ICD-10-CM/PCS MS-DRG v41.1 Definitions Manual
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ICD-10-CM/PCS MS-DRG v41.1 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 33 of 75 |
| A000 B2781 C5712 C8418 D3002 E093219 E133599 F18251 G9204 H18811 H47529 I2541 I69315 J3503 K5731 L812 M05539 M21069 M45A7 M7070 M84444P M86559 N158 O0380 O3130X1 O365133 O6023X0 P2889 Q738 S0005XS S02610G S06384S S12400D S20374D S24144D S31149D S32443D S36209D S41119A S42354A S45012D S52001S S52244P S52389Q S53421A S59149K S61240D S62225A S62615D S63298D S66190D S71102D S72064P S7221XC S72412K S75192S S82009N S82192P S82444Q S8291XP S8700XD S91204D S92301D S93526S S99249B T22422D T24439A T370X5A T43013S T474X5S T5492XD T65292D T82111D T8613 Z808 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S12400D | 08 | 559-561 | S14121S | 01 | 052-053 | S15312S | 05 | 299-301 | ||
| S12400G | 08 | 559-561 | S14122A | 01 | 052-053 | S15319A | 15 | 791 | ||
| S12400K | 08 | 564-566 | S14122A | 24 | 963-965 | S15319A | 15 | 793 | ||
| S12400S | 08 | 551-552 | S14122D | 23 | 949-950 | S15319A | 21 | 913-914 | ||
| S12401A | 08 | 551-552 | S14122S | 01 | 052-053 | S15319A | 24 | 963-965 | ||
| S12401A | 24 | 963-965 | S14123A | 01 | 052-053 | S15319D | 23 | 949-950 | ||
| S12401B | 08 | 551-552 | S14123A | 24 | 963-965 | S15319S | 05 | 299-301 | ||
| S12401B | 24 | 963-965 | S14123D | 23 | 949-950 | S15321A | 15 | 791 | ||
| S12401D | 08 | 559-561 | S14123S | 01 | 052-053 | S15321A | 15 | 793 | ||
| S12401G | 08 | 559-561 | S14124A | 01 | 052-053 | S15321A | 21 | 913-914 | ||
| S12401K | 08 | 564-566 | S14124A | 24 | 963-965 | S15321A | 24 | 963-965 | ||
| S12401S | 08 | 551-552 | S14124D | 23 | 949-950 | S15321D | 23 | 949-950 | ||
| S12430A | 08 | 551-552 | S14124S | 01 | 052-053 | S15321S | 05 | 299-301 | ||
| S12430A | 24 | 963-965 | S14125A | 01 | 052-053 | S15322A | 15 | 791 | ||
| S12430B | 08 | 551-552 | S14125A | 24 | 963-965 | S15322A | 15 | 793 | ||
| S12430B | 24 | 963-965 | S14125D | 23 | 949-950 | S15322A | 21 | 913-914 | ||
| S12430D | 08 | 559-561 | S14125S | 01 | 052-053 | S15322A | 24 | 963-965 | ||
| S12430G | 08 | 559-561 | S14126A | 01 | 052-053 | S15322D | 23 | 949-950 | ||
| S12430K | 08 | 564-566 | S14126A | 24 | 963-965 | S15322S | 05 | 299-301 | ||
| S12430S | 08 | 551-552 | S14126D | 23 | 949-950 | S15329A | 15 | 791 | ||
| S12431A | 08 | 551-552 | S14126S | 01 | 052-053 | S15329A | 15 | 793 | ||
| S12431A | 24 | 963-965 | S14127A | 01 | 052-053 | S15329A | 21 | 913-914 | ||
| S12431B | 08 | 551-552 | S14127A | 24 | 963-965 | S15329A | 24 | 963-965 | ||
| S12431B | 24 | 963-965 | S14127D | 23 | 949-950 | S15329D | 23 | 949-950 | ||
| S12431D | 08 | 559-561 | S14127S | 01 | 052-053 | S15329S | 05 | 299-301 | ||
| S12431G | 08 | 559-561 | S14128A | 01 | 052-053 | S15391A | 15 | 791 | ||
| S12431K | 08 | 564-566 | S14128A | 24 | 963-965 | S15391A | 15 | 793 | ||
| S12431S | 08 | 551-552 | S14128D | 23 | 949-950 | S15391A | 21 | 913-914 | ||
| S1244XA | 08 | 551-552 | S14128S | 01 | 052-053 | S15391A | 24 | 963-965 | ||
| S1244XA | 24 | 963-965 | S14129A | 01 | 052-053 | S15391D | 23 | 949-950 | ||
| S1244XB | 08 | 551-552 | S14129A | 24 | 963-965 | S15391S | 05 | 299-301 | ||
| S1244XB | 24 | 963-965 | S14129D | 23 | 949-950 | S15392A | 15 | 791 | ||
| S1244XD | 08 | 559-561 | S14129S | 01 | 052-053 | S15392A | 15 | 793 | ||
| S1244XG | 08 | 559-561 | S14131A | 01 | 052-053 | S15392A | 21 | 913-914 | ||
| S1244XK | 08 | 564-566 | S14131A | 24 | 963-965 | S15392A | 24 | 963-965 | ||
| S1244XS | 08 | 551-552 | S14131D | 23 | 949-950 | S15392D | 23 | 949-950 | ||
| S12450A | 08 | 551-552 | S14131S | 01 | 052-053 | S15392S | 05 | 299-301 | ||
| S12450A | 24 | 963-965 | S14132A | 01 | 052-053 | S15399A | 15 | 791 | ||
| S12450B | 08 | 551-552 | S14132A | 24 | 963-965 | S15399A | 15 | 793 | ||
| S12450B | 24 | 963-965 | S14132D | 23 | 949-950 | S15399A | 21 | 913-914 | ||
| S12450D | 08 | 559-561 | S14132S | 01 | 052-053 | S15399A | 24 | 963-965 | ||
| S12450G | 08 | 559-561 | S14133A | 01 | 052-053 | S15399D | 23 | 949-950 | ||
| S12450K | 08 | 564-566 | S14133A | 24 | 963-965 | S15399S | 05 | 299-301 | ||
| S12450S | 08 | 551-552 | S14133D | 23 | 949-950 | S158XXA | Pre | 011-013 | ||
| S12451A | 08 | 551-552 | S14133S | 01 | 052-053 | S158XXA | 21 | 913-914 | ||
| S12451A | 24 | 963-965 | S14134A | 01 | 052-053 | S158XXA | 24 | 963-965 | ||
| S12451B | 08 | 551-552 | S14134A | 24 | 963-965 | S158XXD | 23 | 949-950 | ||
| S12451B | 24 | 963-965 | S14134D | 23 | 949-950 | S158XXS | 05 | 299-301 | ||
| S12451D | 08 | 559-561 | S14134S | 01 | 052-053 | S159XXA | Pre | 011-013 | ||
| S12451G | 08 | 559-561 | S14135A | 01 | 052-053 | S159XXA | 21 | 913-914 | ||
| S12451K | 08 | 564-566 | S14135A | 24 | 963-965 | S159XXA | 24 | 963-965 | ||
| S12451S | 08 | 551-552 | S14135D | 23 | 949-950 | S159XXD | 23 | 949-950 | ||
| S12490A | 08 | 551-552 | S14135S | 01 | 052-053 | S159XXS | 05 | 299-301 | ||
| S12490A | 24 | 963-965 | S14136A | 01 | 052-053 | S161XXA | 08 | 551-552 | ||
| S12490B | 08 | 551-552 | S14136A | 24 | 963-965 | S161XXA | 24 | 963-965 | ||
| S12490B | 24 | 963-965 | S14136D | 23 | 949-950 | S161XXD | 23 | 949-950 | ||
| S12490D | 08 | 559-561 | S14136S | 01 | 052-053 | S161XXS | 08 | 562-563 | ||
| S12490G | 08 | 559-561 | S14137A | 01 | 052-053 | S162XXA | Pre | 011-013 | ||
| S12490K | 08 | 564-566 | S14137A | 24 | 963-965 | S162XXA | 09 | 604-605 | ||
| S12490S | 08 | 551-552 | S14137D | 23 | 949-950 | S162XXA | 24 | 963-965 | ||
| S12491A | 08 | 551-552 | S14137S | 01 | 052-053 | S162XXD | 23 | 949-950 | ||
| S12491A | 24 | 963-965 | S14138A | 01 | 052-053 | S162XXS | 09 | 604-605 | ||
| S12491B | 08 | 551-552 | S14138A | 24 | 963-965 | S168XXA | Pre | 011-013 | ||
| S12491B | 24 | 963-965 | S14138D | 23 | 949-950 | S168XXA | 21 | 913-914 | ||
| S12491D | 08 | 559-561 | S14138S | 01 | 052-053 | S168XXA | 24 | 963-965 | ||
| S12491G | 08 | 559-561 | S14139A | 01 | 052-053 | S168XXD | 23 | 949-950 | ||
| S12491K | 08 | 564-566 | S14139A | 24 | 963-965 | S168XXS | 21 | 913-914 | ||
| S12491S | 08 | 551-552 | S14139D | 23 | 949-950 | S169XXA | Pre | 011-013 | ||
| S12500A | 08 | 551-552 | S14139S | 01 | 052-053 | S169XXA | 21 | 913-914 | ||
| S12500A | 24 | 963-965 | S14141A | 01 | 052-053 | S169XXA | 24 | 963-965 | ||
| S12500B | 08 | 551-552 | S14141A | 24 | 963-965 | S169XXD | 23 | 949-950 | ||
| S12500B | 24 | 963-965 | S14141D | 23 | 949-950 | S169XXS | 21 | 913-914 | ||
| S12500D | 08 | 559-561 | S14141S | 01 | 052-053 | S170XXA | Pre | 011-013 | ||
| S12500G | 08 | 559-561 | S14142A | 01 | 052-053 | S170XXA | 21 | 913-914 | ||
| S12500K | 08 | 564-566 | S14142A | 24 | 963-965 | S170XXA | 24 | 963-965 | ||
| S12500S | 08 | 551-552 | S14142D | 23 | 949-950 | S170XXD | 23 | 949-950 | ||
| S12501A | 08 | 551-552 | S14142S | 01 | 052-053 | S170XXS | 09 | 604-605 | ||
| S12501A | 24 | 963-965 | S14143A | 01 | 052-053 | S178XXA | Pre | 011-013 | ||
| S12501B | 08 | 551-552 | S14143A | 24 | 963-965 | S178XXA | 21 | 913-914 | ||
| S12501B | 24 | 963-965 | S14143D | 23 | 949-950 | S178XXA | 24 | 963-965 | ||
| S12501D | 08 | 559-561 | S14143S | 01 | 052-053 | S178XXD | 23 | 949-950 | ||
| S12501G | 08 | 559-561 | S14144A | 01 | 052-053 | S178XXS | 09 | 604-605 | ||
| S12501K | 08 | 564-566 | S14144A | 24 | 963-965 | S179XXA | Pre | 011-013 | ||
| S12501S | 08 | 551-552 | S14144D | 23 | 949-950 | S179XXA | 21 | 913-914 | ||
| S12530A | 08 | 551-552 | S14144S | 01 | 052-053 | S179XXA | 24 | 963-965 | ||
| S12530A | 24 | 963-965 | S14145A | 01 | 052-053 | S179XXD | 23 | 949-950 | ||
| S12530B | 08 | 551-552 | S14145A | 24 | 963-965 | S179XXS | 09 | 604-605 | ||
| S12530B | 24 | 963-965 | S14145D | 23 | 949-950 | S1980XA | Pre | 011-013 | ||
| S12530D | 08 | 559-561 | S14145S | 01 | 052-053 | S1980XA | 21 | 913-914 | ||
| S12530G | 08 | 559-561 | S14146A | 01 | 052-053 | S1980XA | 24 | 963-965 | ||
| S12530K | 08 | 564-566 | S14146A | 24 | 963-965 | S1980XD | 23 | 949-950 | ||
| S12530S | 08 | 551-552 | S14146D | 23 | 949-950 | S1980XS | 21 | 913-914 | ||
| S12531A | 08 | 551-552 | S14146S | 01 | 052-053 | S1981XA | Pre | 011-013 | ||
| S12531A | 24 | 963-965 | S14147A | 01 | 052-053 | S1981XA | 21 | 913-914 | ||
| S12531B | 08 | 551-552 | S14147A | 24 | 963-965 | S1981XA | 24 | 963-965 | ||
| S12531B | 24 | 963-965 | S14147D | 23 | 949-950 | S1981XD | 23 | 949-950 | ||
| S12531D | 08 | 559-561 | S14147S | 01 | 052-053 | S1981XS | 21 | 913-914 | ||
| S12531G | 08 | 559-561 | S14148A | 01 | 052-053 | S1982XA | Pre | 011-013 | ||
| S12531K | 08 | 564-566 | S14148A | 24 | 963-965 | S1982XA | 21 | 913-914 | ||
| S12531S | 08 | 551-552 | S14148D | 23 | 949-950 | S1982XA | 24 | 963-965 | ||
| S1254XA | 08 | 551-552 | S14148S | 01 | 052-053 | S1982XD | 23 | 949-950 | ||
| S1254XA | 24 | 963-965 | S14149A | 01 | 052-053 | S1982XS | 21 | 913-914 | ||
| S1254XB | 08 | 551-552 | S14149A | 24 | 963-965 | S1983XA | Pre | 011-013 | ||
| S1254XB | 24 | 963-965 | S14149D | 23 | 949-950 | S1983XA | 21 | 913-914 | ||
| S1254XD | 08 | 559-561 | S14149S | 01 | 052-053 | S1983XA | 24 | 963-965 | ||
| S1254XG | 08 | 559-561 | S14151A | 01 | 052-053 | S1983XD | 23 | 949-950 | ||
| S1254XK | 08 | 564-566 | S14151A | 24 | 963-965 | S1983XS | 21 | 913-914 | ||
| S1254XS | 08 | 551-552 | S14151D | 23 | 949-950 | S1984XA | Pre | 011-013 | ||
| S12550A | 08 | 551-552 | S14151S | 01 | 052-053 | S1984XA | 21 | 913-914 | ||
| S12550A | 24 | 963-965 | S14152A | 01 | 052-053 | S1984XA | 24 | 963-965 | ||
| S12550B | 08 | 551-552 | S14152A | 24 | 963-965 | S1984XD | 23 | 949-950 | ||
| S12550B | 24 | 963-965 | S14152D | 23 | 949-950 | S1984XS | 21 | 913-914 | ||
| S12550D | 08 | 559-561 | S14152S | 01 | 052-053 | S1985XA | Pre | 011-013 | ||
| S12550G | 08 | 559-561 | S14153A | 01 | 052-053 | S1985XA | 21 | 913-914 | ||
| S12550K | 08 | 564-566 | S14153A | 24 | 963-965 | S1985XA | 24 | 963-965 | ||
| S12550S | 08 | 551-552 | S14153D | 23 | 949-950 | S1985XD | 23 | 949-950 | ||
| S12551A | 08 | 551-552 | S14153S | 01 | 052-053 | S1985XS | 21 | 913-914 | ||
| S12551A | 24 | 963-965 | S14154A | 01 | 052-053 | S1989XA | Pre | 011-013 | ||
| S12551B | 08 | 551-552 | S14154A | 24 | 963-965 | S1989XA | 21 | 913-914 | ||
| S12551B | 24 | 963-965 | S14154D | 23 | 949-950 | S1989XA | 24 | 963-965 | ||
| S12551D | 08 | 559-561 | S14154S | 01 | 052-053 | S1989XD | 23 | 949-950 | ||
| S12551G | 08 | 559-561 | S14155A | 01 | 052-053 | S1989XS | 21 | 913-914 | ||
| S12551K | 08 | 564-566 | S14155A | 24 | 963-965 | S199XXA | Pre | 011-013 | ||
| S12551S | 08 | 551-552 | S14155D | 23 | 949-950 | S199XXA | 21 | 913-914 | ||
| S12590A | 08 | 551-552 | S14155S | 01 | 052-053 | S199XXA | 24 | 963-965 | ||
| S12590A | 24 | 963-965 | S14156A | 01 | 052-053 | S199XXD | 23 | 949-950 | ||
| S12590B | 08 | 551-552 | S14156A | 24 | 963-965 | S199XXS | 21 | 913-914 | ||
| S12590B | 24 | 963-965 | S14156D | 23 | 949-950 | S2000XA | 09 | 604-605 | ||
| S12590D | 08 | 559-561 | S14156S | 01 | 052-053 | S2000XA | 24 | 963-965 | ||
| S12590G | 08 | 559-561 | S14157A | 01 | 052-053 | S2000XD | 23 | 949-950 | ||
| S12590K | 08 | 564-566 | S14157A | 24 | 963-965 | S2000XS | 09 | 604-605 | ||
| S12590S | 08 | 551-552 | S14157D | 23 | 949-950 | S2001XA | 09 | 604-605 | ||
| S12591A | 08 | 551-552 | S14157S | 01 | 052-053 | S2001XA | 24 | 963-965 | ||
| S12591A | 24 | 963-965 | S14158A | 01 | 052-053 | S2001XD | 23 | 949-950 | ||
| S12591B | 08 | 551-552 | S14158A | 24 | 963-965 | S2001XS | 09 | 604-605 | ||
| S12591B | 24 | 963-965 | S14158D | 23 | 949-950 | S2002XA | 09 | 604-605 | ||
| S12591D | 08 | 559-561 | S14158S | 01 | 052-053 | S2002XA | 24 | 963-965 | ||
| S12591G | 08 | 559-561 | S14159A | 01 | 052-053 | S2002XD | 23 | 949-950 | ||
| S12591K | 08 | 564-566 | S14159A | 24 | 963-965 | S2002XS | 09 | 604-605 | ||
| S12591S | 08 | 551-552 | S14159D | 23 | 949-950 | S20101A | 09 | 604-605 | ||
| S12600A | 08 | 551-552 | S14159S | 01 | 052-053 | S20101A | 24 | 963-965 | ||
| S12600A | 24 | 963-965 | S142XXA | 01 | 073-074 | S20101D | 23 | 949-950 | ||
| S12600B | 08 | 551-552 | S142XXA | 24 | 963-965 | S20101S | 09 | 604-605 | ||
| S12600B | 24 | 963-965 | S142XXD | 23 | 949-950 | S20102A | 09 | 604-605 | ||
| S12600D | 08 | 559-561 | S142XXS | 01 | 091-093 | S20102A | 24 | 963-965 | ||
| S12600G | 08 | 559-561 | S143XXA | 01 | 073-074 | S20102D | 23 | 949-950 | ||
| S12600K | 08 | 564-566 | S143XXA | 15 | 791 | S20102S | 09 | 604-605 | ||
| S12600S | 08 | 551-552 | S143XXA | 15 | 793 | S20109A | 09 | 604-605 | ||
| S12601A | 08 | 551-552 | S143XXA | 24 | 963-965 | S20109A | 24 | 963-965 | ||
| S12601A | 24 | 963-965 | S143XXD | 23 | 949-950 | S20109D | 23 | 949-950 | ||
| S12601B | 08 | 551-552 | S143XXS | 01 | 091-093 | S20109S | 09 | 604-605 | ||
| S12601B | 24 | 963-965 | S144XXA | 01 | 073-074 | S20111A | 09 | 604-605 | ||
| S12601D | 08 | 559-561 | S144XXA | 24 | 963-965 | S20111A | 24 | 963-965 | ||
| S12601G | 08 | 559-561 | S144XXD | 23 | 949-950 | S20111D | 23 | 949-950 | ||
| S12601K | 08 | 564-566 | S144XXS | 01 | 091-093 | S20111S | 09 | 604-605 | ||
| S12601S | 08 | 551-552 | S145XXA | 01 | 073-074 | S20112A | 09 | 604-605 | ||
| S12630A | 08 | 551-552 | S145XXA | 24 | 963-965 | S20112A | 24 | 963-965 | ||
| S12630A | 24 | 963-965 | S145XXD | 23 | 949-950 | S20112D | 23 | 949-950 | ||
| S12630B | 08 | 551-552 | S145XXS | 01 | 091-093 | S20112S | 09 | 604-605 | ||
| S12630B | 24 | 963-965 | S148XXA | 01 | 073-074 | S20119A | 09 | 604-605 | ||
| S12630D | 08 | 559-561 | S148XXA | 24 | 963-965 | S20119A | 24 | 963-965 | ||
| S12630G | 08 | 559-561 | S148XXD | 23 | 949-950 | S20119D | 23 | 949-950 | ||
| S12630K | 08 | 564-566 | S148XXS | 01 | 091-093 | S20119S | 09 | 604-605 | ||
| S12630S | 08 | 551-552 | S149XXA | 01 | 073-074 | S20121A | 09 | 606-607 | ||
| S12631A | 08 | 551-552 | S149XXA | 24 | 963-965 | S20121A | 24 | 963-965 | ||
| S12631A | 24 | 963-965 | S149XXD | 23 | 949-950 | S20121D | 23 | 949-950 | ||
| S12631B | 08 | 551-552 | S149XXS | 01 | 091-093 | S20121S | 09 | 604-605 | ||
| S12631B | 24 | 963-965 | S15001A | 15 | 791 | S20122A | 09 | 606-607 | ||
| S12631D | 08 | 559-561 | S15001A | 15 | 793 | S20122A | 24 | 963-965 | ||
| S12631G | 08 | 559-561 | S15001A | 21 | 913-914 | S20122D | 23 | 949-950 | ||
| S12631K | 08 | 564-566 | S15001A | 24 | 963-965 | S20122S | 09 | 604-605 | ||
| S12631S | 08 | 551-552 | S15001D | 23 | 949-950 | S20129A | 09 | 606-607 | ||
| S1264XA | 08 | 551-552 | S15001S | 05 | 299-301 | S20129A | 24 | 963-965 | ||
| S1264XA | 24 | 963-965 | S15002A | 15 | 791 | S20129D | 23 | 949-950 | ||
| S1264XB | 08 | 551-552 | S15002A | 15 | 793 | S20129S | 09 | 604-605 | ||
| S1264XB | 24 | 963-965 | S15002A | 21 | 913-914 | S20141A | 09 | 604-605 | ||
| S1264XD | 08 | 559-561 | S15002A | 24 | 963-965 | S20141A | 24 | 963-965 | ||
| S1264XG | 08 | 559-561 | S15002D | 23 | 949-950 | S20141D | 23 | 949-950 | ||
| S1264XK | 08 | 564-566 | S15002S | 05 | 299-301 | S20141S | 09 | 604-605 | ||
| S1264XS | 08 | 551-552 | S15009A | 15 | 791 | S20142A | 09 | 604-605 | ||
| S12650A | 08 | 551-552 | S15009A | 15 | 793 | S20142A | 24 | 963-965 | ||
| S12650A | 24 | 963-965 | S15009A | 21 | 913-914 | S20142D | 23 | 949-950 | ||
| S12650B | 08 | 551-552 | S15009A | 24 | 963-965 | S20142S | 09 | 604-605 | ||
| S12650B | 24 | 963-965 | S15009D | 23 | 949-950 | S20149A | 09 | 604-605 | ||
| S12650D | 08 | 559-561 | S15009S | 05 | 299-301 | S20149A | 24 | 963-965 | ||
| S12650G | 08 | 559-561 | S15011A | 15 | 791 | S20149D | 23 | 949-950 | ||
| S12650K | 08 | 564-566 | S15011A | 15 | 793 | S20149S | 09 | 604-605 | ||
| S12650S | 08 | 551-552 | S15011A | 21 | 913-914 | S20151A | 09 | 604-605 | ||
| S12651A | 08 | 551-552 | S15011A | 24 | 963-965 | S20151A | 24 | 963-965 | ||
| S12651A | 24 | 963-965 | S15011D | 23 | 949-950 | S20151D | 23 | 949-950 | ||
| S12651B | 08 | 551-552 | S15011S | 05 | 299-301 | S20151S | 09 | 604-605 | ||
| S12651B | 24 | 963-965 | S15012A | 15 | 791 | S20152A | 09 | 604-605 | ||
| S12651D | 08 | 559-561 | S15012A | 15 | 793 | S20152A | 24 | 963-965 | ||
| S12651G | 08 | 559-561 | S15012A | 21 | 913-914 | S20152D | 23 | 949-950 | ||
| S12651K | 08 | 564-566 | S15012A | 24 | 963-965 | S20152S | 09 | 604-605 | ||
| S12651S | 08 | 551-552 | S15012D | 23 | 949-950 | S20159A | 09 | 604-605 | ||
| S12690A | 08 | 551-552 | S15012S | 05 | 299-301 | S20159A | 24 | 963-965 | ||
| S12690A | 24 | 963-965 | S15019A | 15 | 791 | S20159D | 23 | 949-950 | ||
| S12690B | 08 | 551-552 | S15019A | 15 | 793 | S20159S | 09 | 604-605 | ||
| S12690B | 24 | 963-965 | S15019A | 21 | 913-914 | S20161A | 09 | 606-607 | ||
| S12690D | 08 | 559-561 | S15019A | 24 | 963-965 | S20161A | 24 | 963-965 | ||
| S12690G | 08 | 559-561 | S15019D | 23 | 949-950 | S20161D | 23 | 949-950 | ||
| S12690K | 08 | 564-566 | S15019S | 05 | 299-301 | S20161S | 09 | 604-605 | ||
| S12690S | 08 | 551-552 | S15021A | 15 | 791 | S20162A | 09 | 606-607 | ||
| S12691A | 08 | 551-552 | S15021A | 15 | 793 | S20162A | 24 | 963-965 | ||
| S12691A | 24 | 963-965 | S15021A | 21 | 913-914 | S20162D | 23 | 949-950 | ||
| S12691B | 08 | 551-552 | S15021A | 24 | 963-965 | S20162S | 09 | 604-605 | ||
| S12691B | 24 | 963-965 | S15021D | 23 | 949-950 | S20169A | 09 | 606-607 | ||
| S12691D | 08 | 559-561 | S15021S | 05 | 299-301 | S20169A | 24 | 963-965 | ||
| S12691G | 08 | 559-561 | S15022A | 15 | 791 | S20169D | 23 | 949-950 | ||
| S12691K | 08 | 564-566 | S15022A | 15 | 793 | S20169S | 09 | 604-605 | ||
| S12691S | 08 | 551-552 | S15022A | 21 | 913-914 | S20171A | 09 | 604-605 | ||
| S128XXA | Pre | 011-013 | S15022A | 24 | 963-965 | S20171A | 24 | 963-965 | ||
| S128XXA | 03 | 154-156 | S15022D | 23 | 949-950 | S20171D | 23 | 949-950 | ||
| S128XXA | 24 | 963-965 | S15022S | 05 | 299-301 | S20171S | 09 | 604-605 | ||
| S128XXD | 08 | 559-561 | S15029A | 15 | 791 | S20172A | 09 | 604-605 | ||
| S128XXS | 08 | 551-552 | S15029A | 15 | 793 | S20172A | 24 | 963-965 | ||
| S129XXA | 08 | 551-552 | S15029A | 21 | 913-914 | S20172D | 23 | 949-950 | ||
| S129XXA | 24 | 963-965 | S15029A | 24 | 963-965 | S20172S | 09 | 604-605 | ||
| S129XXD | 08 | 559-561 | S15029D | 23 | 949-950 | S20179A | 09 | 604-605 | ||
| S129XXS | 08 | 551-552 | S15029S | 05 | 299-301 | S20179A | 24 | 963-965 | ||
| S130XXA | 08 | 551-552 | S15091A | 15 | 791 | S20179D | 23 | 949-950 | ||
| S130XXA | 24 | 963-965 | S15091A | 15 | 793 | S20179S | 09 | 604-605 | ||
| S130XXD | 23 | 949-950 | S15091A | 21 | 913-914 | S2020XA | 09 | 604-605 | ||
| S130XXS | 08 | 562-563 | S15091A | 24 | 963-965 | S2020XA | 24 | 963-965 | ||
| S13100A | 08 | 551-552 | S15091D | 23 | 949-950 | S2020XD | 23 | 949-950 | ||
| S13100A | 24 | 963-965 | S15091S | 05 | 299-301 | S2020XS | 09 | 604-605 | ||
| S13100D | 23 | 949-950 | S15092A | 15 | 791 | S20211A | 09 | 604-605 | ||
| S13100S | 08 | 562-563 | S15092A | 15 | 793 | S20211A | 24 | 963-965 | ||
| S13101A | 08 | 551-552 | S15092A | 21 | 913-914 | S20211D | 23 | 949-950 | ||
| S13101A | 24 | 963-965 | S15092A | 24 | 963-965 | S20211S | 09 | 604-605 | ||
| S13101D | 23 | 949-950 | S15092D | 23 | 949-950 | S20212A | 09 | 604-605 | ||
| S13101S | 08 | 562-563 | S15092S | 05 | 299-301 | S20212A | 24 | 963-965 | ||
| S13110A | 08 | 551-552 | S15099A | 15 | 791 | S20212D | 23 | 949-950 | ||
| S13110A | 24 | 963-965 | S15099A | 15 | 793 | S20212S | 09 | 604-605 | ||
| S13110D | 23 | 949-950 | S15099A | 21 | 913-914 | S20213A | 09 | 604-605 | ||
| S13110S | 08 | 562-563 | S15099A | 24 | 963-965 | S20213A | 24 | 963-965 | ||
| S13111A | 08 | 551-552 | S15099D | 23 | 949-950 | S20213D | 23 | 949-950 | ||
| S13111A | 24 | 963-965 | S15099S | 05 | 299-301 | S20213S | 09 | 604-605 | ||
| S13111D | 23 | 949-950 | S15101A | Pre | 011-013 | S20214A | 09 | 604-605 | ||
| S13111S | 08 | 562-563 | S15101A | 21 | 913-914 | S20214A | 24 | 963-965 | ||
| S13120A | 08 | 551-552 | S15101A | 24 | 963-965 | S20214D | 23 | 949-950 | ||
| S13120A | 24 | 963-965 | S15101D | 23 | 949-950 | S20214S | 09 | 604-605 | ||
| S13120D | 23 | 949-950 | S15101S | 05 | 299-301 | S20219A | 09 | 604-605 | ||
| S13120S | 08 | 562-563 | S15102A | Pre | 011-013 | S20219A | 24 | 963-965 | ||
| S13121A | 08 | 551-552 | S15102A | 21 | 913-914 | S20219D | 23 | 949-950 | ||
| S13121A | 24 | 963-965 | S15102A | 24 | 963-965 | S20219S | 09 | 604-605 | ||
| S13121D | 23 | 949-950 | S15102D | 23 | 949-950 | S20221A | 09 | 604-605 | ||
| S13121S | 08 | 562-563 | S15102S | 05 | 299-301 | S20221A | 24 | 963-965 | ||
| S13130A | 08 | 551-552 | S15109A | Pre | 011-013 | S20221D | 23 | 949-950 | ||
| S13130A | 24 | 963-965 | S15109A | 21 | 913-914 | S20221S | 09 | 604-605 | ||
| S13130D | 23 | 949-950 | S15109A | 24 | 963-965 | S20222A | 09 | 604-605 | ||
| S13130S | 08 | 562-563 | S15109D | 23 | 949-950 | S20222A | 24 | 963-965 | ||
| S13131A | 08 | 551-552 | S15109S | 05 | 299-301 | S20222D | 23 | 949-950 | ||
| S13131A | 24 | 963-965 | S15111A | Pre | 011-013 | S20222S | 09 | 604-605 | ||
| S13131D | 23 | 949-950 | S15111A | 21 | 913-914 | S20223A | 09 | 604-605 | ||
| S13131S | 08 | 562-563 | S15111A | 24 | 963-965 | S20223A | 24 | 963-965 | ||
| S13140A | 08 | 551-552 | S15111D | 23 | 949-950 | S20223D | 23 | 949-950 | ||
| S13140A | 24 | 963-965 | S15111S | 05 | 299-301 | S20223S | 09 | 604-605 | ||
| S13140D | 23 | 949-950 | S15112A | Pre | 011-013 | S20224A | 09 | 604-605 | ||
| S13140S | 08 | 562-563 | S15112A | 21 | 913-914 | S20224A | 24 | 963-965 | ||
| S13141A | 08 | 551-552 | S15112A | 24 | 963-965 | S20224D | 23 | 949-950 | ||
| S13141A | 24 | 963-965 | S15112D | 23 | 949-950 | S20224S | 09 | 604-605 | ||
| S13141D | 23 | 949-950 | S15112S | 05 | 299-301 | S20229A | 09 | 604-605 | ||
| S13141S | 08 | 562-563 | S15119A | Pre | 011-013 | S20229A | 24 | 963-965 | ||
| S13150A | 08 | 551-552 | S15119A | 21 | 913-914 | S20229D | 23 | 949-950 | ||
| S13150A | 24 | 963-965 | S15119A | 24 | 963-965 | S20229S | 09 | 604-605 | ||
| S13150D | 23 | 949-950 | S15119D | 23 | 949-950 | S20301A | 09 | 604-605 | ||
| S13150S | 08 | 562-563 | S15119S | 05 | 299-301 | S20301A | 24 | 963-965 | ||
| S13151A | 08 | 551-552 | S15121A | Pre | 011-013 | S20301D | 23 | 949-950 | ||
| S13151A | 24 | 963-965 | S15121A | 21 | 913-914 | S20301S | 09 | 604-605 | ||
| S13151D | 23 | 949-950 | S15121A | 24 | 963-965 | S20302A | 09 | 604-605 | ||
| S13151S | 08 | 562-563 | S15121D | 23 | 949-950 | S20302A | 24 | 963-965 | ||
| S13160A | 08 | 551-552 | S15121S | 05 | 299-301 | S20302D | 23 | 949-950 | ||
| S13160A | 24 | 963-965 | S15122A | Pre | 011-013 | S20302S | 09 | 604-605 | ||
| S13160D | 23 | 949-950 | S15122A | 21 | 913-914 | S20303A | 09 | 604-605 | ||
| S13160S | 08 | 562-563 | S15122A | 24 | 963-965 | S20303A | 24 | 963-965 | ||
| S13161A | 08 | 551-552 | S15122D | 23 | 949-950 | S20303D | 23 | 949-950 | ||
| S13161A | 24 | 963-965 | S15122S | 05 | 299-301 | S20303S | 09 | 604-605 | ||
| S13161D | 23 | 949-950 | S15129A | Pre | 011-013 | S20304A | 09 | 604-605 | ||
| S13161S | 08 | 562-563 | S15129A | 21 | 913-914 | S20304A | 24 | 963-965 | ||
| S13170A | 08 | 551-552 | S15129A | 24 | 963-965 | S20304D | 23 | 949-950 | ||
| S13170A | 24 | 963-965 | S15129D | 23 | 949-950 | S20304S | 09 | 604-605 | ||
| S13170D | 23 | 949-950 | S15129S | 05 | 299-301 | S20309A | 09 | 604-605 | ||
| S13170S | 08 | 562-563 | S15191A | Pre | 011-013 | S20309A | 24 | 963-965 | ||
| S13171A | 08 | 551-552 | S15191A | 21 | 913-914 | S20309D | 23 | 949-950 | ||
| S13171A | 24 | 963-965 | S15191A | 24 | 963-965 | S20309S | 09 | 604-605 | ||
| S13171D | 23 | 949-950 | S15191D | 23 | 949-950 | S20311A | 09 | 604-605 | ||
| S13171S | 08 | 562-563 | S15191S | 05 | 299-301 | S20311A | 24 | 963-965 | ||
| S13180A | 08 | 551-552 | S15192A | Pre | 011-013 | S20311D | 23 | 949-950 | ||
| S13180A | 24 | 963-965 | S15192A | 21 | 913-914 | S20311S | 09 | 604-605 | ||
| S13180D | 23 | 949-950 | S15192A | 24 | 963-965 | S20312A | 09 | 604-605 | ||
| S13180S | 08 | 562-563 | S15192D | 23 | 949-950 | S20312A | 24 | 963-965 | ||
| S13181A | 08 | 551-552 | S15192S | 05 | 299-301 | S20312D | 23 | 949-950 | ||
| S13181A | 24 | 963-965 | S15199A | Pre | 011-013 | S20312S | 09 | 604-605 | ||
| S13181D | 23 | 949-950 | S15199A | 21 | 913-914 | S20313A | 09 | 604-605 | ||
| S13181S | 08 | 562-563 | S15199A | 24 | 963-965 | S20313A | 24 | 963-965 | ||
| S1320XA | 08 | 551-552 | S15199D | 23 | 949-950 | S20313D | 23 | 949-950 | ||
| S1320XA | 24 | 963-965 | S15199S | 05 | 299-301 | S20313S | 09 | 604-605 | ||
| S1320XD | 23 | 949-950 | S15201A | 15 | 791 | S20314A | 09 | 604-605 | ||
| S1320XS | 08 | 562-563 | S15201A | 15 | 793 | S20314A | 24 | 963-965 | ||
| S1329XA | 08 | 551-552 | S15201A | 21 | 913-914 | S20314D | 23 | 949-950 | ||
| S1329XA | 24 | 963-965 | S15201A | 24 | 963-965 | S20314S | 09 | 604-605 | ||
| S1329XD | 23 | 949-950 | S15201D | 23 | 949-950 | S20319A | 09 | 604-605 | ||
| S1329XS | 08 | 562-563 | S15201S | 05 | 299-301 | S20319A | 24 | 963-965 | ||
| S134XXA | 08 | 551-552 | S15202A | 15 | 791 | S20319D | 23 | 949-950 | ||
| S134XXA | 24 | 963-965 | S15202A | 15 | 793 | S20319S | 09 | 604-605 | ||
| S134XXD | 23 | 949-950 | S15202A | 21 | 913-914 | S20321A | 09 | 606-607 | ||
| S134XXS | 08 | 562-563 | S15202A | 24 | 963-965 | S20321A | 24 | 963-965 | ||
| S135XXA | 08 | 564-566 | S15202D | 23 | 949-950 | S20321D | 23 | 949-950 | ||
| S135XXA | 24 | 963-965 | S15202S | 05 | 299-301 | S20321S | 09 | 604-605 | ||
| S135XXD | 23 | 949-950 | S15209A | 15 | 791 | S20322A | 09 | 606-607 | ||
| S135XXS | 08 | 562-563 | S15209A | 15 | 793 | S20322A | 24 | 963-965 | ||
| S138XXA | 08 | 551-552 | S15209A | 21 | 913-914 | S20322D | 23 | 949-950 | ||
| S138XXA | 24 | 963-965 | S15209A | 24 | 963-965 | S20322S | 09 | 604-605 | ||
| S138XXD | 23 | 949-950 | S15209D | 23 | 949-950 | S20323A | 09 | 606-607 | ||
| S138XXS | 08 | 562-563 | S15209S | 05 | 299-301 | S20323A | 24 | 963-965 | ||
| S139XXA | 08 | 551-552 | S15211A | 15 | 791 | S20323D | 23 | 949-950 | ||
| S139XXA | 24 | 963-965 | S15211A | 15 | 793 | S20323S | 09 | 604-605 | ||
| S139XXD | 23 | 949-950 | S15211A | 21 | 913-914 | S20324A | 09 | 606-607 | ||
| S139XXS | 08 | 562-563 | S15211A | 24 | 963-965 | S20324A | 24 | 963-965 | ||
| S140XXA | 01 | 052-053 | S15211D | 23 | 949-950 | S20324D | 23 | 949-950 | ||
| S140XXA | 24 | 963-965 | S15211S | 05 | 299-301 | S20324S | 09 | 604-605 | ||
| S140XXD | 23 | 949-950 | S15212A | 15 | 791 | S20329A | 09 | 606-607 | ||
| S140XXS | 01 | 052-053 | S15212A | 15 | 793 | S20329A | 24 | 963-965 | ||
| S14101A | 01 | 052-053 | S15212A | 21 | 913-914 | S20329D | 23 | 949-950 | ||
| S14101A | 24 | 963-965 | S15212A | 24 | 963-965 | S20329S | 09 | 604-605 | ||
| S14101D | 23 | 949-950 | S15212D | 23 | 949-950 | S20341A | 09 | 604-605 | ||
| S14101S | 01 | 052-053 | S15212S | 05 | 299-301 | S20341A | 24 | 963-965 | ||
| S14102A | 01 | 052-053 | S15219A | 15 | 791 | S20341D | 23 | 949-950 | ||
| S14102A | 24 | 963-965 | S15219A | 15 | 793 | S20341S | 09 | 604-605 | ||
| S14102D | 23 | 949-950 | S15219A | 21 | 913-914 | S20342A | 09 | 604-605 | ||
| S14102S | 01 | 052-053 | S15219A | 24 | 963-965 | S20342A | 24 | 963-965 | ||
| S14103A | 01 | 052-053 | S15219D | 23 | 949-950 | S20342D | 23 | 949-950 | ||
| S14103A | 24 | 963-965 | S15219S | 05 | 299-301 | S20342S | 09 | 604-605 | ||
| S14103D | 23 | 949-950 | S15221A | 15 | 791 | S20343A | 09 | 604-605 | ||
| S14103S | 01 | 052-053 | S15221A | 15 | 793 | S20343A | 24 | 963-965 | ||
| S14104A | 01 | 052-053 | S15221A | 21 | 913-914 | S20343D | 23 | 949-950 | ||
| S14104A | 24 | 963-965 | S15221A | 24 | 963-965 | S20343S | 09 | 604-605 | ||
| S14104D | 23 | 949-950 | S15221D | 23 | 949-950 | S20344A | 09 | 604-605 | ||
| S14104S | 01 | 052-053 | S15221S | 05 | 299-301 | S20344A | 24 | 963-965 | ||
| S14105A | 01 | 052-053 | S15222A | 15 | 791 | S20344D | 23 | 949-950 | ||
| S14105A | 24 | 963-965 | S15222A | 15 | 793 | S20344S | 09 | 604-605 | ||
| S14105D | 23 | 949-950 | S15222A | 21 | 913-914 | S20349A | 09 | 604-605 | ||
| S14105S | 01 | 052-053 | S15222A | 24 | 963-965 | S20349A | 24 | 963-965 | ||
| S14106A | 01 | 052-053 | S15222D | 23 | 949-950 | S20349D | 23 | 949-950 | ||
| S14106A | 24 | 963-965 | S15222S | 05 | 299-301 | S20349S | 09 | 604-605 | ||
| S14106D | 23 | 949-950 | S15229A | 15 | 791 | S20351A | 09 | 604-605 | ||
| S14106S | 01 | 052-053 | S15229A | 15 | 793 | S20351A | 24 | 963-965 | ||
| S14107A | 01 | 052-053 | S15229A | 21 | 913-914 | S20351D | 23 | 949-950 | ||
| S14107A | 24 | 963-965 | S15229A | 24 | 963-965 | S20351S | 09 | 604-605 | ||
| S14107D | 23 | 949-950 | S15229D | 23 | 949-950 | S20352A | 09 | 604-605 | ||
| S14107S | 01 | 052-053 | S15229S | 05 | 299-301 | S20352A | 24 | 963-965 | ||
| S14108A | 01 | 052-053 | S15291A | 15 | 791 | S20352D | 23 | 949-950 | ||
| S14108A | 24 | 963-965 | S15291A | 15 | 793 | S20352S | 09 | 604-605 | ||
| S14108D | 23 | 949-950 | S15291A | 21 | 913-914 | S20353A | 09 | 604-605 | ||
| S14108S | 01 | 052-053 | S15291A | 24 | 963-965 | S20353A | 24 | 963-965 | ||
| S14109A | 01 | 052-053 | S15291D | 23 | 949-950 | S20353D | 23 | 949-950 | ||
| S14109A | 24 | 963-965 | S15291S | 05 | 299-301 | S20353S | 09 | 604-605 | ||
| S14109D | 23 | 949-950 | S15292A | 15 | 791 | S20354A | 09 | 604-605 | ||
| S14109S | 01 | 052-053 | S15292A | 15 | 793 | S20354A | 24 | 963-965 | ||
| S14111A | 01 | 052-053 | S15292A | 21 | 913-914 | S20354D | 23 | 949-950 | ||
| S14111A | 24 | 963-965 | S15292A | 24 | 963-965 | S20354S | 09 | 604-605 | ||
| S14111D | 23 | 949-950 | S15292D | 23 | 949-950 | S20359A | 09 | 604-605 | ||
| S14111S | 01 | 052-053 | S15292S | 05 | 299-301 | S20359A | 24 | 963-965 | ||
| S14112A | 01 | 052-053 | S15299A | 15 | 791 | S20359D | 23 | 949-950 | ||
| S14112A | 24 | 963-965 | S15299A | 15 | 793 | S20359S | 09 | 604-605 | ||
| S14112D | 23 | 949-950 | S15299A | 21 | 913-914 | S20361A | 09 | 606-607 | ||
| S14112S | 01 | 052-053 | S15299A | 24 | 963-965 | S20361A | 24 | 963-965 | ||
| S14113A | 01 | 052-053 | S15299D | 23 | 949-950 | S20361D | 23 | 949-950 | ||
| S14113A | 24 | 963-965 | S15299S | 05 | 299-301 | S20361S | 09 | 604-605 | ||
| S14113D | 23 | 949-950 | S15301A | 15 | 791 | S20362A | 09 | 606-607 | ||
| S14113S | 01 | 052-053 | S15301A | 15 | 793 | S20362A | 24 | 963-965 | ||
| S14114A | 01 | 052-053 | S15301A | 21 | 913-914 | S20362D | 23 | 949-950 | ||
| S14114A | 24 | 963-965 | S15301A | 24 | 963-965 | S20362S | 09 | 604-605 | ||
| S14114D | 23 | 949-950 | S15301D | 23 | 949-950 | S20363A | 09 | 606-607 | ||
| S14114S | 01 | 052-053 | S15301S | 05 | 299-301 | S20363A | 24 | 963-965 | ||
| S14115A | 01 | 052-053 | S15302A | 15 | 791 | S20363D | 23 | 949-950 | ||
| S14115A | 24 | 963-965 | S15302A | 15 | 793 | S20363S | 09 | 604-605 | ||
| S14115D | 23 | 949-950 | S15302A | 21 | 913-914 | S20364A | 09 | 606-607 | ||
| S14115S | 01 | 052-053 | S15302A | 24 | 963-965 | S20364A | 24 | 963-965 | ||
| S14116A | 01 | 052-053 | S15302D | 23 | 949-950 | S20364D | 23 | 949-950 | ||
| S14116A | 24 | 963-965 | S15302S | 05 | 299-301 | S20364S | 09 | 604-605 | ||
| S14116D | 23 | 949-950 | S15309A | 15 | 791 | S20369A | 09 | 606-607 | ||
| S14116S | 01 | 052-053 | S15309A | 15 | 793 | S20369A | 24 | 963-965 | ||
| S14117A | 01 | 052-053 | S15309A | 21 | 913-914 | S20369D | 23 | 949-950 | ||
| S14117A | 24 | 963-965 | S15309A | 24 | 963-965 | S20369S | 09 | 604-605 | ||
| S14117D | 23 | 949-950 | S15309D | 23 | 949-950 | S20371A | 09 | 604-605 | ||
| S14117S | 01 | 052-053 | S15309S | 05 | 299-301 | S20371A | 24 | 963-965 | ||
| S14118A | 01 | 052-053 | S15311A | 15 | 791 | S20371D | 23 | 949-950 | ||
| S14118A | 24 | 963-965 | S15311A | 15 | 793 | S20371S | 09 | 604-605 | ||
| S14118D | 23 | 949-950 | S15311A | 21 | 913-914 | S20372A | 09 | 604-605 | ||
| S14118S | 01 | 052-053 | S15311A | 24 | 963-965 | S20372A | 24 | 963-965 | ||
| S14119A | 01 | 052-053 | S15311D | 23 | 949-950 | S20372D | 23 | 949-950 | ||
| S14119A | 24 | 963-965 | S15311S | 05 | 299-301 | S20372S | 09 | 604-605 | ||
| S14119D | 23 | 949-950 | S15312A | 15 | 791 | S20373A | 09 | 604-605 | ||
| S14119S | 01 | 052-053 | S15312A | 15 | 793 | S20373A | 24 | 963-965 | ||
| S14121A | 01 | 052-053 | S15312A | 21 | 913-914 | S20373D | 23 | 949-950 | ||
| S14121A | 24 | 963-965 | S15312A | 24 | 963-965 | S20373S | 09 | 604-605 | ||
| S14121D | 23 | 949-950 | S15312D | 23 | 949-950 | S20374A | 09 | 604-605 | ||
| S20374A | 24 | 963-965 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 08 Mar 2024 10:29:37 CMS, code-revision=359, description-revision=1383 |