ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual
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ICD-10-CM/PCS MS-DRG v42.0 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 34 of 75 |
| A000 B2781 C5712 C8395 D107 E083542 E1301 F13259 G543 H16041 H4303 H8393 I63541 I97610 K4020 L0882 M00239 M19072 M314 M6519 M84311S M84759P M96830 N8501 O2990 O35GXX1 O4192X9 O99845 Q51818 R502 S02118D S06319D S1192XA S15399D S22082B S30823D S32309A S35221D S39002D S42261D S43202A S4991XA S52201Q S52345P S52699N S56909D S60929A S62136P S62390B S63208D S65500D S68619D S72043S S72133F S72355A S7291XC S80211S S82132R S82399Q S82854P S85801A S90821D S92153B S93103D S99032A T2161XA T23661D T3371XA T40903A T457X5D T50B15D T632X3D T8112XD T8454XD Z4801 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S15399D | 23 | 949-950 | S20429D | 23 | 949-950 | S21429D | 23 | 949-950 | ||
| S15399S | 05 | 299-301 | S20429S | 09 | 604-605 | S21429S | 09 | 604-605 | ||
| S158XXA | Pre | 011-013 | S20441A | 09 | 604-605 | S21431A | 21 | 913-914 | ||
| S158XXA | 21 | 913-914 | S20441A | 24 | 963-965 | S21431A | 24 | 963-965 | ||
| S158XXA | 24 | 963-965 | S20441D | 23 | 949-950 | S21431D | 23 | 949-950 | ||
| S158XXD | 23 | 949-950 | S20441S | 09 | 604-605 | S21431S | 09 | 604-605 | ||
| S158XXS | 05 | 299-301 | S20442A | 09 | 604-605 | S21432A | 21 | 913-914 | ||
| S159XXA | Pre | 011-013 | S20442A | 24 | 963-965 | S21432A | 24 | 963-965 | ||
| S159XXA | 21 | 913-914 | S20442D | 23 | 949-950 | S21432D | 23 | 949-950 | ||
| S159XXA | 24 | 963-965 | S20442S | 09 | 604-605 | S21432S | 09 | 604-605 | ||
| S159XXD | 23 | 949-950 | S20449A | 09 | 604-605 | S21439A | 21 | 913-914 | ||
| S159XXS | 05 | 299-301 | S20449A | 24 | 963-965 | S21439A | 24 | 963-965 | ||
| S161XXA | 08 | 551-552 | S20449D | 23 | 949-950 | S21439D | 23 | 949-950 | ||
| S161XXA | 24 | 963-965 | S20449S | 09 | 604-605 | S21439S | 09 | 604-605 | ||
| S161XXD | 23 | 949-950 | S20451A | 09 | 604-605 | S21441A | 21 | 913-914 | ||
| S161XXS | 08 | 562-563 | S20451A | 24 | 963-965 | S21441A | 24 | 963-965 | ||
| S162XXA | Pre | 011-013 | S20451D | 23 | 949-950 | S21441D | 23 | 949-950 | ||
| S162XXA | 09 | 604-605 | S20451S | 09 | 604-605 | S21441S | 09 | 604-605 | ||
| S162XXA | 24 | 963-965 | S20452A | 09 | 604-605 | S21442A | 21 | 913-914 | ||
| S162XXD | 23 | 949-950 | S20452A | 24 | 963-965 | S21442A | 24 | 963-965 | ||
| S162XXS | 09 | 604-605 | S20452D | 23 | 949-950 | S21442D | 23 | 949-950 | ||
| S168XXA | Pre | 011-013 | S20452S | 09 | 604-605 | S21442S | 09 | 604-605 | ||
| S168XXA | 21 | 913-914 | S20459A | 09 | 604-605 | S21449A | 21 | 913-914 | ||
| S168XXA | 24 | 963-965 | S20459A | 24 | 963-965 | S21449A | 24 | 963-965 | ||
| S168XXD | 23 | 949-950 | S20459D | 23 | 949-950 | S21449D | 23 | 949-950 | ||
| S168XXS | 21 | 913-914 | S20459S | 09 | 604-605 | S21449S | 09 | 604-605 | ||
| S169XXA | Pre | 011-013 | S20461A | 09 | 606-607 | S21451A | 21 | 913-914 | ||
| S169XXA | 21 | 913-914 | S20461A | 24 | 963-965 | S21451A | 24 | 963-965 | ||
| S169XXA | 24 | 963-965 | S20461D | 23 | 949-950 | S21451D | 23 | 949-950 | ||
| S169XXD | 23 | 949-950 | S20461S | 09 | 604-605 | S21451S | 09 | 604-605 | ||
| S169XXS | 21 | 913-914 | S20462A | 09 | 606-607 | S21452A | 21 | 913-914 | ||
| S170XXA | Pre | 011-013 | S20462A | 24 | 963-965 | S21452A | 24 | 963-965 | ||
| S170XXA | 21 | 913-914 | S20462D | 23 | 949-950 | S21452D | 23 | 949-950 | ||
| S170XXA | 24 | 963-965 | S20462S | 09 | 604-605 | S21452S | 09 | 604-605 | ||
| S170XXD | 23 | 949-950 | S20469A | 09 | 606-607 | S21459A | 21 | 913-914 | ||
| S170XXS | 09 | 604-605 | S20469A | 24 | 963-965 | S21459A | 24 | 963-965 | ||
| S178XXA | Pre | 011-013 | S20469D | 23 | 949-950 | S21459D | 23 | 949-950 | ||
| S178XXA | 21 | 913-914 | S20469S | 09 | 604-605 | S21459S | 09 | 604-605 | ||
| S178XXA | 24 | 963-965 | S20471A | 09 | 604-605 | S2190XA | 09 | 604-605 | ||
| S178XXD | 23 | 949-950 | S20471A | 24 | 963-965 | S2190XA | 24 | 963-965 | ||
| S178XXS | 09 | 604-605 | S20471D | 23 | 949-950 | S2190XD | 23 | 949-950 | ||
| S179XXA | Pre | 011-013 | S20471S | 09 | 604-605 | S2190XS | 09 | 604-605 | ||
| S179XXA | 21 | 913-914 | S20472A | 09 | 604-605 | S2191XA | 09 | 604-605 | ||
| S179XXA | 24 | 963-965 | S20472A | 24 | 963-965 | S2191XA | 24 | 963-965 | ||
| S179XXD | 23 | 949-950 | S20472D | 23 | 949-950 | S2191XD | 23 | 949-950 | ||
| S179XXS | 09 | 604-605 | S20472S | 09 | 604-605 | S2191XS | 09 | 604-605 | ||
| S1980XA | Pre | 011-013 | S20479A | 09 | 604-605 | S2192XA | 21 | 913-914 | ||
| S1980XA | 21 | 913-914 | S20479A | 24 | 963-965 | S2192XA | 24 | 963-965 | ||
| S1980XA | 24 | 963-965 | S20479D | 23 | 949-950 | S2192XD | 23 | 949-950 | ||
| S1980XD | 23 | 949-950 | S20479S | 09 | 604-605 | S2192XS | 09 | 604-605 | ||
| S1980XS | 21 | 913-914 | S2090XA | 09 | 604-605 | S2193XA | 09 | 604-605 | ||
| S1981XA | Pre | 011-013 | S2090XA | 24 | 963-965 | S2193XA | 24 | 963-965 | ||
| S1981XA | 21 | 913-914 | S2090XD | 23 | 949-950 | S2193XD | 23 | 949-950 | ||
| S1981XA | 24 | 963-965 | S2090XS | 09 | 604-605 | S2193XS | 09 | 604-605 | ||
| S1981XD | 23 | 949-950 | S2091XA | 09 | 604-605 | S2194XA | 21 | 913-914 | ||
| S1981XS | 21 | 913-914 | S2091XA | 24 | 963-965 | S2194XA | 24 | 963-965 | ||
| S1982XA | Pre | 011-013 | S2091XD | 23 | 949-950 | S2194XD | 23 | 949-950 | ||
| S1982XA | 21 | 913-914 | S2091XS | 09 | 604-605 | S2194XS | 09 | 604-605 | ||
| S1982XA | 24 | 963-965 | S2092XA | 09 | 606-607 | S2195XA | 09 | 604-605 | ||
| S1982XD | 23 | 949-950 | S2092XA | 24 | 963-965 | S2195XA | 24 | 963-965 | ||
| S1982XS | 21 | 913-914 | S2092XD | 23 | 949-950 | S2195XD | 23 | 949-950 | ||
| S1983XA | Pre | 011-013 | S2092XS | 09 | 604-605 | S2195XS | 09 | 604-605 | ||
| S1983XA | 21 | 913-914 | S2094XA | 09 | 604-605 | S22000A | 08 | 551-552 | ||
| S1983XA | 24 | 963-965 | S2094XA | 24 | 963-965 | S22000A | 24 | 963-965 | ||
| S1983XD | 23 | 949-950 | S2094XD | 23 | 949-950 | S22000B | 08 | 551-552 | ||
| S1983XS | 21 | 913-914 | S2094XS | 09 | 604-605 | S22000B | 24 | 963-965 | ||
| S1984XA | Pre | 011-013 | S2095XA | 09 | 604-605 | S22000D | 08 | 559-561 | ||
| S1984XA | 21 | 913-914 | S2095XA | 24 | 963-965 | S22000G | 08 | 559-561 | ||
| S1984XA | 24 | 963-965 | S2095XD | 23 | 949-950 | S22000K | 08 | 564-566 | ||
| S1984XD | 23 | 949-950 | S2095XS | 09 | 604-605 | S22000S | 08 | 551-552 | ||
| S1984XS | 21 | 913-914 | S2096XA | 09 | 606-607 | S22001A | 08 | 551-552 | ||
| S1985XA | Pre | 011-013 | S2096XA | 24 | 963-965 | S22001A | 24 | 963-965 | ||
| S1985XA | 21 | 913-914 | S2096XD | 23 | 949-950 | S22001B | 08 | 551-552 | ||
| S1985XA | 24 | 963-965 | S2096XS | 09 | 604-605 | S22001B | 24 | 963-965 | ||
| S1985XD | 23 | 949-950 | S2097XA | 09 | 604-605 | S22001D | 08 | 559-561 | ||
| S1985XS | 21 | 913-914 | S2097XA | 24 | 963-965 | S22001G | 08 | 559-561 | ||
| S1989XA | Pre | 011-013 | S2097XD | 23 | 949-950 | S22001K | 08 | 564-566 | ||
| S1989XA | 21 | 913-914 | S2097XS | 09 | 604-605 | S22001S | 08 | 551-552 | ||
| S1989XA | 24 | 963-965 | S21001A | 09 | 604-605 | S22002A | 08 | 551-552 | ||
| S1989XD | 23 | 949-950 | S21001A | 24 | 963-965 | S22002A | 24 | 963-965 | ||
| S1989XS | 21 | 913-914 | S21001D | 23 | 949-950 | S22002B | 08 | 551-552 | ||
| S199XXA | Pre | 011-013 | S21001S | 09 | 604-605 | S22002B | 24 | 963-965 | ||
| S199XXA | 21 | 913-914 | S21002A | 09 | 604-605 | S22002D | 08 | 559-561 | ||
| S199XXA | 24 | 963-965 | S21002A | 24 | 963-965 | S22002G | 08 | 559-561 | ||
| S199XXD | 23 | 949-950 | S21002D | 23 | 949-950 | S22002K | 08 | 564-566 | ||
| S199XXS | 21 | 913-914 | S21002S | 09 | 604-605 | S22002S | 08 | 551-552 | ||
| S2000XA | 09 | 604-605 | S21009A | 09 | 604-605 | S22008A | 08 | 551-552 | ||
| S2000XA | 24 | 963-965 | S21009A | 24 | 963-965 | S22008A | 24 | 963-965 | ||
| S2000XD | 23 | 949-950 | S21009D | 23 | 949-950 | S22008B | 08 | 551-552 | ||
| S2000XS | 09 | 604-605 | S21009S | 09 | 604-605 | S22008B | 24 | 963-965 | ||
| S2001XA | 09 | 604-605 | S21011A | 09 | 604-605 | S22008D | 08 | 559-561 | ||
| S2001XA | 24 | 963-965 | S21011A | 24 | 963-965 | S22008G | 08 | 559-561 | ||
| S2001XD | 23 | 949-950 | S21011D | 23 | 949-950 | S22008K | 08 | 564-566 | ||
| S2001XS | 09 | 604-605 | S21011S | 09 | 604-605 | S22008S | 08 | 551-552 | ||
| S2002XA | 09 | 604-605 | S21012A | 09 | 604-605 | S22009A | 08 | 551-552 | ||
| S2002XA | 24 | 963-965 | S21012A | 24 | 963-965 | S22009A | 24 | 963-965 | ||
| S2002XD | 23 | 949-950 | S21012D | 23 | 949-950 | S22009B | 08 | 551-552 | ||
| S2002XS | 09 | 604-605 | S21012S | 09 | 604-605 | S22009B | 24 | 963-965 | ||
| S20101A | 09 | 604-605 | S21019A | 09 | 604-605 | S22009D | 08 | 559-561 | ||
| S20101A | 24 | 963-965 | S21019A | 24 | 963-965 | S22009G | 08 | 559-561 | ||
| S20101D | 23 | 949-950 | S21019D | 23 | 949-950 | S22009K | 08 | 564-566 | ||
| S20101S | 09 | 604-605 | S21019S | 09 | 604-605 | S22009S | 08 | 551-552 | ||
| S20102A | 09 | 604-605 | S21021A | 09 | 604-605 | S22010A | 08 | 551-552 | ||
| S20102A | 24 | 963-965 | S21021A | 24 | 963-965 | S22010A | 24 | 963-965 | ||
| S20102D | 23 | 949-950 | S21021D | 23 | 949-950 | S22010B | 08 | 551-552 | ||
| S20102S | 09 | 604-605 | S21021S | 09 | 604-605 | S22010B | 24 | 963-965 | ||
| S20109A | 09 | 604-605 | S21022A | 09 | 604-605 | S22010D | 08 | 559-561 | ||
| S20109A | 24 | 963-965 | S21022A | 24 | 963-965 | S22010G | 08 | 559-561 | ||
| S20109D | 23 | 949-950 | S21022D | 23 | 949-950 | S22010K | 08 | 564-566 | ||
| S20109S | 09 | 604-605 | S21022S | 09 | 604-605 | S22010S | 08 | 551-552 | ||
| S20111A | 09 | 604-605 | S21029A | 09 | 604-605 | S22011A | 08 | 551-552 | ||
| S20111A | 24 | 963-965 | S21029A | 24 | 963-965 | S22011A | 24 | 963-965 | ||
| S20111D | 23 | 949-950 | S21029D | 23 | 949-950 | S22011B | 08 | 551-552 | ||
| S20111S | 09 | 604-605 | S21029S | 09 | 604-605 | S22011B | 24 | 963-965 | ||
| S20112A | 09 | 604-605 | S21031A | 09 | 604-605 | S22011D | 08 | 559-561 | ||
| S20112A | 24 | 963-965 | S21031A | 24 | 963-965 | S22011G | 08 | 559-561 | ||
| S20112D | 23 | 949-950 | S21031D | 23 | 949-950 | S22011K | 08 | 564-566 | ||
| S20112S | 09 | 604-605 | S21031S | 09 | 604-605 | S22011S | 08 | 551-552 | ||
| S20119A | 09 | 604-605 | S21032A | 09 | 604-605 | S22012A | 08 | 551-552 | ||
| S20119A | 24 | 963-965 | S21032A | 24 | 963-965 | S22012A | 24 | 963-965 | ||
| S20119D | 23 | 949-950 | S21032D | 23 | 949-950 | S22012B | 08 | 551-552 | ||
| S20119S | 09 | 604-605 | S21032S | 09 | 604-605 | S22012B | 24 | 963-965 | ||
| S20121A | 09 | 606-607 | S21039A | 09 | 604-605 | S22012D | 08 | 559-561 | ||
| S20121A | 24 | 963-965 | S21039A | 24 | 963-965 | S22012G | 08 | 559-561 | ||
| S20121D | 23 | 949-950 | S21039D | 23 | 949-950 | S22012K | 08 | 564-566 | ||
| S20121S | 09 | 604-605 | S21039S | 09 | 604-605 | S22012S | 08 | 551-552 | ||
| S20122A | 09 | 606-607 | S21041A | 09 | 604-605 | S22018A | 08 | 551-552 | ||
| S20122A | 24 | 963-965 | S21041A | 24 | 963-965 | S22018A | 24 | 963-965 | ||
| S20122D | 23 | 949-950 | S21041D | 23 | 949-950 | S22018B | 08 | 551-552 | ||
| S20122S | 09 | 604-605 | S21041S | 09 | 604-605 | S22018B | 24 | 963-965 | ||
| S20129A | 09 | 606-607 | S21042A | 09 | 604-605 | S22018D | 08 | 559-561 | ||
| S20129A | 24 | 963-965 | S21042A | 24 | 963-965 | S22018G | 08 | 559-561 | ||
| S20129D | 23 | 949-950 | S21042D | 23 | 949-950 | S22018K | 08 | 564-566 | ||
| S20129S | 09 | 604-605 | S21042S | 09 | 604-605 | S22018S | 08 | 551-552 | ||
| S20141A | 09 | 604-605 | S21049A | 09 | 604-605 | S22019A | 08 | 551-552 | ||
| S20141A | 24 | 963-965 | S21049A | 24 | 963-965 | S22019A | 24 | 963-965 | ||
| S20141D | 23 | 949-950 | S21049D | 23 | 949-950 | S22019B | 08 | 551-552 | ||
| S20141S | 09 | 604-605 | S21049S | 09 | 604-605 | S22019B | 24 | 963-965 | ||
| S20142A | 09 | 604-605 | S21051A | 09 | 604-605 | S22019D | 08 | 559-561 | ||
| S20142A | 24 | 963-965 | S21051A | 24 | 963-965 | S22019G | 08 | 559-561 | ||
| S20142D | 23 | 949-950 | S21051D | 23 | 949-950 | S22019K | 08 | 564-566 | ||
| S20142S | 09 | 604-605 | S21051S | 09 | 604-605 | S22019S | 08 | 551-552 | ||
| S20149A | 09 | 604-605 | S21052A | 09 | 604-605 | S22020A | 08 | 551-552 | ||
| S20149A | 24 | 963-965 | S21052A | 24 | 963-965 | S22020A | 24 | 963-965 | ||
| S20149D | 23 | 949-950 | S21052D | 23 | 949-950 | S22020B | 08 | 551-552 | ||
| S20149S | 09 | 604-605 | S21052S | 09 | 604-605 | S22020B | 24 | 963-965 | ||
| S20151A | 09 | 604-605 | S21059A | 09 | 604-605 | S22020D | 08 | 559-561 | ||
| S20151A | 24 | 963-965 | S21059A | 24 | 963-965 | S22020G | 08 | 559-561 | ||
| S20151D | 23 | 949-950 | S21059D | 23 | 949-950 | S22020K | 08 | 564-566 | ||
| S20151S | 09 | 604-605 | S21059S | 09 | 604-605 | S22020S | 08 | 551-552 | ||
| S20152A | 09 | 604-605 | S21101A | 09 | 604-605 | S22021A | 08 | 551-552 | ||
| S20152A | 24 | 963-965 | S21101A | 24 | 963-965 | S22021A | 24 | 963-965 | ||
| S20152D | 23 | 949-950 | S21101D | 23 | 949-950 | S22021B | 08 | 551-552 | ||
| S20152S | 09 | 604-605 | S21101S | 09 | 604-605 | S22021B | 24 | 963-965 | ||
| S20159A | 09 | 604-605 | S21102A | 09 | 604-605 | S22021D | 08 | 559-561 | ||
| S20159A | 24 | 963-965 | S21102A | 24 | 963-965 | S22021G | 08 | 559-561 | ||
| S20159D | 23 | 949-950 | S21102D | 23 | 949-950 | S22021K | 08 | 564-566 | ||
| S20159S | 09 | 604-605 | S21102S | 09 | 604-605 | S22021S | 08 | 551-552 | ||
| S20161A | 09 | 606-607 | S21109A | 09 | 604-605 | S22022A | 08 | 551-552 | ||
| S20161A | 24 | 963-965 | S21109A | 24 | 963-965 | S22022A | 24 | 963-965 | ||
| S20161D | 23 | 949-950 | S21109D | 23 | 949-950 | S22022B | 08 | 551-552 | ||
| S20161S | 09 | 604-605 | S21109S | 09 | 604-605 | S22022B | 24 | 963-965 | ||
| S20162A | 09 | 606-607 | S21111A | 09 | 604-605 | S22022D | 08 | 559-561 | ||
| S20162A | 24 | 963-965 | S21111A | 24 | 963-965 | S22022G | 08 | 559-561 | ||
| S20162D | 23 | 949-950 | S21111D | 23 | 949-950 | S22022K | 08 | 564-566 | ||
| S20162S | 09 | 604-605 | S21111S | 09 | 604-605 | S22022S | 08 | 551-552 | ||
| S20169A | 09 | 606-607 | S21112A | 09 | 604-605 | S22028A | 08 | 551-552 | ||
| S20169A | 24 | 963-965 | S21112A | 24 | 963-965 | S22028A | 24 | 963-965 | ||
| S20169D | 23 | 949-950 | S21112D | 23 | 949-950 | S22028B | 08 | 551-552 | ||
| S20169S | 09 | 604-605 | S21112S | 09 | 604-605 | S22028B | 24 | 963-965 | ||
| S20171A | 09 | 604-605 | S21119A | 09 | 604-605 | S22028D | 08 | 559-561 | ||
| S20171A | 24 | 963-965 | S21119A | 24 | 963-965 | S22028G | 08 | 559-561 | ||
| S20171D | 23 | 949-950 | S21119D | 23 | 949-950 | S22028K | 08 | 564-566 | ||
| S20171S | 09 | 604-605 | S21119S | 09 | 604-605 | S22028S | 08 | 551-552 | ||
| S20172A | 09 | 604-605 | S21121A | 21 | 913-914 | S22029A | 08 | 551-552 | ||
| S20172A | 24 | 963-965 | S21121A | 24 | 963-965 | S22029A | 24 | 963-965 | ||
| S20172D | 23 | 949-950 | S21121D | 23 | 949-950 | S22029B | 08 | 551-552 | ||
| S20172S | 09 | 604-605 | S21121S | 09 | 604-605 | S22029B | 24 | 963-965 | ||
| S20179A | 09 | 604-605 | S21122A | 21 | 913-914 | S22029D | 08 | 559-561 | ||
| S20179A | 24 | 963-965 | S21122A | 24 | 963-965 | S22029G | 08 | 559-561 | ||
| S20179D | 23 | 949-950 | S21122D | 23 | 949-950 | S22029K | 08 | 564-566 | ||
| S20179S | 09 | 604-605 | S21122S | 09 | 604-605 | S22029S | 08 | 551-552 | ||
| S2020XA | 09 | 604-605 | S21129A | 21 | 913-914 | S22030A | 08 | 551-552 | ||
| S2020XA | 24 | 963-965 | S21129A | 24 | 963-965 | S22030A | 24 | 963-965 | ||
| S2020XD | 23 | 949-950 | S21129D | 23 | 949-950 | S22030B | 08 | 551-552 | ||
| S2020XS | 09 | 604-605 | S21129S | 09 | 604-605 | S22030B | 24 | 963-965 | ||
| S20211A | 09 | 604-605 | S21131A | 09 | 604-605 | S22030D | 08 | 559-561 | ||
| S20211A | 24 | 963-965 | S21131A | 24 | 963-965 | S22030G | 08 | 559-561 | ||
| S20211D | 23 | 949-950 | S21131D | 23 | 949-950 | S22030K | 08 | 564-566 | ||
| S20211S | 09 | 604-605 | S21131S | 09 | 604-605 | S22030S | 08 | 551-552 | ||
| S20212A | 09 | 604-605 | S21132A | 09 | 604-605 | S22031A | 08 | 551-552 | ||
| S20212A | 24 | 963-965 | S21132A | 24 | 963-965 | S22031A | 24 | 963-965 | ||
| S20212D | 23 | 949-950 | S21132D | 23 | 949-950 | S22031B | 08 | 551-552 | ||
| S20212S | 09 | 604-605 | S21132S | 09 | 604-605 | S22031B | 24 | 963-965 | ||
| S20213A | 09 | 604-605 | S21139A | 09 | 604-605 | S22031D | 08 | 559-561 | ||
| S20213A | 24 | 963-965 | S21139A | 24 | 963-965 | S22031G | 08 | 559-561 | ||
| S20213D | 23 | 949-950 | S21139D | 23 | 949-950 | S22031K | 08 | 564-566 | ||
| S20213S | 09 | 604-605 | S21139S | 09 | 604-605 | S22031S | 08 | 551-552 | ||
| S20214A | 09 | 604-605 | S21141A | 21 | 913-914 | S22032A | 08 | 551-552 | ||
| S20214A | 24 | 963-965 | S21141A | 24 | 963-965 | S22032A | 24 | 963-965 | ||
| S20214D | 23 | 949-950 | S21141D | 23 | 949-950 | S22032B | 08 | 551-552 | ||
| S20214S | 09 | 604-605 | S21141S | 09 | 604-605 | S22032B | 24 | 963-965 | ||
| S20219A | 09 | 604-605 | S21142A | 21 | 913-914 | S22032D | 08 | 559-561 | ||
| S20219A | 24 | 963-965 | S21142A | 24 | 963-965 | S22032G | 08 | 559-561 | ||
| S20219D | 23 | 949-950 | S21142D | 23 | 949-950 | S22032K | 08 | 564-566 | ||
| S20219S | 09 | 604-605 | S21142S | 09 | 604-605 | S22032S | 08 | 551-552 | ||
| S20221A | 09 | 604-605 | S21149A | 21 | 913-914 | S22038A | 08 | 551-552 | ||
| S20221A | 24 | 963-965 | S21149A | 24 | 963-965 | S22038A | 24 | 963-965 | ||
| S20221D | 23 | 949-950 | S21149D | 23 | 949-950 | S22038B | 08 | 551-552 | ||
| S20221S | 09 | 604-605 | S21149S | 09 | 604-605 | S22038B | 24 | 963-965 | ||
| S20222A | 09 | 604-605 | S21151A | 09 | 604-605 | S22038D | 08 | 559-561 | ||
| S20222A | 24 | 963-965 | S21151A | 24 | 963-965 | S22038G | 08 | 559-561 | ||
| S20222D | 23 | 949-950 | S21151D | 23 | 949-950 | S22038K | 08 | 564-566 | ||
| S20222S | 09 | 604-605 | S21151S | 09 | 604-605 | S22038S | 08 | 551-552 | ||
| S20223A | 09 | 604-605 | S21152A | 09 | 604-605 | S22039A | 08 | 551-552 | ||
| S20223A | 24 | 963-965 | S21152A | 24 | 963-965 | S22039A | 24 | 963-965 | ||
| S20223D | 23 | 949-950 | S21152D | 23 | 949-950 | S22039B | 08 | 551-552 | ||
| S20223S | 09 | 604-605 | S21152S | 09 | 604-605 | S22039B | 24 | 963-965 | ||
| S20224A | 09 | 604-605 | S21159A | 09 | 604-605 | S22039D | 08 | 559-561 | ||
| S20224A | 24 | 963-965 | S21159A | 24 | 963-965 | S22039G | 08 | 559-561 | ||
| S20224D | 23 | 949-950 | S21159D | 23 | 949-950 | S22039K | 08 | 564-566 | ||
| S20224S | 09 | 604-605 | S21159S | 09 | 604-605 | S22039S | 08 | 551-552 | ||
| S20229A | 09 | 604-605 | S21201A | 09 | 604-605 | S22040A | 08 | 551-552 | ||
| S20229A | 24 | 963-965 | S21201A | 24 | 963-965 | S22040A | 24 | 963-965 | ||
| S20229D | 23 | 949-950 | S21201D | 23 | 949-950 | S22040B | 08 | 551-552 | ||
| S20229S | 09 | 604-605 | S21201S | 09 | 604-605 | S22040B | 24 | 963-965 | ||
| S20301A | 09 | 604-605 | S21202A | 09 | 604-605 | S22040D | 08 | 559-561 | ||
| S20301A | 24 | 963-965 | S21202A | 24 | 963-965 | S22040G | 08 | 559-561 | ||
| S20301D | 23 | 949-950 | S21202D | 23 | 949-950 | S22040K | 08 | 564-566 | ||
| S20301S | 09 | 604-605 | S21202S | 09 | 604-605 | S22040S | 08 | 551-552 | ||
| S20302A | 09 | 604-605 | S21209A | 09 | 604-605 | S22041A | 08 | 551-552 | ||
| S20302A | 24 | 963-965 | S21209A | 24 | 963-965 | S22041A | 24 | 963-965 | ||
| S20302D | 23 | 949-950 | S21209D | 23 | 949-950 | S22041B | 08 | 551-552 | ||
| S20302S | 09 | 604-605 | S21209S | 09 | 604-605 | S22041B | 24 | 963-965 | ||
| S20303A | 09 | 604-605 | S21211A | 09 | 604-605 | S22041D | 08 | 559-561 | ||
| S20303A | 24 | 963-965 | S21211A | 24 | 963-965 | S22041G | 08 | 559-561 | ||
| S20303D | 23 | 949-950 | S21211D | 23 | 949-950 | S22041K | 08 | 564-566 | ||
| S20303S | 09 | 604-605 | S21211S | 09 | 604-605 | S22041S | 08 | 551-552 | ||
| S20304A | 09 | 604-605 | S21212A | 09 | 604-605 | S22042A | 08 | 551-552 | ||
| S20304A | 24 | 963-965 | S21212A | 24 | 963-965 | S22042A | 24 | 963-965 | ||
| S20304D | 23 | 949-950 | S21212D | 23 | 949-950 | S22042B | 08 | 551-552 | ||
| S20304S | 09 | 604-605 | S21212S | 09 | 604-605 | S22042B | 24 | 963-965 | ||
| S20309A | 09 | 604-605 | S21219A | 09 | 604-605 | S22042D | 08 | 559-561 | ||
| S20309A | 24 | 963-965 | S21219A | 24 | 963-965 | S22042G | 08 | 559-561 | ||
| S20309D | 23 | 949-950 | S21219D | 23 | 949-950 | S22042K | 08 | 564-566 | ||
| S20309S | 09 | 604-605 | S21219S | 09 | 604-605 | S22042S | 08 | 551-552 | ||
| S20311A | 09 | 604-605 | S21221A | 09 | 604-605 | S22048A | 08 | 551-552 | ||
| S20311A | 24 | 963-965 | S21221A | 24 | 963-965 | S22048A | 24 | 963-965 | ||
| S20311D | 23 | 949-950 | S21221D | 23 | 949-950 | S22048B | 08 | 551-552 | ||
| S20311S | 09 | 604-605 | S21221S | 09 | 604-605 | S22048B | 24 | 963-965 | ||
| S20312A | 09 | 604-605 | S21222A | 09 | 604-605 | S22048D | 08 | 559-561 | ||
| S20312A | 24 | 963-965 | S21222A | 24 | 963-965 | S22048G | 08 | 559-561 | ||
| S20312D | 23 | 949-950 | S21222D | 23 | 949-950 | S22048K | 08 | 564-566 | ||
| S20312S | 09 | 604-605 | S21222S | 09 | 604-605 | S22048S | 08 | 551-552 | ||
| S20313A | 09 | 604-605 | S21229A | 09 | 604-605 | S22049A | 08 | 551-552 | ||
| S20313A | 24 | 963-965 | S21229A | 24 | 963-965 | S22049A | 24 | 963-965 | ||
| S20313D | 23 | 949-950 | S21229D | 23 | 949-950 | S22049B | 08 | 551-552 | ||
| S20313S | 09 | 604-605 | S21229S | 09 | 604-605 | S22049B | 24 | 963-965 | ||
| S20314A | 09 | 604-605 | S21231A | 09 | 604-605 | S22049D | 08 | 559-561 | ||
| S20314A | 24 | 963-965 | S21231A | 24 | 963-965 | S22049G | 08 | 559-561 | ||
| S20314D | 23 | 949-950 | S21231D | 23 | 949-950 | S22049K | 08 | 564-566 | ||
| S20314S | 09 | 604-605 | S21231S | 09 | 604-605 | S22049S | 08 | 551-552 | ||
| S20319A | 09 | 604-605 | S21232A | 09 | 604-605 | S22050A | 08 | 551-552 | ||
| S20319A | 24 | 963-965 | S21232A | 24 | 963-965 | S22050A | 24 | 963-965 | ||
| S20319D | 23 | 949-950 | S21232D | 23 | 949-950 | S22050B | 08 | 551-552 | ||
| S20319S | 09 | 604-605 | S21232S | 09 | 604-605 | S22050B | 24 | 963-965 | ||
| S20321A | 09 | 606-607 | S21239A | 09 | 604-605 | S22050D | 08 | 559-561 | ||
| S20321A | 24 | 963-965 | S21239A | 24 | 963-965 | S22050G | 08 | 559-561 | ||
| S20321D | 23 | 949-950 | S21239D | 23 | 949-950 | S22050K | 08 | 564-566 | ||
| S20321S | 09 | 604-605 | S21239S | 09 | 604-605 | S22050S | 08 | 551-552 | ||
| S20322A | 09 | 606-607 | S21241A | 09 | 604-605 | S22051A | 08 | 551-552 | ||
| S20322A | 24 | 963-965 | S21241A | 24 | 963-965 | S22051A | 24 | 963-965 | ||
| S20322D | 23 | 949-950 | S21241D | 23 | 949-950 | S22051B | 08 | 551-552 | ||
| S20322S | 09 | 604-605 | S21241S | 09 | 604-605 | S22051B | 24 | 963-965 | ||
| S20323A | 09 | 606-607 | S21242A | 09 | 604-605 | S22051D | 08 | 559-561 | ||
| S20323A | 24 | 963-965 | S21242A | 24 | 963-965 | S22051G | 08 | 559-561 | ||
| S20323D | 23 | 949-950 | S21242D | 23 | 949-950 | S22051K | 08 | 564-566 | ||
| S20323S | 09 | 604-605 | S21242S | 09 | 604-605 | S22051S | 08 | 551-552 | ||
| S20324A | 09 | 606-607 | S21249A | 09 | 604-605 | S22052A | 08 | 551-552 | ||
| S20324A | 24 | 963-965 | S21249A | 24 | 963-965 | S22052A | 24 | 963-965 | ||
| S20324D | 23 | 949-950 | S21249D | 23 | 949-950 | S22052B | 08 | 551-552 | ||
| S20324S | 09 | 604-605 | S21249S | 09 | 604-605 | S22052B | 24 | 963-965 | ||
| S20329A | 09 | 606-607 | S21251A | 09 | 604-605 | S22052D | 08 | 559-561 | ||
| S20329A | 24 | 963-965 | S21251A | 24 | 963-965 | S22052G | 08 | 559-561 | ||
| S20329D | 23 | 949-950 | S21251D | 23 | 949-950 | S22052K | 08 | 564-566 | ||
| S20329S | 09 | 604-605 | S21251S | 09 | 604-605 | S22052S | 08 | 551-552 | ||
| S20341A | 09 | 604-605 | S21252A | 09 | 604-605 | S22058A | 08 | 551-552 | ||
| S20341A | 24 | 963-965 | S21252A | 24 | 963-965 | S22058A | 24 | 963-965 | ||
| S20341D | 23 | 949-950 | S21252D | 23 | 949-950 | S22058B | 08 | 551-552 | ||
| S20341S | 09 | 604-605 | S21252S | 09 | 604-605 | S22058B | 24 | 963-965 | ||
| S20342A | 09 | 604-605 | S21259A | 09 | 604-605 | S22058D | 08 | 559-561 | ||
| S20342A | 24 | 963-965 | S21259A | 24 | 963-965 | S22058G | 08 | 559-561 | ||
| S20342D | 23 | 949-950 | S21259D | 23 | 949-950 | S22058K | 08 | 564-566 | ||
| S20342S | 09 | 604-605 | S21259S | 09 | 604-605 | S22058S | 08 | 551-552 | ||
| S20343A | 09 | 604-605 | S21301A | 21 | 913-914 | S22059A | 08 | 551-552 | ||
| S20343A | 24 | 963-965 | S21301A | 24 | 963-965 | S22059A | 24 | 963-965 | ||
| S20343D | 23 | 949-950 | S21301D | 23 | 949-950 | S22059B | 08 | 551-552 | ||
| S20343S | 09 | 604-605 | S21301S | 09 | 604-605 | S22059B | 24 | 963-965 | ||
| S20344A | 09 | 604-605 | S21302A | 21 | 913-914 | S22059D | 08 | 559-561 | ||
| S20344A | 24 | 963-965 | S21302A | 24 | 963-965 | S22059G | 08 | 559-561 | ||
| S20344D | 23 | 949-950 | S21302D | 23 | 949-950 | S22059K | 08 | 564-566 | ||
| S20344S | 09 | 604-605 | S21302S | 09 | 604-605 | S22059S | 08 | 551-552 | ||
| S20349A | 09 | 604-605 | S21309A | 21 | 913-914 | S22060A | 08 | 551-552 | ||
| S20349A | 24 | 963-965 | S21309A | 24 | 963-965 | S22060A | 24 | 963-965 | ||
| S20349D | 23 | 949-950 | S21309D | 23 | 949-950 | S22060B | 08 | 551-552 | ||
| S20349S | 09 | 604-605 | S21309S | 09 | 604-605 | S22060B | 24 | 963-965 | ||
| S20351A | 09 | 604-605 | S21311A | 21 | 913-914 | S22060D | 08 | 559-561 | ||
| S20351A | 24 | 963-965 | S21311A | 24 | 963-965 | S22060G | 08 | 559-561 | ||
| S20351D | 23 | 949-950 | S21311D | 23 | 949-950 | S22060K | 08 | 564-566 | ||
| S20351S | 09 | 604-605 | S21311S | 09 | 604-605 | S22060S | 08 | 551-552 | ||
| S20352A | 09 | 604-605 | S21312A | 21 | 913-914 | S22061A | 08 | 551-552 | ||
| S20352A | 24 | 963-965 | S21312A | 24 | 963-965 | S22061A | 24 | 963-965 | ||
| S20352D | 23 | 949-950 | S21312D | 23 | 949-950 | S22061B | 08 | 551-552 | ||
| S20352S | 09 | 604-605 | S21312S | 09 | 604-605 | S22061B | 24 | 963-965 | ||
| S20353A | 09 | 604-605 | S21319A | 21 | 913-914 | S22061D | 08 | 559-561 | ||
| S20353A | 24 | 963-965 | S21319A | 24 | 963-965 | S22061G | 08 | 559-561 | ||
| S20353D | 23 | 949-950 | S21319D | 23 | 949-950 | S22061K | 08 | 564-566 | ||
| S20353S | 09 | 604-605 | S21319S | 09 | 604-605 | S22061S | 08 | 551-552 | ||
| S20354A | 09 | 604-605 | S21321A | 21 | 913-914 | S22062A | 08 | 551-552 | ||
| S20354A | 24 | 963-965 | S21321A | 24 | 963-965 | S22062A | 24 | 963-965 | ||
| S20354D | 23 | 949-950 | S21321D | 23 | 949-950 | S22062B | 08 | 551-552 | ||
| S20354S | 09 | 604-605 | S21321S | 09 | 604-605 | S22062B | 24 | 963-965 | ||
| S20359A | 09 | 604-605 | S21322A | 21 | 913-914 | S22062D | 08 | 559-561 | ||
| S20359A | 24 | 963-965 | S21322A | 24 | 963-965 | S22062G | 08 | 559-561 | ||
| S20359D | 23 | 949-950 | S21322D | 23 | 949-950 | S22062K | 08 | 564-566 | ||
| S20359S | 09 | 604-605 | S21322S | 09 | 604-605 | S22062S | 08 | 551-552 | ||
| S20361A | 09 | 606-607 | S21329A | 21 | 913-914 | S22068A | 08 | 551-552 | ||
| S20361A | 24 | 963-965 | S21329A | 24 | 963-965 | S22068A | 24 | 963-965 | ||
| S20361D | 23 | 949-950 | S21329D | 23 | 949-950 | S22068B | 08 | 551-552 | ||
| S20361S | 09 | 604-605 | S21329S | 09 | 604-605 | S22068B | 24 | 963-965 | ||
| S20362A | 09 | 606-607 | S21331A | 21 | 913-914 | S22068D | 08 | 559-561 | ||
| S20362A | 24 | 963-965 | S21331A | 24 | 963-965 | S22068G | 08 | 559-561 | ||
| S20362D | 23 | 949-950 | S21331D | 23 | 949-950 | S22068K | 08 | 564-566 | ||
| S20362S | 09 | 604-605 | S21331S | 09 | 604-605 | S22068S | 08 | 551-552 | ||
| S20363A | 09 | 606-607 | S21332A | 21 | 913-914 | S22069A | 08 | 551-552 | ||
| S20363A | 24 | 963-965 | S21332A | 24 | 963-965 | S22069A | 24 | 963-965 | ||
| S20363D | 23 | 949-950 | S21332D | 23 | 949-950 | S22069B | 08 | 551-552 | ||
| S20363S | 09 | 604-605 | S21332S | 09 | 604-605 | S22069B | 24 | 963-965 | ||
| S20364A | 09 | 606-607 | S21339A | 21 | 913-914 | S22069D | 08 | 559-561 | ||
| S20364A | 24 | 963-965 | S21339A | 24 | 963-965 | S22069G | 08 | 559-561 | ||
| S20364D | 23 | 949-950 | S21339D | 23 | 949-950 | S22069K | 08 | 564-566 | ||
| S20364S | 09 | 604-605 | S21339S | 09 | 604-605 | S22069S | 08 | 551-552 | ||
| S20369A | 09 | 606-607 | S21341A | 21 | 913-914 | S22070A | 08 | 551-552 | ||
| S20369A | 24 | 963-965 | S21341A | 24 | 963-965 | S22070A | 24 | 963-965 | ||
| S20369D | 23 | 949-950 | S21341D | 23 | 949-950 | S22070B | 08 | 551-552 | ||
| S20369S | 09 | 604-605 | S21341S | 09 | 604-605 | S22070B | 24 | 963-965 | ||
| S20371A | 09 | 604-605 | S21342A | 21 | 913-914 | S22070D | 08 | 559-561 | ||
| S20371A | 24 | 963-965 | S21342A | 24 | 963-965 | S22070G | 08 | 559-561 | ||
| S20371D | 23 | 949-950 | S21342D | 23 | 949-950 | S22070K | 08 | 564-566 | ||
| S20371S | 09 | 604-605 | S21342S | 09 | 604-605 | S22070S | 08 | 551-552 | ||
| S20372A | 09 | 604-605 | S21349A | 21 | 913-914 | S22071A | 08 | 551-552 | ||
| S20372A | 24 | 963-965 | S21349A | 24 | 963-965 | S22071A | 24 | 963-965 | ||
| S20372D | 23 | 949-950 | S21349D | 23 | 949-950 | S22071B | 08 | 551-552 | ||
| S20372S | 09 | 604-605 | S21349S | 09 | 604-605 | S22071B | 24 | 963-965 | ||
| S20373A | 09 | 604-605 | S21351A | 21 | 913-914 | S22071D | 08 | 559-561 | ||
| S20373A | 24 | 963-965 | S21351A | 24 | 963-965 | S22071G | 08 | 559-561 | ||
| S20373D | 23 | 949-950 | S21351D | 23 | 949-950 | S22071K | 08 | 564-566 | ||
| S20373S | 09 | 604-605 | S21351S | 09 | 604-605 | S22071S | 08 | 551-552 | ||
| S20374A | 09 | 604-605 | S21352A | 21 | 913-914 | S22072A | 08 | 551-552 | ||
| S20374A | 24 | 963-965 | S21352A | 24 | 963-965 | S22072A | 24 | 963-965 | ||
| S20374D | 23 | 949-950 | S21352D | 23 | 949-950 | S22072B | 08 | 551-552 | ||
| S20374S | 09 | 604-605 | S21352S | 09 | 604-605 | S22072B | 24 | 963-965 | ||
| S20379A | 09 | 604-605 | S21359A | 21 | 913-914 | S22072D | 08 | 559-561 | ||
| S20379A | 24 | 963-965 | S21359A | 24 | 963-965 | S22072G | 08 | 559-561 | ||
| S20379D | 23 | 949-950 | S21359D | 23 | 949-950 | S22072K | 08 | 564-566 | ||
| S20379S | 09 | 604-605 | S21359S | 09 | 604-605 | S22072S | 08 | 551-552 | ||
| S20401A | 09 | 604-605 | S21401A | 21 | 913-914 | S22078A | 08 | 551-552 | ||
| S20401A | 24 | 963-965 | S21401A | 24 | 963-965 | S22078A | 24 | 963-965 | ||
| S20401D | 23 | 949-950 | S21401D | 23 | 949-950 | S22078B | 08 | 551-552 | ||
| S20401S | 09 | 604-605 | S21401S | 09 | 604-605 | S22078B | 24 | 963-965 | ||
| S20402A | 09 | 604-605 | S21402A | 21 | 913-914 | S22078D | 08 | 559-561 | ||
| S20402A | 24 | 963-965 | S21402A | 24 | 963-965 | S22078G | 08 | 559-561 | ||
| S20402D | 23 | 949-950 | S21402D | 23 | 949-950 | S22078K | 08 | 564-566 | ||
| S20402S | 09 | 604-605 | S21402S | 09 | 604-605 | S22078S | 08 | 551-552 | ||
| S20409A | 09 | 604-605 | S21409A | 21 | 913-914 | S22079A | 08 | 551-552 | ||
| S20409A | 24 | 963-965 | S21409A | 24 | 963-965 | S22079A | 24 | 963-965 | ||
| S20409D | 23 | 949-950 | S21409D | 23 | 949-950 | S22079B | 08 | 551-552 | ||
| S20409S | 09 | 604-605 | S21409S | 09 | 604-605 | S22079B | 24 | 963-965 | ||
| S20411A | 09 | 604-605 | S21411A | 21 | 913-914 | S22079D | 08 | 559-561 | ||
| S20411A | 24 | 963-965 | S21411A | 24 | 963-965 | S22079G | 08 | 559-561 | ||
| S20411D | 23 | 949-950 | S21411D | 23 | 949-950 | S22079K | 08 | 564-566 | ||
| S20411S | 09 | 604-605 | S21411S | 09 | 604-605 | S22079S | 08 | 551-552 | ||
| S20412A | 09 | 604-605 | S21412A | 21 | 913-914 | S22080A | 08 | 551-552 | ||
| S20412A | 24 | 963-965 | S21412A | 24 | 963-965 | S22080A | 24 | 963-965 | ||
| S20412D | 23 | 949-950 | S21412D | 23 | 949-950 | S22080B | 08 | 551-552 | ||
| S20412S | 09 | 604-605 | S21412S | 09 | 604-605 | S22080B | 24 | 963-965 | ||
| S20419A | 09 | 604-605 | S21419A | 21 | 913-914 | S22080D | 08 | 559-561 | ||
| S20419A | 24 | 963-965 | S21419A | 24 | 963-965 | S22080G | 08 | 559-561 | ||
| S20419D | 23 | 949-950 | S21419D | 23 | 949-950 | S22080K | 08 | 564-566 | ||
| S20419S | 09 | 604-605 | S21419S | 09 | 604-605 | S22080S | 08 | 551-552 | ||
| S20421A | 09 | 606-607 | S21421A | 21 | 913-914 | S22081A | 08 | 551-552 | ||
| S20421A | 24 | 963-965 | S21421A | 24 | 963-965 | S22081A | 24 | 963-965 | ||
| S20421D | 23 | 949-950 | S21421D | 23 | 949-950 | S22081B | 08 | 551-552 | ||
| S20421S | 09 | 604-605 | S21421S | 09 | 604-605 | S22081B | 24 | 963-965 | ||
| S20422A | 09 | 606-607 | S21422A | 21 | 913-914 | S22081D | 08 | 559-561 | ||
| S20422A | 24 | 963-965 | S21422A | 24 | 963-965 | S22081G | 08 | 559-561 | ||
| S20422D | 23 | 949-950 | S21422D | 23 | 949-950 | S22081K | 08 | 564-566 | ||
| S20422S | 09 | 604-605 | S21422S | 09 | 604-605 | S22081S | 08 | 551-552 | ||
| S20429A | 09 | 606-607 | S21429A | 21 | 913-914 | S22082A | 08 | 551-552 | ||
| S20429A | 24 | 963-965 | S21429A | 24 | 963-965 | S22082A | 24 | 963-965 |
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Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 06 Sep 2024 16:41:54 CMS, code-revision=366, description-revision=1405 |