 23 | 949-950 | S91203A | 09 | 604-605 | S92034P | 08 | 564-566 | ||
| S90551S | 09 | 604-605 | S91203A | 24 | 963-965 | S92034S | 08 | 559-561 | ||
| S90552A | 09 | 604-605 | S91203D | 23 | 949-950 | S92035A | 08 | 562-563 | ||
| S90552A | 24 | 963-965 | S91203S | 09 | 604-605 | S92035A | 24 | 963-965 | ||
| S90552D | 23 | 949-950 | S91204A | 09 | 604-605 | S92035B | 08 | 562-563 | ||
| S90552S | 09 | 604-605 | S91204A | 24 | 963-965 | S92035B | 24 | 963-965 | ||
| S90559A | 09 | 604-605 | S91204D | 23 | 949-950 | S92035D | 08 | 559-561 | ||
| S90559A | 24 | 963-965 | S91204S | 09 | 604-605 | S92035G | 08 | 559-561 | ||
| S90559D | 23 | 949-950 | S91205A | 09 | 604-605 | S92035K | 08 | 564-566 | ||
| S90559S | 09 | 604-605 | S91205A | 24 | 963-965 | S92035P | 08 | 564-566 | ||
| S90561A | 09 | 606-607 | S91205D | 23 | 949-950 | S92035S | 08 | 559-561 | ||
| S90561A | 24 | 963-965 | S91205S | 09 | 604-605 | S92036A | 08 | 562-563 | ||
| S90561D | 23 | 949-950 | S91206A | 09 | 604-605 | S92036A | 24 | 963-965 | ||
| S90561S | 09 | 604-605 | S91206A | 24 | 963-965 | S92036B | 08 | 562-563 | ||
| S90562A | 09 | 606-607 | S91206D | 23 | 949-950 | S92036B | 24 | 963-965 | ||
| S90562A | 24 | 963-965 | S91206S | 09 | 604-605 | S92036D | 08 | 559-561 | ||
| S90562D | 23 | 949-950 | S91209A | 09 | 604-605 | S92036G | 08 | 559-561 | ||
| S90562S | 09 | 604-605 | S91209A | 24 | 963-965 | S92036K | 08 | 564-566 | ||
| S90569A | 09 | 606-607 | S91209D | 23 | 949-950 | S92036P | 08 | 564-566 | ||
| S90569A | 24 | 963-965 | S91209S | 09 | 604-605 | S92036S | 08 | 559-561 | ||
| S90569D | 23 | 949-950 | S91211A | 09 | 604-605 | S92041A | 08 | 562-563 | ||
| S90569S | 09 | 604-605 | S91211A | 24 | 963-965 | S92041A | 24 | 963-965 | ||
| S90571A | 09 | 604-605 | S91211D | 23 | 949-950 | S92041B | 08 | 562-563 | ||
| S90571A | 24 | 963-965 | S91211S | 09 | 604-605 | S92041B | 24 | 963-965 | ||
| S90571D | 23 | 949-950 | S91212A | 09 | 604-605 | S92041D | 08 | 559-561 | ||
| S90571S | 09 | 604-605 | S91212A | 24 | 963-965 | S92041G | 08 | 559-561 | ||
| S90572A | 09 | 604-605 | S91212D | 23 | 949-950 | S92041K | 08 | 564-566 | ||
| S90572A | 24 | 963-965 | S91212S | 09 | 604-605 | S92041P | 08 | 564-566 | ||
| S90572D | 23 | 949-950 | S91213A | 09 | 604-605 | S92041S | 08 | 559-561 | ||
| S90572S | 09 | 604-605 | S91213A | 24 | 963-965 | S92042A | 08 | 562-563 | ||
| S90579A | 09 | 604-605 | S91213D | 23 | 949-950 | S92042A | 24 | 963-965 | ||
| S90579A | 24 | 963-965 | S91213S | 09 | 604-605 | S92042B | 08 | 562-563 | ||
| S90579D | 23 | 949-950 | S91214A | 09 | 604-605 | S92042B | 24 | 963-965 | ||
| S90579S | 09 | 604-605 | S91214A | 24 | 963-965 | S92042D | 08 | 559-561 | ||
| S90811A | 09 | 604-605 | S91214D | 23 | 949-950 | S92042G | 08 | 559-561 | ||
| S90811A | 24 | 963-965 | S91214S | 09 | 604-605 | S92042K | 08 | 564-566 | ||
| S90811D | 23 | 949-950 | S91215A | 09 | 604-605 | S92042P | 08 | 564-566 | ||
| S90811S | 09 | 604-605 | S91215A | 24 | 963-965 | S92042S | 08 | 559-561 | ||
| S90812A | 09 | 604-605 | S91215D | 23 | 949-950 | S92043A | 08 | 562-563 | ||
| S90812A | 24 | 963-965 | S91215S | 09 | 604-605 | S92043A | 24 | 963-965 | ||
| S90812D | 23 | 949-950 | S91216A | 09 | 604-605 | S92043B | 08 | 562-563 | ||
| S90812S | 09 | 604-605 | S91216A | 24 | 963-965 | S92043B | 24 | 963-965 | ||
| S90819A | 09 | 604-605 | S91216D | 23 | 949-950 | S92043D | 08 | 559-561 | ||
| S90819A | 24 | 963-965 | S91216S | 09 | 604-605 | S92043G | 08 | 559-561 | ||
| S90819D | 23 | 949-950 | S91219A | 09 | 604-605 | S92043K | 08 | 564-566 | ||
| S90819S | 09 | 604-605 | S91219A | 24 | 963-965 | S92043P | 08 | 564-566 | ||
| S90821A | 09 | 606-607 | S91219D | 23 | 949-950 | S92043S | 08 | 559-561 | ||
| S90821A | 24 | 963-965 | S91219S | 09 | 604-605 | S92044A | 08 | 562-563 | ||
| S90821D | 23 | 949-950 | S91221A | 21 | 913-914 | S92044A | 24 | 963-965 | ||
| S90821S | 09 | 604-605 | S91221A | 24 | 963-965 | S92044B | 08 | 562-563 | ||
| S90822A | 09 | 606-607 | S91221D | 23 | 949-950 | S92044B | 24 | 963-965 | ||
| S90822A | 24 | 963-965 | S91221S | 09 | 604-605 | S92044D | 08 | 559-561 | ||
| S90822D | 23 | 949-950 | S91222A | 21 | 913-914 | S92044G | 08 | 559-561 | ||
| S90822S | 09 | 604-605 | S91222A | 24 | 963-965 | S92044K | 08 | 564-566 | ||
| S90829A | 09 | 606-607 | S91222D | 23 | 949-950 | S92044P | 08 | 564-566 | ||
| S90829A | 24 | 963-965 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 18 Jan 2023 08:46:59 CMS, code-revision=337, description-revision=1351 |