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 45 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 | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S53421A | 08 | 562-563 | S56115A | 08 | 562-563 | S56819A | 08 | 562-563 | ||
| S53421A | 24 | 963-965 | S56115A | 24 | 963-965 | S56819A | 24 | 963-965 | ||
| S53421D | 23 | 949-950 | S56115D | 23 | 949-950 | S56819D | 23 | 949-950 | ||
| S53421S | 08 | 562-563 | S56115S | 08 | 562-563 | S56819S | 08 | 562-563 | ||
| S53422A | 08 | 562-563 | S56116A | 08 | 562-563 | S56821A | 08 | 564-566 | ||
| S53422A | 24 | 963-965 | S56116A | 24 | 963-965 | S56821A | 24 | 963-965 | ||
| S53422D | 23 | 949-950 | S56116D | 23 | 949-950 | S56821D | 23 | 949-950 | ||
| S53422S | 08 | 562-563 | S56116S | 08 | 562-563 | S56821S | 09 | 604-605 | ||
| S53429A | 08 | 562-563 | S56117A | 08 | 562-563 | S56822A | 08 | 564-566 | ||
| S53429A | 24 | 963-965 | S56117A | 24 | 963-965 | S56822A | 24 | 963-965 | ||
| S53429D | 23 | 949-950 | S56117D | 23 | 949-950 | S56822D | 23 | 949-950 | ||
| S53429S | 08 | 562-563 | S56117S | 08 | 562-563 | S56822S | 09 | 604-605 | ||
| S53431A | 08 | 562-563 | S56118A | 08 | 562-563 | S56829A | 08 | 564-566 | ||
| S53431A | 24 | 963-965 | S56118A | 24 | 963-965 | S56829A | 24 | 963-965 | ||
| S53431D | 23 | 949-950 | S56118D | 23 | 949-950 | S56829D | 23 | 949-950 | ||
| S53431S | 08 | 562-563 | S56118S | 08 | 562-563 | S56829S | 09 | 604-605 | ||
| S53432A | 08 | 562-563 | S56119A | 08 | 562-563 | S56891A | 21 | 913-914 | ||
| S53432A | 24 | 963-965 | S56119A | 24 | 963-965 | S56891A | 24 | 963-965 | ||
| S53432D | 23 | 949-950 | S56119D | 23 | 949-950 | S56891D | 23 | 949-950 | ||
| S53432S | 08 | 562-563 | S56119S | 08 | 562-563 | S56891S | 21 | 913-914 | ||
| S53439A | 08 | 562-563 | S56121A | 08 | 564-566 | S56892A | 21 | 913-914 | ||
| S53439A | 24 | 963-965 | S56121A | 24 | 963-965 | S56892A | 24 | 963-965 | ||
| S53439D | 23 | 949-950 | S56121D | 23 | 949-950 | S56892D | 23 | 949-950 | ||
| S53439S | 08 | 562-563 | S56121S | 09 | 604-605 | S56892S | 21 | 913-914 | ||
| S53441A | 08 | 562-563 | S56122A | 08 | 564-566 | S56899A | 21 | 913-914 | ||
| S53441A | 24 | 963-965 | S56122A | 24 | 963-965 | S56899A | 24 | 963-965 | ||
| S53441D | 23 | 949-950 | S56122D | 23 | 949-950 | S56899D | 23 | 949-950 | ||
| S53441S | 08 | 562-563 | S56122S | 09 | 604-605 | S56899S | 21 | 913-914 | ||
| S53442A | 08 | 562-563 | S56123A | 08 | 564-566 | S56901A | 21 | 913-914 | ||
| S53442A | 24 | 963-965 | S56123A | 24 | 963-965 | S56901A | 24 | 963-965 | ||
| S53442D | 23 | 949-950 | S56123D | 23 | 949-950 | S56901D | 23 | 949-950 | ||
| S53442S | 08 | 562-563 | S56123S | 09 | 604-605 | S56901S | 21 | 913-914 | ||
| S53449A | 08 | 562-563 | S56124A | 08 | 564-566 | S56902A | 21 | 913-914 | ||
| S53449A | 24 | 963-965 | S56124A | 24 | 963-965 | S56902A | 24 | 963-965 | ||
| S53449D | 23 | 949-950 | S56124D | 23 | 949-950 | S56902D | 23 | 949-950 | ||
| S53449S | 08 | 562-563 | S56124S | 09 | 604-605 | S56902S | 21 | 913-914 | ||
| S53491A | 08 | 562-563 | S56125A | 08 | 564-566 | S56909A | 21 | 913-914 | ||
| S53491A | 24 | 963-965 | S56125A | 24 | 963-965 | S56909A | 24 | 963-965 | ||
| S53491D | 23 | 949-950 | S56125D | 23 | 949-950 | S56909D | 23 | 949-950 | ||
| S53491S | 08 | 562-563 | S56125S | 09 | 604-605 | S56909S | 21 | 913-914 | ||
| S53492A | 08 | 562-563 | S56126A | 08 | 564-566 | S56911A | 08 | 562-563 | ||
| S53492A | 24 | 963-965 | S56126A | 24 | 963-965 | S56911A | 24 | 963-965 | ||
| S53492D | 23 | 949-950 | S56126D | 23 | 949-950 | S56911D | 23 | 949-950 | ||
| S53492S | 08 | 562-563 | S56126S | 09 | 604-605 | S56911S | 08 | 562-563 | ||
| S53499A | 08 | 562-563 | S56127A | 08 | 564-566 | S56912A | 08 | 562-563 | ||
| S53499A | 24 | 963-965 | S56127A | 24 | 963-965 | S56912A | 24 | 963-965 | ||
| S53499D | 23 | 949-950 | S56127D | 23 | 949-950 | S56912D | 23 | 949-950 | ||
| S53499S | 08 | 562-563 | S56127S | 09 | 604-605 | S56912S | 08 | 562-563 | ||
| S5400XA | 01 | 073-074 | S56128A | 08 | 564-566 | S56919A | 08 | 562-563 | ||
| S5400XA | 24 | 963-965 | S56128A | 24 | 963-965 | S56919A | 24 | 963-965 | ||
| S5400XD | 23 | 949-950 | S56128D | 23 | 949-950 | S56919D | 23 | 949-950 | ||
| S5400XS | 01 | 091-093 | S56128S | 09 | 604-605 | S56919S | 08 | 562-563 | ||
| S5401XA | 01 | 073-074 | S56129A | 08 | 564-566 | S56921A | 08 | 564-566 | ||
| S5401XA | 24 | 963-965 | S56129A | 24 | 963-965 | S56921A | 24 | 963-965 | ||
| S5401XD | 23 | 949-950 | S56129D | 23 | 949-950 | S56921D | 23 | 949-950 | ||
| S5401XS | 01 | 091-093 | S56129S | 09 | 604-605 | S56921S | 09 | 604-605 | ||
| S5402XA | 01 | 073-074 | S56191A | 21 | 913-914 | S56922A | 08 | 564-566 | ||
| S5402XA | 24 | 963-965 | S56191A | 24 | 963-965 | S56922A | 24 | 963-965 | ||
| S5402XD | 23 | 949-950 | S56191D | 23 | 949-950 | S56922D | 23 | 949-950 | ||
| S5402XS | 01 | 091-093 | S56191S | 21 | 913-914 | S56922S | 09 | 604-605 | ||
| S5410XA | 01 | 073-074 | S56192A | 21 | 913-914 | S56929A | 08 | 564-566 | ||
| S5410XA | 24 | 963-965 | S56192A | 24 | 963-965 | S56929A | 24 | 963-965 | ||
| S5410XD | 23 | 949-950 | S56192D | 23 | 949-950 | S56929D | 23 | 949-950 | ||
| S5410XS | 01 | 091-093 | S56192S | 21 | 913-914 | S56929S | 09 | 604-605 | ||
| S5411XA | 01 | 073-074 | S56193A | 21 | 913-914 | S56991A | 21 | 913-914 | ||
| S5411XA | 24 | 963-965 | S56193A | 24 | 963-965 | S56991A | 24 | 963-965 | ||
| S5411XD | 23 | 949-950 | S56193D | 23 | 949-950 | S56991D | 23 | 949-950 | ||
| S5411XS | 01 | 091-093 | S56193S | 21 | 913-914 | S56991S | 21 | 913-914 | ||
| S5412XA | 01 | 073-074 | S56194A | 21 | 913-914 | S56992A | 21 | 913-914 | ||
| S5412XA | 24 | 963-965 | S56194A | 24 | 963-965 | S56992A | 24 | 963-965 | ||
| S5412XD | 23 | 949-950 | S56194D | 23 | 949-950 | S56992D | 23 | 949-950 | ||
| S5412XS | 01 | 091-093 | S56194S | 21 | 913-914 | S56992S | 21 | 913-914 | ||
| S5420XA | 01 | 073-074 | S56195A | 21 | 913-914 | S56999A | 21 | 913-914 | ||
| S5420XA | 24 | 963-965 | S56195A | 24 | 963-965 | S56999A | 24 | 963-965 | ||
| S5420XD | 23 | 949-950 | S56195D | 23 | 949-950 | S56999D | 23 | 949-950 | ||
| S5420XS | 01 | 091-093 | S56195S | 21 | 913-914 | S56999S | 21 | 913-914 | ||
| S5421XA | 01 | 073-074 | S56196A | 21 | 913-914 | S5700XA | 21 | 913-914 | ||
| S5421XA | 24 | 963-965 | S56196A | 24 | 963-965 | S5700XA | 24 | 963-965 | ||
| S5421XD | 23 | 949-950 | S56196D | 23 | 949-950 | S5700XD | 23 | 949-950 | ||
| S5421XS | 01 | 091-093 | S56196S | 21 | 913-914 | S5700XS | 09 | 604-605 | ||
| S5422XA | 01 | 073-074 | S56197A | 21 | 913-914 | S5701XA | 21 | 913-914 | ||
| S5422XA | 24 | 963-965 | S56197A | 24 | 963-965 | S5701XA | 24 | 963-965 | ||
| S5422XD | 23 | 949-950 | S56197D | 23 | 949-950 | S5701XD | 23 | 949-950 | ||
| S5422XS | 01 | 091-093 | S56197S | 21 | 913-914 | S5701XS | 09 | 604-605 | ||
| S5430XA | 01 | 073-074 | S56198A | 21 | 913-914 | S5702XA | 21 | 913-914 | ||
| S5430XA | 24 | 963-965 | S56198A | 24 | 963-965 | S5702XA | 24 | 963-965 | ||
| S5430XD | 23 | 949-950 | S56198D | 23 | 949-950 | S5702XD | 23 | 949-950 | ||
| S5430XS | 01 | 091-093 | S56198S | 21 | 913-914 | S5702XS | 09 | 604-605 | ||
| S5431XA | 01 | 073-074 | S56199A | 21 | 913-914 | S5780XA | 21 | 913-914 | ||
| S5431XA | 24 | 963-965 | S56199A | 24 | 963-965 | S5780XA | 24 | 963-965 | ||
| S5431XD | 23 | 949-950 | S56199D | 23 | 949-950 | S5780XD | 23 | 949-950 | ||
| S5431XS | 01 | 091-093 | S56199S | 21 | 913-914 | S5780XS | 09 | 604-605 | ||
| S5432XA | 01 | 073-074 | S56201A | 21 | 913-914 | S5781XA | 21 | 913-914 | ||
| S5432XA | 24 | 963-965 | S56201A | 24 | 963-965 | S5781XA | 24 | 963-965 | ||
| S5432XD | 23 | 949-950 | S56201D | 23 | 949-950 | S5781XD | 23 | 949-950 | ||
| S5432XS | 01 | 091-093 | S56201S | 21 | 913-914 | S5781XS | 09 | 604-605 | ||
| S548X1A | 01 | 073-074 | S56202A | 21 | 913-914 | S5782XA | 21 | 913-914 | ||
| S548X1A | 24 | 963-965 | S56202A | 24 | 963-965 | S5782XA | 24 | 963-965 | ||
| S548X1D | 23 | 949-950 | S56202D | 23 | 949-950 | S5782XD | 23 | 949-950 | ||
| S548X1S | 01 | 091-093 | S56202S | 21 | 913-914 | S5782XS | 09 | 604-605 | ||
| S548X2A | 01 | 073-074 | S56209A | 21 | 913-914 | S58011A | 21 | 913-914 | ||
| S548X2A | 24 | 963-965 | S56209A | 24 | 963-965 | S58011A | 24 | 963-965 | ||
| S548X2D | 23 | 949-950 | S56209D | 23 | 949-950 | S58011D | 23 | 949-950 | ||
| S548X2S | 01 | 091-093 | S56209S | 21 | 913-914 | S58011S | 08 | 559-561 | ||
| S548X9A | 01 | 073-074 | S56211A | 08 | 562-563 | S58012A | 21 | 913-914 | ||
| S548X9A | 24 | 963-965 | S56211A | 24 | 963-965 | S58012A | 24 | 963-965 | ||
| S548X9D | 23 | 949-950 | S56211D | 23 | 949-950 | S58012D | 23 | 949-950 | ||
| S548X9S | 01 | 091-093 | S56211S | 08 | 562-563 | S58012S | 08 | 559-561 | ||
| S5490XA | 01 | 073-074 | S56212A | 08 | 562-563 | S58019A | 21 | 913-914 | ||
| S5490XA | 24 | 963-965 | S56212A | 24 | 963-965 | S58019A | 24 | 963-965 | ||
| S5490XD | 23 | 949-950 | S56212D | 23 | 949-950 | S58019D | 23 | 949-950 | ||
| S5490XS | 01 | 091-093 | S56212S | 08 | 562-563 | S58019S | 08 | 559-561 | ||
| S5491XA | 01 | 073-074 | S56219A | 08 | 562-563 | S58021A | 21 | 913-914 | ||
| S5491XA | 24 | 963-965 | S56219A | 24 | 963-965 | S58021A | 24 | 963-965 | ||
| S5491XD | 23 | 949-950 | S56219D | 23 | 949-950 | S58021D | 23 | 949-950 | ||
| S5491XS | 01 | 091-093 | S56219S | 08 | 562-563 | S58021S | 08 | 559-561 | ||
| S5492XA | 01 | 073-074 | S56221A | 08 | 564-566 | S58022A | 21 | 913-914 | ||
| S5492XA | 24 | 963-965 | S56221A | 24 | 963-965 | S58022A | 24 | 963-965 | ||
| S5492XD | 23 | 949-950 | S56221D | 23 | 949-950 | S58022D | 23 | 949-950 | ||
| S5492XS | 01 | 091-093 | S56221S | 09 | 604-605 | S58022S | 08 | 559-561 | ||
| S55001A | 21 | 913-914 | S56222A | 08 | 564-566 | S58029A | 21 | 913-914 | ||
| S55001A | 24 | 963-965 | S56222A | 24 | 963-965 | S58029A | 24 | 963-965 | ||
| S55001D | 23 | 949-950 | S56222D | 23 | 949-950 | S58029D | 23 | 949-950 | ||
| S55001S | 05 | 299-301 | S56222S | 09 | 604-605 | S58029S | 08 | 559-561 | ||
| S55002A | 21 | 913-914 | S56229A | 08 | 564-566 | S58111A | 21 | 913-914 | ||
| S55002A | 24 | 963-965 | S56229A | 24 | 963-965 | S58111A | 24 | 963-965 | ||
| S55002D | 23 | 949-950 | S56229D | 23 | 949-950 | S58111D | 23 | 949-950 | ||
| S55002S | 05 | 299-301 | S56229S | 09 | 604-605 | S58111S | 08 | 559-561 | ||
| S55009A | 21 | 913-914 | S56291A | 21 | 913-914 | S58112A | 21 | 913-914 | ||
| S55009A | 24 | 963-965 | S56291A | 24 | 963-965 | S58112A | 24 | 963-965 | ||
| S55009D | 23 | 949-950 | S56291D | 23 | 949-950 | S58112D | 23 | 949-950 | ||
| S55009S | 05 | 299-301 | S56291S | 21 | 913-914 | S58112S | 08 | 559-561 | ||
| S55011A | 21 | 913-914 | S56292A | 21 | 913-914 | S58119A | 21 | 913-914 | ||
| S55011A | 24 | 963-965 | S56292A | 24 | 963-965 | S58119A | 24 | 963-965 | ||
| S55011D | 23 | 949-950 | S56292D | 23 | 949-950 | S58119D | 23 | 949-950 | ||
| S55011S | 05 | 299-301 | S56292S | 21 | 913-914 | S58119S | 08 | 559-561 | ||
| S55012A | 21 | 913-914 | S56299A | 21 | 913-914 | S58121A | 21 | 913-914 | ||
| S55012A | 24 | 963-965 | S56299A | 24 | 963-965 | S58121A | 24 | 963-965 | ||
| S55012D | 23 | 949-950 | S56299D | 23 | 949-950 | S58121D | 23 | 949-950 | ||
| S55012S | 05 | 299-301 | S56299S | 21 | 913-914 | S58121S | 08 | 559-561 | ||
| S55019A | 21 | 913-914 | S56301A | 21 | 913-914 | S58122A | 21 | 913-914 | ||
| S55019A | 24 | 963-965 | S56301A | 24 | 963-965 | S58122A | 24 | 963-965 | ||
| S55019D | 23 | 949-950 | S56301D | 23 | 949-950 | S58122D | 23 | 949-950 | ||
| S55019S | 05 | 299-301 | S56301S | 21 | 913-914 | S58122S | 08 | 559-561 | ||
| S55091A | 21 | 913-914 | S56302A | 21 | 913-914 | S58129A | 21 | 913-914 | ||
| S55091A | 24 | 963-965 | S56302A | 24 | 963-965 | S58129A | 24 | 963-965 | ||
| S55091D | 23 | 949-950 | S56302D | 23 | 949-950 | S58129D | 23 | 949-950 | ||
| S55091S | 05 | 299-301 | S56302S | 21 | 913-914 | S58129S | 08 | 559-561 | ||
| S55092A | 21 | 913-914 | S56309A | 21 | 913-914 | S58911A | 21 | 913-914 | ||
| S55092A | 24 | 963-965 | S56309A | 24 | 963-965 | S58911A | 24 | 963-965 | ||
| S55092D | 23 | 949-950 | S56309D | 23 | 949-950 | S58911D | 23 | 949-950 | ||
| S55092S | 05 | 299-301 | S56309S | 21 | 913-914 | S58911S | 08 | 559-561 | ||
| S55099A | 21 | 913-914 | S56311A | 08 | 562-563 | S58912A | 21 | 913-914 | ||
| S55099A | 24 | 963-965 | S56311A | 24 | 963-965 | S58912A | 24 | 963-965 | ||
| S55099D | 23 | 949-950 | S56311D | 23 | 949-950 | S58912D | 23 | 949-950 | ||
| S55099S | 05 | 299-301 | S56311S | 08 | 562-563 | S58912S | 08 | 559-561 | ||
| S55101A | 21 | 913-914 | S56312A | 08 | 562-563 | S58919A | 21 | 913-914 | ||
| S55101A | 24 | 963-965 | S56312A | 24 | 963-965 | S58919A | 24 | 963-965 | ||
| S55101D | 23 | 949-950 | S56312D | 23 | 949-950 | S58919D | 23 | 949-950 | ||
| S55101S | 05 | 299-301 | S56312S | 08 | 562-563 | S58919S | 08 | 559-561 | ||
| S55102A | 21 | 913-914 | S56319A | 08 | 562-563 | S58921A | 21 | 913-914 | ||
| S55102A | 24 | 963-965 | S56319A | 24 | 963-965 | S58921A | 24 | 963-965 | ||
| S55102D | 23 | 949-950 | S56319D | 23 | 949-950 | S58921D | 23 | 949-950 | ||
| S55102S | 05 | 299-301 | S56319S | 08 | 562-563 | S58921S | 08 | 559-561 | ||
| S55109A | 21 | 913-914 | S56321A | 08 | 564-566 | S58922A | 21 | 913-914 | ||
| S55109A | 24 | 963-965 | S56321A | 24 | 963-965 | S58922A | 24 | 963-965 | ||
| S55109D | 23 | 949-950 | S56321D | 23 | 949-950 | S58922D | 23 | 949-950 | ||
| S55109S | 05 | 299-301 | S56321S | 09 | 604-605 | S58922S | 08 | 559-561 | ||
| S55111A | 21 | 913-914 | S56322A | 08 | 564-566 | S58929A | 21 | 913-914 | ||
| S55111A | 24 | 963-965 | S56322A | 24 | 963-965 | S58929A | 24 | 963-965 | ||
| S55111D | 23 | 949-950 | S56322D | 23 | 949-950 | S58929D | 23 | 949-950 | ||
| S55111S | 05 | 299-301 | S56322S | 09 | 604-605 | S58929S | 08 | 559-561 | ||
| S55112A | 21 | 913-914 | S56329A | 08 | 564-566 | S59001A | 08 | 562-563 | ||
| S55112A | 24 | 963-965 | S56329A | 24 | 963-965 | S59001A | 24 | 963-965 | ||
| S55112D | 23 | 949-950 | S56329D | 23 | 949-950 | S59001D | 08 | 559-561 | ||
| S55112S | 05 | 299-301 | S56329S | 09 | 604-605 | S59001G | 08 | 559-561 | ||
| S55119A | 21 | 913-914 | S56391A | 21 | 913-914 | S59001K | 08 | 564-566 | ||
| S55119A | 24 | 963-965 | S56391A | 24 | 963-965 | S59001P | 08 | 564-566 | ||
| S55119D | 23 | 949-950 | S56391D | 23 | 949-950 | S59001S | 08 | 559-561 | ||
| S55119S | 05 | 299-301 | S56391S | 21 | 913-914 | S59002A | 08 | 562-563 | ||
| S55191A | 21 | 913-914 | S56392A | 21 | 913-914 | S59002A | 24 | 963-965 | ||
| S55191A | 24 | 963-965 | S56392A | 24 | 963-965 | S59002D | 08 | 559-561 | ||
| S55191D | 23 | 949-950 | S56392D | 23 | 949-950 | S59002G | 08 | 559-561 | ||
| S55191S | 05 | 299-301 | S56392S | 21 | 913-914 | S59002K | 08 | 564-566 | ||
| S55192A | 21 | 913-914 | S56399A | 21 | 913-914 | S59002P | 08 | 564-566 | ||
| S55192A | 24 | 963-965 | S56399A | 24 | 963-965 | S59002S | 08 | 559-561 | ||
| S55192D | 23 | 949-950 | S56399D | 23 | 949-950 | S59009A | 08 | 562-563 | ||
| S55192S | 05 | 299-301 | S56399S | 21 | 913-914 | S59009A | 24 | 963-965 | ||
| S55199A | 21 | 913-914 | S56401A | 21 | 913-914 | S59009D | 08 | 559-561 | ||
| S55199A | 24 | 963-965 | S56401A | 24 | 963-965 | S59009G | 08 | 559-561 | ||
| S55199D | 23 | 949-950 | S56401D | 23 | 949-950 | S59009K | 08 | 564-566 | ||
| S55199S | 05 | 299-301 | S56401S | 21 | 913-914 | S59009P | 08 | 564-566 | ||
| S55201A | 21 | 913-914 | S56402A | 21 | 913-914 | S59009S | 08 | 559-561 | ||
| S55201A | 24 | 963-965 | S56402A | 24 | 963-965 | S59011A | 08 | 562-563 | ||
| S55201D | 23 | 949-950 | S56402D | 23 | 949-950 | S59011A | 24 | 963-965 | ||
| S55201S | 05 | 299-301 | S56402S | 21 | 913-914 | S59011D | 08 | 559-561 | ||
| S55202A | 21 | 913-914 | S56403A | 21 | 913-914 | S59011G | 08 | 559-561 | ||
| S55202A | 24 | 963-965 | S56403A | 24 | 963-965 | S59011K | 08 | 564-566 | ||
| S55202D | 23 | 949-950 | S56403D | 23 | 949-950 | S59011P | 08 | 564-566 | ||
| S55202S | 05 | 299-301 | S56403S | 21 | 913-914 | S59011S | 08 | 559-561 | ||
| S55209A | 21 | 913-914 | S56404A | 21 | 913-914 | S59012A | 08 | 562-563 | ||
| S55209A | 24 | 963-965 | S56404A | 24 | 963-965 | S59012A | 24 | 963-965 | ||
| S55209D | 23 | 949-950 | S56404D | 23 | 949-950 | S59012D | 08 | 559-561 | ||
| S55209S | 05 | 299-301 | S56404S | 21 | 913-914 | S59012G | 08 | 559-561 | ||
| S55211A | 21 | 913-914 | S56405A | 21 | 913-914 | S59012K | 08 | 564-566 | ||
| S55211A | 24 | 963-965 | S56405A | 24 | 963-965 | S59012P | 08 | 564-566 | ||
| S55211D | 23 | 949-950 | S56405D | 23 | 949-950 | S59012S | 08 | 559-561 | ||
| S55211S | 05 | 299-301 | S56405S | 21 | 913-914 | S59019A | 08 | 562-563 | ||
| S55212A | 21 | 913-914 | S56406A | 21 | 913-914 | S59019A | 24 | 963-965 | ||
| S55212A | 24 | 963-965 | S56406A | 24 | 963-965 | S59019D | 08 | 559-561 | ||
| S55212D | 23 | 949-950 | S56406D | 23 | 949-950 | S59019G | 08 | 559-561 | ||
| S55212S | 05 | 299-301 | S56406S | 21 | 913-914 | S59019K | 08 | 564-566 | ||
| S55219A | 21 | 913-914 | S56407A | 21 | 913-914 | S59019P | 08 | 564-566 | ||
| S55219A | 24 | 963-965 | S56407A | 24 | 963-965 | S59019S | 08 | 559-561 | ||
| S55219D | 23 | 949-950 | S56407D | 23 | 949-950 | S59021A | 08 | 562-563 | ||
| S55219S | 05 | 299-301 | S56407S | 21 | 913-914 | S59021A | 24 | 963-965 | ||
| S55291A | 21 | 913-914 | S56408A | 21 | 913-914 | S59021D | 08 | 559-561 | ||
| S55291A | 24 | 963-965 | S56408A | 24 | 963-965 | S59021G | 08 | 559-561 | ||
| S55291D | 23 | 949-950 | S56408D | 23 | 949-950 | S59021K | 08 | 564-566 | ||
| S55291S | 05 | 299-301 | S56408S | 21 | 913-914 | S59021P | 08 | 564-566 | ||
| S55292A | 21 | 913-914 | S56409A | 21 | 913-914 | S59021S | 08 | 559-561 | ||
| S55292A | 24 | 963-965 | S56409A | 24 | 963-965 | S59022A | 08 | 562-563 | ||
| S55292D | 23 | 949-950 | S56409D | 23 | 949-950 | S59022A | 24 | 963-965 | ||
| S55292S | 05 | 299-301 | S56409S | 21 | 913-914 | S59022D | 08 | 559-561 | ||
| S55299A | 21 | 913-914 | S56411A | 08 | 562-563 | S59022G | 08 | 559-561 | ||
| S55299A | 24 | 963-965 | S56411A | 24 | 963-965 | S59022K | 08 | 564-566 | ||
| S55299D | 23 | 949-950 | S56411D | 23 | 949-950 | S59022P | 08 | 564-566 | ||
| S55299S | 05 | 299-301 | S56411S | 08 | 562-563 | S59022S | 08 | 559-561 | ||
| S55801A | 21 | 913-914 | S56412A | 08 | 562-563 | S59029A | 08 | 562-563 | ||
| S55801A | 24 | 963-965 | S56412A | 24 | 963-965 | S59029A | 24 | 963-965 | ||
| S55801D | 23 | 949-950 | S56412D | 23 | 949-950 | S59029D | 08 | 559-561 | ||
| S55801S | 05 | 299-301 | S56412S | 08 | 562-563 | S59029G | 08 | 559-561 | ||
| S55802A | 21 | 913-914 | S56413A | 08 | 562-563 | S59029K | 08 | 564-566 | ||
| S55802A | 24 | 963-965 | S56413A | 24 | 963-965 | S59029P | 08 | 564-566 | ||
| S55802D | 23 | 949-950 | S56413D | 23 | 949-950 | S59029S | 08 | 559-561 | ||
| S55802S | 05 | 299-301 | S56413S | 08 | 562-563 | S59031A | 08 | 562-563 | ||
| S55809A | 21 | 913-914 | S56414A | 08 | 562-563 | S59031A | 24 | 963-965 | ||
| S55809A | 24 | 963-965 | S56414A | 24 | 963-965 | S59031D | 08 | 559-561 | ||
| S55809D | 23 | 949-950 | S56414D | 23 | 949-950 | S59031G | 08 | 559-561 | ||
| S55809S | 05 | 299-301 | S56414S | 08 | 562-563 | S59031K | 08 | 564-566 | ||
| S55811A | 21 | 913-914 | S56415A | 08 | 562-563 | S59031P | 08 | 564-566 | ||
| S55811A | 24 | 963-965 | S56415A | 24 | 963-965 | S59031S | 08 | 559-561 | ||
| S55811D | 23 | 949-950 | S56415D | 23 | 949-950 | S59032A | 08 | 562-563 | ||
| S55811S | 05 | 299-301 | S56415S | 08 | 562-563 | S59032A | 24 | 963-965 | ||
| S55812A | 21 | 913-914 | S56416A | 08 | 562-563 | S59032D | 08 | 559-561 | ||
| S55812A | 24 | 963-965 | S56416A | 24 | 963-965 | S59032G | 08 | 559-561 | ||
| S55812D | 23 | 949-950 | S56416D | 23 | 949-950 | S59032K | 08 | 564-566 | ||
| S55812S | 05 | 299-301 | S56416S | 08 | 562-563 | S59032P | 08 | 564-566 | ||
| S55819A | 21 | 913-914 | S56417A | 08 | 562-563 | S59032S | 08 | 559-561 | ||
| S55819A | 24 | 963-965 | S56417A | 24 | 963-965 | S59039A | 08 | 562-563 | ||
| S55819D | 23 | 949-950 | S56417D | 23 | 949-950 | S59039A | 24 | 963-965 | ||
| S55819S | 05 | 299-301 | S56417S | 08 | 562-563 | S59039D | 08 | 559-561 | ||
| S55891A | 21 | 913-914 | S56418A | 08 | 562-563 | S59039G | 08 | 559-561 | ||
| S55891A | 24 | 963-965 | S56418A | 24 | 963-965 | S59039K | 08 | 564-566 | ||
| S55891D | 23 | 949-950 | S56418D | 23 | 949-950 | S59039P | 08 | 564-566 | ||
| S55891S | 05 | 299-301 | S56418S | 08 | 562-563 | S59039S | 08 | 559-561 | ||
| S55892A | 21 | 913-914 | S56419A | 08 | 562-563 | S59041A | 08 | 562-563 | ||
| S55892A | 24 | 963-965 | S56419A | 24 | 963-965 | S59041A | 24 | 963-965 | ||
| S55892D | 23 | 949-950 | S56419D | 23 | 949-950 | S59041D | 08 | 559-561 | ||
| S55892S | 05 | 299-301 | S56419S | 08 | 562-563 | S59041G | 08 | 559-561 | ||
| S55899A | 21 | 913-914 | S56421A | 08 | 564-566 | S59041K | 08 | 564-566 | ||
| S55899A | 24 | 963-965 | S56421A | 24 | 963-965 | S59041P | 08 | 564-566 | ||
| S55899D | 23 | 949-950 | S56421D | 23 | 949-950 | S59041S | 08 | 559-561 | ||
| S55899S | 05 | 299-301 | S56421S | 09 | 604-605 | S59042A | 08 | 562-563 | ||
| S55901A | 21 | 913-914 | S56422A | 08 | 564-566 | S59042A | 24 | 963-965 | ||
| S55901A | 24 | 963-965 | S56422A | 24 | 963-965 | S59042D | 08 | 559-561 | ||
| S55901D | 23 | 949-950 | S56422D | 23 | 949-950 | S59042G | 08 | 559-561 | ||
| S55901S | 05 | 299-301 | S56422S | 09 | 604-605 | S59042K | 08 | 564-566 | ||
| S55902A | 21 | 913-914 | S56423A | 08 | 564-566 | S59042P | 08 | 564-566 | ||
| S55902A | 24 | 963-965 | S56423A | 24 | 963-965 | S59042S | 08 | 559-561 | ||
| S55902D | 23 | 949-950 | S56423D | 23 | 949-950 | S59049A | 08 | 562-563 | ||
| S55902S | 05 | 299-301 | S56423S | 09 | 604-605 | S59049A | 24 | 963-965 | ||
| S55909A | 21 | 913-914 | S56424A | 08 | 564-566 | S59049D | 08 | 559-561 | ||
| S55909A | 24 | 963-965 | S56424A | 24 | 963-965 | S59049G | 08 | 559-561 | ||
| S55909D | 23 | 949-950 | S56424D | 23 | 949-950 | S59049K | 08 | 564-566 | ||
| S55909S | 05 | 299-301 | S56424S | 09 | 604-605 | S59049P | 08 | 564-566 | ||
| S55911A | 21 | 913-914 | S56425A | 08 | 564-566 | S59049S | 08 | 559-561 | ||
| S55911A | 24 | 963-965 | S56425A | 24 | 963-965 | S59091A | 08 | 562-563 | ||
| S55911D | 23 | 949-950 | S56425D | 23 | 949-950 | S59091A | 24 | 963-965 | ||
| S55911S | 05 | 299-301 | S56425S | 09 | 604-605 | S59091D | 08 | 559-561 | ||
| S55912A | 21 | 913-914 | S56426A | 08 | 564-566 | S59091G | 08 | 559-561 | ||
| S55912A | 24 | 963-965 | S56426A | 24 | 963-965 | S59091K | 08 | 564-566 | ||
| S55912D | 23 | 949-950 | S56426D | 23 | 949-950 | S59091P | 08 | 564-566 | ||
| S55912S | 05 | 299-301 | S56426S | 09 | 604-605 | S59091S | 08 | 559-561 | ||
| S55919A | 21 | 913-914 | S56427A | 08 | 564-566 | S59092A | 08 | 562-563 | ||
| S55919A | 24 | 963-965 | S56427A | 24 | 963-965 | S59092A | 24 | 963-965 | ||
| S55919D | 23 | 949-950 | S56427D | 23 | 949-950 | S59092D | 08 | 559-561 | ||
| S55919S | 05 | 299-301 | S56427S | 09 | 604-605 | S59092G | 08 | 559-561 | ||
| S55991A | 21 | 913-914 | S56428A | 08 | 564-566 | S59092K | 08 | 564-566 | ||
| S55991A | 24 | 963-965 | S56428A | 24 | 963-965 | S59092P | 08 | 564-566 | ||
| S55991D | 23 | 949-950 | S56428D | 23 | 949-950 | S59092S | 08 | 559-561 | ||
| S55991S | 05 | 299-301 | S56428S | 09 | 604-605 | S59099A | 08 | 562-563 | ||
| S55992A | 21 | 913-914 | S56429A | 08 | 564-566 | S59099A | 24 | 963-965 | ||
| S55992A | 24 | 963-965 | S56429A | 24 | 963-965 | S59099D | 08 | 559-561 | ||
| S55992D | 23 | 949-950 | S56429D | 23 | 949-950 | S59099G | 08 | 559-561 | ||
| S55992S | 05 | 299-301 | S56429S | 09 | 604-605 | S59099K | 08 | 564-566 | ||
| S55999A | 21 | 913-914 | S56491A | 21 | 913-914 | S59099P | 08 | 564-566 | ||
| S55999A | 24 | 963-965 | S56491A | 24 | 963-965 | S59099S | 08 | 559-561 | ||
| S55999D | 23 | 949-950 | S56491D | 23 | 949-950 | S59101A | 08 | 562-563 | ||
| S55999S | 05 | 299-301 | S56491S | 21 | 913-914 | S59101A | 24 | 963-965 | ||
| S56001A | 21 | 913-914 | S56492A | 21 | 913-914 | S59101D | 08 | 559-561 | ||
| S56001A | 24 | 963-965 | S56492A | 24 | 963-965 | S59101G | 08 | 559-561 | ||
| S56001D | 23 | 949-950 | S56492D | 23 | 949-950 | S59101K | 08 | 564-566 | ||
| S56001S | 21 | 913-914 | S56492S | 21 | 913-914 | S59101P | 08 | 564-566 | ||
| S56002A | 21 | 913-914 | S56493A | 21 | 913-914 | S59101S | 08 | 559-561 | ||
| S56002A | 24 | 963-965 | S56493A | 24 | 963-965 | S59102A | 08 | 562-563 | ||
| S56002D | 23 | 949-950 | S56493D | 23 | 949-950 | S59102A | 24 | 963-965 | ||
| S56002S | 21 | 913-914 | S56493S | 21 | 913-914 | S59102D | 08 | 559-561 | ||
| S56009A | 21 | 913-914 | S56494A | 21 | 913-914 | S59102G | 08 | 559-561 | ||
| S56009A | 24 | 963-965 | S56494A | 24 | 963-965 | S59102K | 08 | 564-566 | ||
| S56009D | 23 | 949-950 | S56494D | 23 | 949-950 | S59102P | 08 | 564-566 | ||
| S56009S | 21 | 913-914 | S56494S | 21 | 913-914 | S59102S | 08 | 559-561 | ||
| S56011A | 08 | 562-563 | S56495A | 21 | 913-914 | S59109A | 08 | 562-563 | ||
| S56011A | 24 | 963-965 | S56495A | 24 | 963-965 | S59109A | 24 | 963-965 | ||
| S56011D | 23 | 949-950 | S56495D | 23 | 949-950 | S59109D | 08 | 559-561 | ||
| S56011S | 08 | 562-563 | S56495S | 21 | 913-914 | S59109G | 08 | 559-561 | ||
| S56012A | 08 | 562-563 | S56496A | 21 | 913-914 | S59109K | 08 | 564-566 | ||
| S56012A | 24 | 963-965 | S56496A | 24 | 963-965 | S59109P | 08 | 564-566 | ||
| S56012D | 23 | 949-950 | S56496D | 23 | 949-950 | S59109S | 08 | 559-561 | ||
| S56012S | 08 | 562-563 | S56496S | 21 | 913-914 | S59111A | 08 | 562-563 | ||
| S56019A | 08 | 562-563 | S56497A | 21 | 913-914 | S59111A | 24 | 963-965 | ||
| S56019A | 24 | 963-965 | S56497A | 24 | 963-965 | S59111D | 08 | 559-561 | ||
| S56019D | 23 | 949-950 | S56497D | 23 | 949-950 | S59111G | 08 | 559-561 | ||
| S56019S | 08 | 562-563 | S56497S | 21 | 913-914 | S59111K | 08 | 564-566 | ||
| S56021A | 08 | 564-566 | S56498A | 21 | 913-914 | S59111P | 08 | 564-566 | ||
| S56021A | 24 | 963-965 | S56498A | 24 | 963-965 | S59111S | 08 | 559-561 | ||
| S56021D | 23 | 949-950 | S56498D | 23 | 949-950 | S59112A | 08 | 562-563 | ||
| S56021S | 09 | 604-605 | S56498S | 21 | 913-914 | S59112A | 24 | 963-965 | ||
| S56022A | 08 | 564-566 | S56499A | 21 | 913-914 | S59112D | 08 | 559-561 | ||
| S56022A | 24 | 963-965 | S56499A | 24 | 963-965 | S59112G | 08 | 559-561 | ||
| S56022D | 23 | 949-950 | S56499D | 23 | 949-950 | S59112K | 08 | 564-566 | ||
| S56022S | 09 | 604-605 | S56499S | 21 | 913-914 | S59112P | 08 | 564-566 | ||
| S56029A | 08 | 564-566 | S56501A | 21 | 913-914 | S59112S | 08 | 559-561 | ||
| S56029A | 24 | 963-965 | S56501A | 24 | 963-965 | S59119A | 08 | 562-563 | ||
| S56029D | 23 | 949-950 | S56501D | 23 | 949-950 | S59119A | 24 | 963-965 | ||
| S56029S | 09 | 604-605 | S56501S | 21 | 913-914 | S59119D | 08 | 559-561 | ||
| S56091A | 21 | 913-914 | S56502A | 21 | 913-914 | S59119G | 08 | 559-561 | ||
| S56091A | 24 | 963-965 | S56502A | 24 | 963-965 | S59119K | 08 | 564-566 | ||
| S56091D | 23 | 949-950 | S56502D | 23 | 949-950 | S59119P | 08 | 564-566 | ||
| S56091S | 21 | 913-914 | S56502S | 21 | 913-914 | S59119S | 08 | 559-561 | ||
| S56092A | 21 | 913-914 | S56509A | 21 | 913-914 | S59121A | 08 | 562-563 | ||
| S56092A | 24 | 963-965 | S56509A | 24 | 963-965 | S59121A | 24 | 963-965 | ||
| S56092D | 23 | 949-950 | S56509D | 23 | 949-950 | S59121D | 08 | 559-561 | ||
| S56092S | 21 | 913-914 | S56509S | 21 | 913-914 | S59121G | 08 | 559-561 | ||
| S56099A | 21 | 913-914 | S56511A | 08 | 562-563 | S59121K | 08 | 564-566 | ||
| S56099A | 24 | 963-965 | S56511A | 24 | 963-965 | S59121P | 08 | 564-566 | ||
| S56099D | 23 | 949-950 | S56511D | 23 | 949-950 | S59121S | 08 | 559-561 | ||
| S56099S | 21 | 913-914 | S56511S | 08 | 562-563 | S59122A | 08 | 562-563 | ||
| S56101A | 21 | 913-914 | S56512A | 08 | 562-563 | S59122A | 24 | 963-965 | ||
| S56101A | 24 | 963-965 | S56512A | 24 | 963-965 | S59122D | 08 | 559-561 | ||
| S56101D | 23 | 949-950 | S56512D | 23 | 949-950 | S59122G | 08 | 559-561 | ||
| S56101S | 21 | 913-914 | S56512S | 08 | 562-563 | S59122K | 08 | 564-566 | ||
| S56102A | 21 | 913-914 | S56519A | 08 | 562-563 | S59122P | 08 | 564-566 | ||
| S56102A | 24 | 963-965 | S56519A | 24 | 963-965 | S59122S | 08 | 559-561 | ||
| S56102D | 23 | 949-950 | S56519D | 23 | 949-950 | S59129A | 08 | 562-563 | ||
| S56102S | 21 | 913-914 | S56519S | 08 | 562-563 | S59129A | 24 | 963-965 | ||
| S56103A | 21 | 913-914 | S56521A | 08 | 564-566 | S59129D | 08 | 559-561 | ||
| S56103A | 24 | 963-965 | S56521A | 24 | 963-965 | S59129G | 08 | 559-561 | ||
| S56103D | 23 | 949-950 | S56521D | 23 | 949-950 | S59129K | 08 | 564-566 | ||
| S56103S | 21 | 913-914 | S56521S | 09 | 604-605 | S59129P | 08 | 564-566 | ||
| S56104A | 21 | 913-914 | S56522A | 08 | 564-566 | S59129S | 08 | 559-561 | ||
| S56104A | 24 | 963-965 | S56522A | 24 | 963-965 | S59131A | 08 | 562-563 | ||
| S56104D | 23 | 949-950 | S56522D | 23 | 949-950 | S59131A | 24 | 963-965 | ||
| S56104S | 21 | 913-914 | S56522S | 09 | 604-605 | S59131D | 08 | 559-561 | ||
| S56105A | 21 | 913-914 | S56529A | 08 | 564-566 | S59131G | 08 | 559-561 | ||
| S56105A | 24 | 963-965 | S56529A | 24 | 963-965 | S59131K | 08 | 564-566 | ||
| S56105D | 23 | 949-950 | S56529D | 23 | 949-950 | S59131P | 08 | 564-566 | ||
| S56105S | 21 | 913-914 | S56529S | 09 | 604-605 | S59131S | 08 | 559-561 | ||
| S56106A | 21 | 913-914 | S56591A | 21 | 913-914 | S59132A | 08 | 562-563 | ||
| S56106A | 24 | 963-965 | S56591A | 24 | 963-965 | S59132A | 24 | 963-965 | ||
| S56106D | 23 | 949-950 | S56591D | 23 | 949-950 | S59132D | 08 | 559-561 | ||
| S56106S | 21 | 913-914 | S56591S | 21 | 913-914 | S59132G | 08 | 559-561 | ||
| S56107A | 21 | 913-914 | S56592A | 21 | 913-914 | S59132K | 08 | 564-566 | ||
| S56107A | 24 | 963-965 | S56592A | 24 | 963-965 | S59132P | 08 | 564-566 | ||
| S56107D | 23 | 949-950 | S56592D | 23 | 949-950 | S59132S | 08 | 559-561 | ||
| S56107S | 21 | 913-914 | S56592S | 21 | 913-914 | S59139A | 08 | 562-563 | ||
| S56108A | 21 | 913-914 | S56599A | 21 | 913-914 | S59139A | 24 | 963-965 | ||
| S56108A | 24 | 963-965 | S56599A | 24 | 963-965 | S59139D | 08 | 559-561 | ||
| S56108D | 23 | 949-950 | S56599D | 23 | 949-950 | S59139G | 08 | 559-561 | ||
| S56108S | 21 | 913-914 | S56599S | 21 | 913-914 | S59139K | 08 | 564-566 | ||
| S56109A | 21 | 913-914 | S56801A | 21 | 913-914 | S59139P | 08 | 564-566 | ||
| S56109A | 24 | 963-965 | S56801A | 24 | 963-965 | S59139S | 08 | 559-561 | ||
| S56109D | 23 | 949-950 | S56801D | 23 | 949-950 | S59141A | 08 | 562-563 | ||
| S56109S | 21 | 913-914 | S56801S | 21 | 913-914 | S59141A | 24 | 963-965 | ||
| S56111A | 08 | 562-563 | S56802A | 21 | 913-914 | S59141D | 08 | 559-561 | ||
| S56111A | 24 | 963-965 | S56802A | 24 | 963-965 | S59141G | 08 | 559-561 | ||
| S56111D | 23 | 949-950 | S56802D | 23 | 949-950 | S59141K | 08 | 564-566 | ||
| S56111S | 08 | 562-563 | S56802S | 21 | 913-914 | S59141P | 08 | 564-566 | ||
| S56112A | 08 | 562-563 | S56809A | 21 | 913-914 | S59141S | 08 | 559-561 | ||
| S56112A | 24 | 963-965 | S56809A | 24 | 963-965 | S59142A | 08 | 562-563 | ||
| S56112D | 23 | 949-950 | S56809D | 23 | 949-950 | S59142A | 24 | 963-965 | ||
| S56112S | 08 | 562-563 | S56809S | 21 | 913-914 | S59142D | 08 | 559-561 | ||
| S56113A | 08 | 562-563 | S56811A | 08 | 562-563 | S59142G | 08 | 559-561 | ||
| S56113A | 24 | 963-965 | S56811A | 24 | 963-965 | S59142K | 08 | 564-566 | ||
| S56113D | 23 | 949-950 | S56811D | 23 | 949-950 | S59142P | 08 | 564-566 | ||
| S56113S | 08 | 562-563 | S56811S | 08 | 562-563 | S59142S | 08 | 559-561 | ||
| S56114A | 08 | 562-563 | S56812A | 08 | 562-563 | S59149A | 08 | 562-563 | ||
| S56114A | 24 | 963-965 | S56812A | 24 | 963-965 | S59149A | 24 | 963-965 | ||
| S56114D | 23 | 949-950 | S56812D | 23 | 949-950 | S59149D | 08 | 559-561 | ||
| S56114S | 08 | 562-563 | S56812S | 08 | 562-563 | S59149G | 08 | 559-561 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 08 Mar 2024 10:29:37 CMS, code-revision=359, description-revision=1383 |