ICD-10-CM/PCS MS-DRG v35.0 Definitions Manual
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ICD-10-CM/PCS MS-DRG v35.0 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 56 of 70 |
| A000 B400 C771 C84Z9 D490 E113319 F15188 G930 H2143 H52512 I479 I7401 K08411 L101 M02049 M1A1291 M4104 M66822 M84451D M87332 N6019 O2652 O361915 O43811 O92113 Q512 R791 S02400A S06375A S1244XS S21022D S25302A S31611D S32591K S37092A S42135B S42462B S46909A S52099H S52301K S52562N S56191S S60417A S62001D S62329B S62668A S63682S S66821S S72042A S72322M S72451B S7722XS S82092Q S82255B S8264XD S8410XS S89399D S92055S S92504G S96919A T2039XD T23309D T2652XD T3991XA T45521D T50B13D T63303D T81519D T85510S Z7389 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S8410XS | 01 | 091-093 | S85999A | 21 | 913-914 | S89002S | 08 | 559-561 | ||
| S8411XA | 01 | 073-074 | S85999A | 24 | 955-965 | S89009A | 08 | 562-563 | ||
| S8411XA | 24 | 955-965 | S85999D | 23 | 949-950 | S89009A | 24 | 955-965 | ||
| S8411XD | 23 | 949-950 | S85999S | 05 | 299-301 | S89009D | 08 | 559-561 | ||
| S8411XS | 01 | 091-093 | S86001A | 21 | 913-914 | S89009G | 08 | 559-561 | ||
| S8412XA | 01 | 073-074 | S86001A | 24 | 955-965 | S89009K | 08 | 564-566 | ||
| S8412XA | 24 | 955-965 | S86001D | 23 | 949-950 | S89009P | 08 | 564-566 | ||
| S8412XD | 23 | 949-950 | S86001S | 21 | 913-914 | S89009S | 08 | 559-561 | ||
| S8412XS | 01 | 091-093 | S86002A | 21 | 913-914 | S89011A | 08 | 562-563 | ||
| S8420XA | 01 | 073-074 | S86002A | 24 | 955-965 | S89011A | 24 | 955-965 | ||
| S8420XA | 24 | 955-965 | S86002D | 23 | 949-950 | S89011D | 08 | 559-561 | ||
| S8420XD | 23 | 949-950 | S86002S | 21 | 913-914 | S89011G | 08 | 559-561 | ||
| S8420XS | 01 | 091-093 | S86009A | 21 | 913-914 | S89011K | 08 | 564-566 | ||
| S8421XA | 01 | 073-074 | S86009A | 24 | 955-965 | S89011P | 08 | 564-566 | ||
| S8421XA | 24 | 955-965 | S86009D | 23 | 949-950 | S89011S | 08 | 559-561 | ||
| S8421XD | 23 | 949-950 | S86009S | 21 | 913-914 | S89012A | 08 | 562-563 | ||
| S8421XS | 01 | 091-093 | S86011A | 08 | 562-563 | S89012A | 24 | 955-965 | ||
| S8422XA | 01 | 073-074 | S86011A | 24 | 955-965 | S89012D | 08 | 559-561 | ||
| S8422XA | 24 | 955-965 | S86011D | 23 | 949-950 | S89012G | 08 | 559-561 | ||
| S8422XD | 23 | 949-950 | S86011S | 08 | 562-563 | S89012K | 08 | 564-566 | ||
| S8422XS | 01 | 091-093 | S86012A | 08 | 562-563 | S89012P | 08 | 564-566 | ||
| S84801A | 01 | 073-074 | S86012A | 24 | 955-965 | S89012S | 08 | 559-561 | ||
| S84801A | 24 | 955-965 | S86012D | 23 | 949-950 | S89019A | 08 | 562-563 | ||
| S84801D | 23 | 949-950 | S86012S | 08 | 562-563 | S89019A | 24 | 955-965 | ||
| S84801S | 01 | 091-093 | S86019A | 08 | 562-563 | S89019D | 08 | 559-561 | ||
| S84802A | 01 | 073-074 | S86019A | 24 | 955-965 | S89019G | 08 | 559-561 | ||
| S84802A | 24 | 955-965 | S86019D | 23 | 949-950 | S89019K | 08 | 564-566 | ||
| S84802D | 23 | 949-950 | S86019S | 08 | 562-563 | S89019P | 08 | 564-566 | ||
| S84802S | 01 | 091-093 | S86021A | 08 | 564-566 | S89019S | 08 | 559-561 | ||
| S84809A | 01 | 073-074 | S86021A | 24 | 955-965 | S89021A | 08 | 562-563 | ||
| S84809A | 24 | 955-965 | S86021D | 23 | 949-950 | S89021A | 24 | 955-965 | ||
| S84809D | 23 | 949-950 | S86021S | 09 | 604-605 | S89021D | 08 | 559-561 | ||
| S84809S | 01 | 091-093 | S86022A | 08 | 564-566 | S89021G | 08 | 559-561 | ||
| S8490XA | 01 | 073-074 | S86022A | 24 | 955-965 | S89021K | 08 | 564-566 | ||
| S8490XA | 24 | 955-965 | S86022D | 23 | 949-950 | S89021P | 08 | 564-566 | ||
| S8490XD | 23 | 949-950 | S86022S | 09 | 604-605 | S89021S | 08 | 559-561 | ||
| S8490XS | 01 | 091-093 | S86029A | 08 | 564-566 | S89022A | 08 | 562-563 | ||
| S8491XA | 01 | 073-074 | S86029A | 24 | 955-965 | S89022A | 24 | 955-965 | ||
| S8491XA | 24 | 955-965 | S86029D | 23 | 949-950 | S89022D | 08 | 559-561 | ||
| S8491XD | 23 | 949-950 | S86029S | 09 | 604-605 | S89022G | 08 | 559-561 | ||
| S8491XS | 01 | 091-093 | S86091A | 21 | 913-914 | S89022K | 08 | 564-566 | ||
| S8492XA | 01 | 073-074 | S86091A | 24 | 955-965 | S89022P | 08 | 564-566 | ||
| S8492XA | 24 | 955-965 | S86091D | 23 | 949-950 | S89022S | 08 | 559-561 | ||
| S8492XD | 23 | 949-950 | S86091S | 21 | 913-914 | S89029A | 08 | 562-563 | ||
| S8492XS | 01 | 091-093 | S86092A | 21 | 913-914 | S89029A | 24 | 955-965 | ||
| S85001A | 21 | 913-914 | S86092A | 24 | 955-965 | S89029D | 08 | 559-561 | ||
| S85001A | 24 | 955-965 | S86092D | 23 | 949-950 | S89029G | 08 | 559-561 | ||
| S85001D | 23 | 949-950 | S86092S | 21 | 913-914 | S89029K | 08 | 564-566 | ||
| S85001S | 05 | 299-301 | S86099A | 21 | 913-914 | S89029P | 08 | 564-566 | ||
| S85002A | 21 | 913-914 | S86099A | 24 | 955-965 | S89029S | 08 | 559-561 | ||
| S85002A | 24 | 955-965 | S86099D | 23 | 949-950 | S89031A | 08 | 562-563 | ||
| S85002D | 23 | 949-950 | S86099S | 21 | 913-914 | S89031A | 24 | 955-965 | ||
| S85002S | 05 | 299-301 | S86101A | 21 | 913-914 | S89031D | 08 | 559-561 | ||
| S85009A | 21 | 913-914 | S86101A | 24 | 955-965 | S89031G | 08 | 559-561 | ||
| S85009A | 24 | 955-965 | S86101D | 23 | 949-950 | S89031K | 08 | 564-566 | ||
| S85009D | 23 | 949-950 | S86101S | 21 | 913-914 | S89031P | 08 | 564-566 | ||
| S85009S | 05 | 299-301 | S86102A | 21 | 913-914 | S89031S | 08 | 559-561 | ||
| S85011A | 21 | 913-914 | S86102A | 24 | 955-965 | S89032A | 08 | 562-563 | ||
| S85011A | 24 | 955-965 | S86102D | 23 | 949-950 | S89032A | 24 | 955-965 | ||
| S85011D | 23 | 949-950 | S86102S | 21 | 913-914 | S89032D | 08 | 559-561 | ||
| S85011S | 05 | 299-301 | S86109A | 21 | 913-914 | S89032G | 08 | 559-561 | ||
| S85012A | 21 | 913-914 | S86109A | 24 | 955-965 | S89032K | 08 | 564-566 | ||
| S85012A | 24 | 955-965 | S86109D | 23 | 949-950 | S89032P | 08 | 564-566 | ||
| S85012D | 23 | 949-950 | S86109S | 21 | 913-914 | S89032S | 08 | 559-561 | ||
| S85012S | 05 | 299-301 | S86111A | 08 | 562-563 | S89039A | 08 | 562-563 | ||
| S85019A | 21 | 913-914 | S86111A | 24 | 955-965 | S89039A | 24 | 955-965 | ||
| S85019A | 24 | 955-965 | S86111D | 23 | 949-950 | S89039D | 08 | 559-561 | ||
| S85019D | 23 | 949-950 | S86111S | 08 | 562-563 | S89039G | 08 | 559-561 | ||
| S85019S | 05 | 299-301 | S86112A | 08 | 562-563 | S89039K | 08 | 564-566 | ||
| S85091A | 21 | 913-914 | S86112A | 24 | 955-965 | S89039P | 08 | 564-566 | ||
| S85091A | 24 | 955-965 | S86112D | 23 | 949-950 | S89039S | 08 | 559-561 | ||
| S85091D | 23 | 949-950 | S86112S | 08 | 562-563 | S89041A | 08 | 562-563 | ||
| S85091S | 05 | 299-301 | S86119A | 08 | 562-563 | S89041A | 24 | 955-965 | ||
| S85092A | 21 | 913-914 | S86119A | 24 | 955-965 | S89041D | 08 | 559-561 | ||
| S85092A | 24 | 955-965 | S86119D | 23 | 949-950 | S89041G | 08 | 559-561 | ||
| S85092D | 23 | 949-950 | S86119S | 08 | 562-563 | S89041K | 08 | 564-566 | ||
| S85092S | 05 | 299-301 | S86121A | 08 | 564-566 | S89041P | 08 | 564-566 | ||
| S85099A | 21 | 913-914 | S86121A | 24 | 955-965 | S89041S | 08 | 559-561 | ||
| S85099A | 24 | 955-965 | S86121D | 23 | 949-950 | S89042A | 08 | 562-563 | ||
| S85099D | 23 | 949-950 | S86121S | 09 | 604-605 | S89042A | 24 | 955-965 | ||
| S85099S | 05 | 299-301 | S86122A | 08 | 564-566 | S89042D | 08 | 559-561 | ||
| S85101A | 21 | 913-914 | S86122A | 24 | 955-965 | S89042G | 08 | 559-561 | ||
| S85101A | 24 | 955-965 | S86122D | 23 | 949-950 | S89042K | 08 | 564-566 | ||
| S85101D | 23 | 949-950 | S86122S | 09 | 604-605 | S89042P | 08 | 564-566 | ||
| S85101S | 05 | 299-301 | S86129A | 08 | 564-566 | S89042S | 08 | 559-561 | ||
| S85102A | 21 | 913-914 | S86129A | 24 | 955-965 | S89049A | 08 | 562-563 | ||
| S85102A | 24 | 955-965 | S86129D | 23 | 949-950 | S89049A | 24 | 955-965 | ||
| S85102D | 23 | 949-950 | S86129S | 09 | 604-605 | S89049D | 08 | 559-561 | ||
| S85102S | 05 | 299-301 | S86191A | 21 | 913-914 | S89049G | 08 | 559-561 | ||
| S85109A | 21 | 913-914 | S86191A | 24 | 955-965 | S89049K | 08 | 564-566 | ||
| S85109A | 24 | 955-965 | S86191D | 23 | 949-950 | S89049P | 08 | 564-566 | ||
| S85109D | 23 | 949-950 | S86191S | 21 | 913-914 | S89049S | 08 | 559-561 | ||
| S85109S | 05 | 299-301 | S86192A | 21 | 913-914 | S89091A | 08 | 562-563 | ||
| S85111A | 21 | 913-914 | S86192A | 24 | 955-965 | S89091A | 24 | 955-965 | ||
| S85111A | 24 | 955-965 | S86192D | 23 | 949-950 | S89091D | 08 | 559-561 | ||
| S85111D | 23 | 949-950 | S86192S | 21 | 913-914 | S89091G | 08 | 559-561 | ||
| S85111S | 05 | 299-301 | S86199A | 21 | 913-914 | S89091K | 08 | 564-566 | ||
| S85112A | 21 | 913-914 | S86199A | 24 | 955-965 | S89091P | 08 | 564-566 | ||
| S85112A | 24 | 955-965 | S86199D | 23 | 949-950 | S89091S | 08 | 559-561 | ||
| S85112D | 23 | 949-950 | S86199S | 21 | 913-914 | S89092A | 08 | 562-563 | ||
| S85112S | 05 | 299-301 | S86201A | 21 | 913-914 | S89092A | 24 | 955-965 | ||
| S85119A | 21 | 913-914 | S86201A | 24 | 955-965 | S89092D | 08 | 559-561 | ||
| S85119A | 24 | 955-965 | S86201D | 23 | 949-950 | S89092G | 08 | 559-561 | ||
| S85119D | 23 | 949-950 | S86201S | 21 | 913-914 | S89092K | 08 | 564-566 | ||
| S85119S | 05 | 299-301 | S86202A | 21 | 913-914 | S89092P | 08 | 564-566 | ||
| S85121A | 21 | 913-914 | S86202A | 24 | 955-965 | S89092S | 08 | 559-561 | ||
| S85121A | 24 | 955-965 | S86202D | 23 | 949-950 | S89099A | 08 | 562-563 | ||
| S85121D | 23 | 949-950 | S86202S | 21 | 913-914 | S89099A | 24 | 955-965 | ||
| S85121S | 05 | 299-301 | S86209A | 21 | 913-914 | S89099D | 08 | 559-561 | ||
| S85122A | 21 | 913-914 | S86209A | 24 | 955-965 | S89099G | 08 | 559-561 | ||
| S85122A | 24 | 955-965 | S86209D | 23 | 949-950 | S89099K | 08 | 564-566 | ||
| S85122D | 23 | 949-950 | S86209S | 21 | 913-914 | S89099P | 08 | 564-566 | ||
| S85122S | 05 | 299-301 | S86211A | 08 | 562-563 | S89099S | 08 | 559-561 | ||
| S85129A | 21 | 913-914 | S86211A | 24 | 955-965 | S89101A | 08 | 562-563 | ||
| S85129A | 24 | 955-965 | S86211D | 23 | 949-950 | S89101A | 24 | 955-965 | ||
| S85129D | 23 | 949-950 | S86211S | 08 | 562-563 | S89101D | 08 | 559-561 | ||
| S85129S | 05 | 299-301 | S86212A | 08 | 562-563 | S89101G | 08 | 559-561 | ||
| S85131A | 21 | 913-914 | S86212A | 24 | 955-965 | S89101K | 08 | 564-566 | ||
| S85131A | 24 | 955-965 | S86212D | 23 | 949-950 | S89101P | 08 | 564-566 | ||
| S85131D | 23 | 949-950 | S86212S | 08 | 562-563 | S89101S | 08 | 559-561 | ||
| S85131S | 05 | 299-301 | S86219A | 08 | 562-563 | S89102A | 08 | 562-563 | ||
| S85132A | 21 | 913-914 | S86219A | 24 | 955-965 | S89102A | 24 | 955-965 | ||
| S85132A | 24 | 955-965 | S86219D | 23 | 949-950 | S89102D | 08 | 559-561 | ||
| S85132D | 23 | 949-950 | S86219S | 08 | 562-563 | S89102G | 08 | 559-561 | ||
| S85132S | 05 | 299-301 | S86221A | 08 | 564-566 | S89102K | 08 | 564-566 | ||
| S85139A | 21 | 913-914 | S86221A | 24 | 955-965 | S89102P | 08 | 564-566 | ||
| S85139A | 24 | 955-965 | S86221D | 23 | 949-950 | S89102S | 08 | 559-561 | ||
| S85139D | 23 | 949-950 | S86221S | 09 | 604-605 | S89109A | 08 | 562-563 | ||
| S85139S | 05 | 299-301 | S86222A | 08 | 564-566 | S89109A | 24 | 955-965 | ||
| S85141A | 21 | 913-914 | S86222A | 24 | 955-965 | S89109D | 08 | 559-561 | ||
| S85141A | 24 | 955-965 | S86222D | 23 | 949-950 | S89109G | 08 | 559-561 | ||
| S85141D | 23 | 949-950 | S86222S | 09 | 604-605 | S89109K | 08 | 564-566 | ||
| S85141S | 05 | 299-301 | S86229A | 08 | 564-566 | S89109P | 08 | 564-566 | ||
| S85142A | 21 | 913-914 | S86229A | 24 | 955-965 | S89109S | 08 | 559-561 | ||
| S85142A | 24 | 955-965 | S86229D | 23 | 949-950 | S89111A | 08 | 562-563 | ||
| S85142D | 23 | 949-950 | S86229S | 09 | 604-605 | S89111A | 24 | 955-965 | ||
| S85142S | 05 | 299-301 | S86291A | 21 | 913-914 | S89111D | 08 | 559-561 | ||
| S85149A | 21 | 913-914 | S86291A | 24 | 955-965 | S89111G | 08 | 559-561 | ||
| S85149A | 24 | 955-965 | S86291D | 23 | 949-950 | S89111K | 08 | 564-566 | ||
| S85149D | 23 | 949-950 | S86291S | 21 | 913-914 | S89111P | 08 | 564-566 | ||
| S85149S | 05 | 299-301 | S86292A | 21 | 913-914 | S89111S | 08 | 559-561 | ||
| S85151A | 21 | 913-914 | S86292A | 24 | 955-965 | S89112A | 08 | 562-563 | ||
| S85151A | 24 | 955-965 | S86292D | 23 | 949-950 | S89112A | 24 | 955-965 | ||
| S85151D | 23 | 949-950 | S86292S | 21 | 913-914 | S89112D | 08 | 559-561 | ||
| S85151S | 05 | 299-301 | S86299A | 21 | 913-914 | S89112G | 08 | 559-561 | ||
| S85152A | 21 | 913-914 | S86299A | 24 | 955-965 | S89112K | 08 | 564-566 | ||
| S85152A | 24 | 955-965 | S86299D | 23 | 949-950 | S89112P | 08 | 564-566 | ||
| S85152D | 23 | 949-950 | S86299S | 21 | 913-914 | S89112S | 08 | 559-561 | ||
| S85152S | 05 | 299-301 | S86301A | 21 | 913-914 | S89119A | 08 | 562-563 | ||
| S85159A | 21 | 913-914 | S86301A | 24 | 955-965 | S89119A | 24 | 955-965 | ||
| S85159A | 24 | 955-965 | S86301D | 23 | 949-950 | S89119D | 08 | 559-561 | ||
| S85159D | 23 | 949-950 | S86301S | 21 | 913-914 | S89119G | 08 | 559-561 | ||
| S85159S | 05 | 299-301 | S86302A | 21 | 913-914 | S89119K | 08 | 564-566 | ||
| S85161A | 21 | 913-914 | S86302A | 24 | 955-965 | S89119P | 08 | 564-566 | ||
| S85161A | 24 | 955-965 | S86302D | 23 | 949-950 | S89119S | 08 | 559-561 | ||
| S85161D | 23 | 949-950 | S86302S | 21 | 913-914 | S89121A | 08 | 562-563 | ||
| S85161S | 05 | 299-301 | S86309A | 21 | 913-914 | S89121A | 24 | 955-965 | ||
| S85162A | 21 | 913-914 | S86309A | 24 | 955-965 | S89121D | 08 | 559-561 | ||
| S85162A | 24 | 955-965 | S86309D | 23 | 949-950 | S89121G | 08 | 559-561 | ||
| S85162D | 23 | 949-950 | S86309S | 21 | 913-914 | S89121K | 08 | 564-566 | ||
| S85162S | 05 | 299-301 | S86311A | 08 | 562-563 | S89121P | 08 | 564-566 | ||
| S85169A | 21 | 913-914 | S86311A | 24 | 955-965 | S89121S | 08 | 559-561 | ||
| S85169A | 24 | 955-965 | S86311D | 23 | 949-950 | S89122A | 08 | 562-563 | ||
| S85169D | 23 | 949-950 | S86311S | 08 | 562-563 | S89122A | 24 | 955-965 | ||
| S85169S | 05 | 299-301 | S86312A | 08 | 562-563 | S89122D | 08 | 559-561 | ||
| S85171A | 21 | 913-914 | S86312A | 24 | 955-965 | S89122G | 08 | 559-561 | ||
| S85171A | 24 | 955-965 | S86312D | 23 | 949-950 | S89122K | 08 | 564-566 | ||
| S85171D | 23 | 949-950 | S86312S | 08 | 562-563 | S89122P | 08 | 564-566 | ||
| S85171S | 05 | 299-301 | S86319A | 08 | 562-563 | S89122S | 08 | 559-561 | ||
| S85172A | 21 | 913-914 | S86319A | 24 | 955-965 | S89129A | 08 | 562-563 | ||
| S85172A | 24 | 955-965 | S86319D | 23 | 949-950 | S89129A | 24 | 955-965 | ||
| S85172D | 23 | 949-950 | S86319S | 08 | 562-563 | S89129D | 08 | 559-561 | ||
| S85172S | 05 | 299-301 | S86321A | 08 | 564-566 | S89129G | 08 | 559-561 | ||
| S85179A | 21 | 913-914 | S86321A | 24 | 955-965 | S89129K | 08 | 564-566 | ||
| S85179A | 24 | 955-965 | S86321D | 23 | 949-950 | S89129P | 08 | 564-566 | ||
| S85179D | 23 | 949-950 | S86321S | 09 | 604-605 | S89129S | 08 | 559-561 | ||
| S85179S | 05 | 299-301 | S86322A | 08 | 564-566 | S89131A | 08 | 562-563 | ||
| S85181A | 21 | 913-914 | S86322A | 24 | 955-965 | S89131A | 24 | 955-965 | ||
| S85181A | 24 | 955-965 | S86322D | 23 | 949-950 | S89131D | 08 | 559-561 | ||
| S85181D | 23 | 949-950 | S86322S | 09 | 604-605 | S89131G | 08 | 559-561 | ||
| S85181S | 05 | 299-301 | S86329A | 08 | 564-566 | S89131K | 08 | 564-566 | ||
| S85182A | 21 | 913-914 | S86329A | 24 | 955-965 | S89131P | 08 | 564-566 | ||
| S85182A | 24 | 955-965 | S86329D | 23 | 949-950 | S89131S | 08 | 559-561 | ||
| S85182D | 23 | 949-950 | S86329S | 09 | 604-605 | S89132A | 08 | 562-563 | ||
| S85182S | 05 | 299-301 | S86391A | 21 | 913-914 | S89132A | 24 | 955-965 | ||
| S85189A | 21 | 913-914 | S86391A | 24 | 955-965 | S89132D | 08 | 559-561 | ||
| S85189A | 24 | 955-965 | S86391D | 23 | 949-950 | S89132G | 08 | 559-561 | ||
| S85189D | 23 | 949-950 | S86391S | 21 | 913-914 | S89132K | 08 | 564-566 | ||
| S85189S | 05 | 299-301 | S86392A | 21 | 913-914 | S89132P | 08 | 564-566 | ||
| S85201A | 21 | 913-914 | S86392A | 24 | 955-965 | S89132S | 08 | 559-561 | ||
| S85201A | 24 | 955-965 | S86392D | 23 | 949-950 | S89139A | 08 | 562-563 | ||
| S85201D | 23 | 949-950 | S86392S | 21 | 913-914 | S89139A | 24 | 955-965 | ||
| S85201S | 05 | 299-301 | S86399A | 21 | 913-914 | S89139D | 08 | 559-561 | ||
| S85202A | 21 | 913-914 | S86399A | 24 | 955-965 | S89139G | 08 | 559-561 | ||
| S85202A | 24 | 955-965 | S86399D | 23 | 949-950 | S89139K | 08 | 564-566 | ||
| S85202D | 23 | 949-950 | S86399S | 21 | 913-914 | S89139P | 08 | 564-566 | ||
| S85202S | 05 | 299-301 | S86801A | 21 | 913-914 | S89139S | 08 | 559-561 | ||
| S85209A | 21 | 913-914 | S86801A | 24 | 955-965 | S89141A | 08 | 562-563 | ||
| S85209A | 24 | 955-965 | S86801D | 23 | 949-950 | S89141A | 24 | 955-965 | ||
| S85209D | 23 | 949-950 | S86801S | 21 | 913-914 | S89141D | 08 | 559-561 | ||
| S85209S | 05 | 299-301 | S86802A | 21 | 913-914 | S89141G | 08 | 559-561 | ||
| S85211A | 21 | 913-914 | S86802A | 24 | 955-965 | S89141K | 08 | 564-566 | ||
| S85211A | 24 | 955-965 | S86802D | 23 | 949-950 | S89141P | 08 | 564-566 | ||
| S85211D | 23 | 949-950 | S86802S | 21 | 913-914 | S89141S | 08 | 559-561 | ||
| S85211S | 05 | 299-301 | S86809A | 21 | 913-914 | S89142A | 08 | 562-563 | ||
| S85212A | 21 | 913-914 | S86809A | 24 | 955-965 | S89142A | 24 | 955-965 | ||
| S85212A | 24 | 955-965 | S86809D | 23 | 949-950 | S89142D | 08 | 559-561 | ||
| S85212D | 23 | 949-950 | S86809S | 21 | 913-914 | S89142G | 08 | 559-561 | ||
| S85212S | 05 | 299-301 | S86811A | 08 | 562-563 | S89142K | 08 | 564-566 | ||
| S85219A | 21 | 913-914 | S86811A | 24 | 955-965 | S89142P | 08 | 564-566 | ||
| S85219A | 24 | 955-965 | S86811D | 23 | 949-950 | S89142S | 08 | 559-561 | ||
| S85219D | 23 | 949-950 | S86811S | 08 | 562-563 | S89149A | 08 | 562-563 | ||
| S85219S | 05 | 299-301 | S86812A | 08 | 562-563 | S89149A | 24 | 955-965 | ||
| S85291A | 21 | 913-914 | S86812A | 24 | 955-965 | S89149D | 08 | 559-561 | ||
| S85291A | 24 | 955-965 | S86812D | 23 | 949-950 | S89149G | 08 | 559-561 | ||
| S85291D | 23 | 949-950 | S86812S | 08 | 562-563 | S89149K | 08 | 564-566 | ||
| S85291S | 05 | 299-301 | S86819A | 08 | 562-563 | S89149P | 08 | 564-566 | ||
| S85292A | 21 | 913-914 | S86819A | 24 | 955-965 | S89149S | 08 | 559-561 | ||
| S85292A | 24 | 955-965 | S86819D | 23 | 949-950 | S89191A | 08 | 562-563 | ||
| S85292D | 23 | 949-950 | S86819S | 08 | 562-563 | S89191A | 24 | 955-965 | ||
| S85292S | 05 | 299-301 | S86821A | 08 | 564-566 | S89191D | 08 | 559-561 | ||
| S85299A | 21 | 913-914 | S86821A | 24 | 955-965 | S89191G | 08 | 559-561 | ||
| S85299A | 24 | 955-965 | S86821D | 23 | 949-950 | S89191K | 08 | 564-566 | ||
| S85299D | 23 | 949-950 | S86821S | 09 | 604-605 | S89191P | 08 | 564-566 | ||
| S85299S | 05 | 299-301 | S86822A | 08 | 564-566 | S89191S | 08 | 559-561 | ||
| S85301A | 21 | 913-914 | S86822A | 24 | 955-965 | S89192A | 08 | 562-563 | ||
| S85301A | 24 | 955-965 | S86822D | 23 | 949-950 | S89192A | 24 | 955-965 | ||
| S85301D | 23 | 949-950 | S86822S | 09 | 604-605 | S89192D | 08 | 559-561 | ||
| S85301S | 05 | 299-301 | S86829A | 08 | 564-566 | S89192G | 08 | 559-561 | ||
| S85302A | 21 | 913-914 | S86829A | 24 | 955-965 | S89192K | 08 | 564-566 | ||
| S85302A | 24 | 955-965 | S86829D | 23 | 949-950 | S89192P | 08 | 564-566 | ||
| S85302D | 23 | 949-950 | S86829S | 09 | 604-605 | S89192S | 08 | 559-561 | ||
| S85302S | 05 | 299-301 | S86891A | 21 | 913-914 | S89199A | 08 | 562-563 | ||
| S85309A | 21 | 913-914 | S86891A | 24 | 955-965 | S89199A | 24 | 955-965 | ||
| S85309A | 24 | 955-965 | S86891D | 23 | 949-950 | S89199D | 08 | 559-561 | ||
| S85309D | 23 | 949-950 | S86891S | 21 | 913-914 | S89199G | 08 | 559-561 | ||
| S85309S | 05 | 299-301 | S86892A | 21 | 913-914 | S89199K | 08 | 564-566 | ||
| S85311A | 21 | 913-914 | S86892A | 24 | 955-965 | S89199P | 08 | 564-566 | ||
| S85311A | 24 | 955-965 | S86892D | 23 | 949-950 | S89199S | 08 | 559-561 | ||
| S85311D | 23 | 949-950 | S86892S | 21 | 913-914 | S89201A | 08 | 562-563 | ||
| S85311S | 05 | 299-301 | S86899A | 21 | 913-914 | S89201A | 24 | 955-965 | ||
| S85312A | 21 | 913-914 | S86899A | 24 | 955-965 | S89201D | 08 | 559-561 | ||
| S85312A | 24 | 955-965 | S86899D | 23 | 949-950 | S89201G | 08 | 559-561 | ||
| S85312D | 23 | 949-950 | S86899S | 21 | 913-914 | S89201K | 08 | 564-566 | ||
| S85312S | 05 | 299-301 | S86901A | 21 | 913-914 | S89201P | 08 | 564-566 | ||
| S85319A | 21 | 913-914 | S86901A | 24 | 955-965 | S89201S | 08 | 559-561 | ||
| S85319A | 24 | 955-965 | S86901D | 23 | 949-950 | S89202A | 08 | 562-563 | ||
| S85319D | 23 | 949-950 | S86901S | 21 | 913-914 | S89202A | 24 | 955-965 | ||
| S85319S | 05 | 299-301 | S86902A | 21 | 913-914 | S89202D | 08 | 559-561 | ||
| S85391A | 21 | 913-914 | S86902A | 24 | 955-965 | S89202G | 08 | 559-561 | ||
| S85391A | 24 | 955-965 | S86902D | 23 | 949-950 | S89202K | 08 | 564-566 | ||
| S85391D | 23 | 949-950 | S86902S | 21 | 913-914 | S89202P | 08 | 564-566 | ||
| S85391S | 05 | 299-301 | S86909A | 21 | 913-914 | S89202S | 08 | 559-561 | ||
| S85392A | 21 | 913-914 | S86909A | 24 | 955-965 | S89209A | 08 | 562-563 | ||
| S85392A | 24 | 955-965 | S86909D | 23 | 949-950 | S89209A | 24 | 955-965 | ||
| S85392D | 23 | 949-950 | S86909S | 21 | 913-914 | S89209D | 08 | 559-561 | ||
| S85392S | 05 | 299-301 | S86911A | 08 | 562-563 | S89209G | 08 | 559-561 | ||
| S85399A | 21 | 913-914 | S86911A | 24 | 955-965 | S89209K | 08 | 564-566 | ||
| S85399A | 24 | 955-965 | S86911D | 23 | 949-950 | S89209P | 08 | 564-566 | ||
| S85399D | 23 | 949-950 | S86911S | 08 | 562-563 | S89209S | 08 | 559-561 | ||
| S85399S | 05 | 299-301 | S86912A | 08 | 562-563 | S89211A | 08 | 562-563 | ||
| S85401A | 21 | 913-914 | S86912A | 24 | 955-965 | S89211A | 24 | 955-965 | ||
| S85401A | 24 | 955-965 | S86912D | 23 | 949-950 | S89211D | 08 | 559-561 | ||
| S85401D | 23 | 949-950 | S86912S | 08 | 562-563 | S89211G | 08 | 559-561 | ||
| S85401S | 05 | 299-301 | S86919A | 08 | 562-563 | S89211K | 08 | 564-566 | ||
| S85402A | 21 | 913-914 | S86919A | 24 | 955-965 | S89211P | 08 | 564-566 | ||
| S85402A | 24 | 955-965 | S86919D | 23 | 949-950 | S89211S | 08 | 559-561 | ||
| S85402D | 23 | 949-950 | S86919S | 08 | 562-563 | S89212A | 08 | 562-563 | ||
| S85402S | 05 | 299-301 | S86921A | 08 | 564-566 | S89212A | 24 | 955-965 | ||
| S85409A | 21 | 913-914 | S86921A | 24 | 955-965 | S89212D | 08 | 559-561 | ||
| S85409A | 24 | 955-965 | S86921D | 23 | 949-950 | S89212G | 08 | 559-561 | ||
| S85409D | 23 | 949-950 | S86921S | 09 | 604-605 | S89212K | 08 | 564-566 | ||
| S85409S | 05 | 299-301 | S86922A | 08 | 564-566 | S89212P | 08 | 564-566 | ||
| S85411A | 21 | 913-914 | S86922A | 24 | 955-965 | S89212S | 08 | 559-561 | ||
| S85411A | 24 | 955-965 | S86922D | 23 | 949-950 | S89219A | 08 | 562-563 | ||
| S85411D | 23 | 949-950 | S86922S | 09 | 604-605 | S89219A | 24 | 955-965 | ||
| S85411S | 05 | 299-301 | S86929A | 08 | 564-566 | S89219D | 08 | 559-561 | ||
| S85412A | 21 | 913-914 | S86929A | 24 | 955-965 | S89219G | 08 | 559-561 | ||
| S85412A | 24 | 955-965 | S86929D | 23 | 949-950 | S89219K | 08 | 564-566 | ||
| S85412D | 23 | 949-950 | S86929S | 09 | 604-605 | S89219P | 08 | 564-566 | ||
| S85412S | 05 | 299-301 | S86991A | 21 | 913-914 | S89219S | 08 | 559-561 | ||
| S85419A | 21 | 913-914 | S86991A | 24 | 955-965 | S89221A | 08 | 562-563 | ||
| S85419A | 24 | 955-965 | S86991D | 23 | 949-950 | S89221A | 24 | 955-965 | ||
| S85419D | 23 | 949-950 | S86991S | 21 | 913-914 | S89221D | 08 | 559-561 | ||
| S85419S | 05 | 299-301 | S86992A | 21 | 913-914 | S89221G | 08 | 559-561 | ||
| S85491A | 21 | 913-914 | S86992A | 24 | 955-965 | S89221K | 08 | 564-566 | ||
| S85491A | 24 | 955-965 | S86992D | 23 | 949-950 | S89221P | 08 | 564-566 | ||
| S85491D | 23 | 949-950 | S86992S | 21 | 913-914 | S89221S | 08 | 559-561 | ||
| S85491S | 05 | 299-301 | S86999A | 21 | 913-914 | S89222A | 08 | 562-563 | ||
| S85492A | 21 | 913-914 | S86999A | 24 | 955-965 | S89222A | 24 | 955-965 | ||
| S85492A | 24 | 955-965 | S86999D | 23 | 949-950 | S89222D | 08 | 559-561 | ||
| S85492D | 23 | 949-950 | S86999S | 21 | 913-914 | S89222G | 08 | 559-561 | ||
| S85492S | 05 | 299-301 | S8700XA | 21 | 913-914 | S89222K | 08 | 564-566 | ||
| S85499A | 21 | 913-914 | S8700XA | 24 | 955-965 | S89222P | 08 | 564-566 | ||
| S85499A | 24 | 955-965 | S8700XD | 23 | 949-950 | S89222S | 08 | 559-561 | ||
| S85499D | 23 | 949-950 | S8700XS | 09 | 604-605 | S89229A | 08 | 562-563 | ||
| S85499S | 05 | 299-301 | S8701XA | 21 | 913-914 | S89229A | 24 | 955-965 | ||
| S85501A | 21 | 913-914 | S8701XA | 24 | 955-965 | S89229D | 08 | 559-561 | ||
| S85501A | 24 | 955-965 | S8701XD | 23 | 949-950 | S89229G | 08 | 559-561 | ||
| S85501D | 23 | 949-950 | S8701XS | 09 | 604-605 | S89229K | 08 | 564-566 | ||
| S85501S | 05 | 299-301 | S8702XA | 21 | 913-914 | S89229P | 08 | 564-566 | ||
| S85502A | 21 | 913-914 | S8702XA | 24 | 955-965 | S89229S | 08 | 559-561 | ||
| S85502A | 24 | 955-965 | S8702XD | 23 | 949-950 | S89291A | 08 | 562-563 | ||
| S85502D | 23 | 949-950 | S8702XS | 09 | 604-605 | S89291A | 24 | 955-965 | ||
| S85502S | 05 | 299-301 | S8780XA | 21 | 913-914 | S89291D | 08 | 559-561 | ||
| S85509A | 21 | 913-914 | S8780XA | 24 | 955-965 | S89291G | 08 | 559-561 | ||
| S85509A | 24 | 955-965 | S8780XD | 23 | 949-950 | S89291K | 08 | 564-566 | ||
| S85509D | 23 | 949-950 | S8780XS | 09 | 604-605 | S89291P | 08 | 564-566 | ||
| S85509S | 05 | 299-301 | S8781XA | 21 | 913-914 | S89291S | 08 | 559-561 | ||
| S85511A | 21 | 913-914 | S8781XA | 24 | 955-965 | S89292A | 08 | 562-563 | ||
| S85511A | 24 | 955-965 | S8781XD | 23 | 949-950 | S89292A | 24 | 955-965 | ||
| S85511D | 23 | 949-950 | S8781XS | 09 | 604-605 | S89292D | 08 | 559-561 | ||
| S85511S | 05 | 299-301 | S8782XA | 21 | 913-914 | S89292G | 08 | 559-561 | ||
| S85512A | 21 | 913-914 | S8782XA | 24 | 955-965 | S89292K | 08 | 564-566 | ||
| S85512A | 24 | 955-965 | S8782XD | 23 | 949-950 | S89292P | 08 | 564-566 | ||
| S85512D | 23 | 949-950 | S8782XS | 09 | 604-605 | S89292S | 08 | 559-561 | ||
| S85512S | 05 | 299-301 | S88011A | 21 | 913-914 | S89299A | 08 | 562-563 | ||
| S85519A | 21 | 913-914 | S88011A | 24 | 955-965 | S89299A | 24 | 955-965 | ||
| S85519A | 24 | 955-965 | S88011D | 23 | 949-950 | S89299D | 08 | 559-561 | ||
| S85519D | 23 | 949-950 | S88011S | 08 | 559-561 | S89299G | 08 | 559-561 | ||
| S85519S | 05 | 299-301 | S88012A | 21 | 913-914 | S89299K | 08 | 564-566 | ||
| S85591A | 21 | 913-914 | S88012A | 24 | 955-965 | S89299P | 08 | 564-566 | ||
| S85591A | 24 | 955-965 | S88012D | 23 | 949-950 | S89299S | 08 | 559-561 | ||
| S85591D | 23 | 949-950 | S88012S | 08 | 559-561 | S89301A | 08 | 562-563 | ||
| S85591S | 05 | 299-301 | S88019A | 21 | 913-914 | S89301A | 24 | 955-965 | ||
| S85592A | 21 | 913-914 | S88019A | 24 | 955-965 | S89301D | 08 | 559-561 | ||
| S85592A | 24 | 955-965 | S88019D | 23 | 949-950 | S89301G | 08 | 559-561 | ||
| S85592D | 23 | 949-950 | S88019S | 08 | 559-561 | S89301K | 08 | 564-566 | ||
| S85592S | 05 | 299-301 | S88021A | 21 | 913-914 | S89301P | 08 | 564-566 | ||
| S85599A | 21 | 913-914 | S88021A | 24 | 955-965 | S89301S | 08 | 559-561 | ||
| S85599A | 24 | 955-965 | S88021D | 23 | 949-950 | S89302A | 08 | 562-563 | ||
| S85599D | 23 | 949-950 | S88021S | 08 | 559-561 | S89302A | 24 | 955-965 | ||
| S85599S | 05 | 299-301 | S88022A | 21 | 913-914 | S89302D | 08 | 559-561 | ||
| S85801A | 21 | 913-914 | S88022A | 24 | 955-965 | S89302G | 08 | 559-561 | ||
| S85801A | 24 | 955-965 | S88022D | 23 | 949-950 | S89302K | 08 | 564-566 | ||
| S85801D | 23 | 949-950 | S88022S | 08 | 559-561 | S89302P | 08 | 564-566 | ||
| S85801S | 05 | 299-301 | S88029A | 21 | 913-914 | S89302S | 08 | 559-561 | ||
| S85802A | 21 | 913-914 | S88029A | 24 | 955-965 | S89309A | 08 | 562-563 | ||
| S85802A | 24 | 955-965 | S88029D | 23 | 949-950 | S89309A | 24 | 955-965 | ||
| S85802D | 23 | 949-950 | S88029S | 08 | 559-561 | S89309D | 08 | 559-561 | ||
| S85802S | 05 | 299-301 | S88111A | 21 | 913-914 | S89309G | 08 | 559-561 | ||
| S85809A | 21 | 913-914 | S88111A | 24 | 955-965 | S89309K | 08 | 564-566 | ||
| S85809A | 24 | 955-965 | S88111D | 23 | 949-950 | S89309P | 08 | 564-566 | ||
| S85809D | 23 | 949-950 | S88111S | 08 | 559-561 | S89309S | 08 | 559-561 | ||
| S85809S | 05 | 299-301 | S88112A | 21 | 913-914 | S89311A | 08 | 562-563 | ||
| S85811A | 21 | 913-914 | S88112A | 24 | 955-965 | S89311A | 24 | 955-965 | ||
| S85811A | 24 | 955-965 | S88112D | 23 | 949-950 | S89311D | 08 | 559-561 | ||
| S85811D | 23 | 949-950 | S88112S | 08 | 559-561 | S89311G | 08 | 559-561 | ||
| S85811S | 05 | 299-301 | S88119A | 21 | 913-914 | S89311K | 08 | 564-566 | ||
| S85812A | 21 | 913-914 | S88119A | 24 | 955-965 | S89311P | 08 | 564-566 | ||
| S85812A | 24 | 955-965 | S88119D | 23 | 949-950 | S89311S | 08 | 559-561 | ||
| S85812D | 23 | 949-950 | S88119S | 08 | 559-561 | S89312A | 08 | 562-563 | ||
| S85812S | 05 | 299-301 | S88121A | 21 | 913-914 | S89312A | 24 | 955-965 | ||
| S85819A | 21 | 913-914 | S88121A | 24 | 955-965 | S89312D | 08 | 559-561 | ||
| S85819A | 24 | 955-965 | S88121D | 23 | 949-950 | S89312G | 08 | 559-561 | ||
| S85819D | 23 | 949-950 | S88121S | 08 | 559-561 | S89312K | 08 | 564-566 | ||
| S85819S | 05 | 299-301 | S88122A | 21 | 913-914 | S89312P | 08 | 564-566 | ||
| S85891A | 21 | 913-914 | S88122A | 24 | 955-965 | S89312S | 08 | 559-561 | ||
| S85891A | 24 | 955-965 | S88122D | 23 | 949-950 | S89319A | 08 | 562-563 | ||
| S85891D | 23 | 949-950 | S88122S | 08 | 559-561 | S89319A | 24 | 955-965 | ||
| S85891S | 05 | 299-301 | S88129A | 21 | 913-914 | S89319D | 08 | 559-561 | ||
| S85892A | 21 | 913-914 | S88129A | 24 | 955-965 | S89319G | 08 | 559-561 | ||
| S85892A | 24 | 955-965 | S88129D | 23 | 949-950 | S89319K | 08 | 564-566 | ||
| S85892D | 23 | 949-950 | S88129S | 08 | 559-561 | S89319P | 08 | 564-566 | ||
| S85892S | 05 | 299-301 | S88911A | 21 | 913-914 | S89319S | 08 | 559-561 | ||
| S85899A | 21 | 913-914 | S88911A | 24 | 955-965 | S89321A | 08 | 562-563 | ||
| S85899A | 24 | 955-965 | S88911D | 23 | 949-950 | S89321A | 24 | 955-965 | ||
| S85899D | 23 | 949-950 | S88911S | 08 | 559-561 | S89321D | 08 | 559-561 | ||
| S85899S | 05 | 299-301 | S88912A | 21 | 913-914 | S89321G | 08 | 559-561 | ||
| S85901A | 21 | 913-914 | S88912A | 24 | 955-965 | S89321K | 08 | 564-566 | ||
| S85901A | 24 | 955-965 | S88912D | 23 | 949-950 | S89321P | 08 | 564-566 | ||
| S85901D | 23 | 949-950 | S88912S | 08 | 559-561 | S89321S | 08 | 559-561 | ||
| S85901S | 05 | 299-301 | S88919A | 21 | 913-914 | S89322A | 08 | 562-563 | ||
| S85902A | 21 | 913-914 | S88919A | 24 | 955-965 | S89322A | 24 | 955-965 | ||
| S85902A | 24 | 955-965 | S88919D | 23 | 949-950 | S89322D | 08 | 559-561 | ||
| S85902D | 23 | 949-950 | S88919S | 08 | 559-561 | S89322G | 08 | 559-561 | ||
| S85902S | 05 | 299-301 | S88921A | 21 | 913-914 | S89322K | 08 | 564-566 | ||
| S85909A | 21 | 913-914 | S88921A | 24 | 955-965 | S89322P | 08 | 564-566 | ||
| S85909A | 24 | 955-965 | S88921D | 23 | 949-950 | S89322S | 08 | 559-561 | ||
| S85909D | 23 | 949-950 | S88921S | 08 | 559-561 | S89329A | 08 | 562-563 | ||
| S85909S | 05 | 299-301 | S88922A | 21 | 913-914 | S89329A | 24 | 955-965 | ||
| S85911A | 21 | 913-914 | S88922A | 24 | 955-965 | S89329D | 08 | 559-561 | ||
| S85911A | 24 | 955-965 | S88922D | 23 | 949-950 | S89329G | 08 | 559-561 | ||
| S85911D | 23 | 949-950 | S88922S | 08 | 559-561 | S89329K | 08 | 564-566 | ||
| S85911S | 05 | 299-301 | S88929A | 21 | 913-914 | S89329P | 08 | 564-566 | ||
| S85912A | 21 | 913-914 | S88929A | 24 | 955-965 | S89329S | 08 | 559-561 | ||
| S85912A | 24 | 955-965 | S88929D | 23 | 949-950 | S89391A | 08 | 562-563 | ||
| S85912D | 23 | 949-950 | S88929S | 08 | 559-561 | S89391A | 24 | 955-965 | ||
| S85912S | 05 | 299-301 | S89001A | 08 | 562-563 | S89391D | 08 | 559-561 | ||
| S85919A | 21 | 913-914 | S89001A | 24 | 955-965 | S89391G | 08 | 559-561 | ||
| S85919A | 24 | 955-965 | S89001D | 08 | 559-561 | S89391K | 08 | 564-566 | ||
| S85919D | 23 | 949-950 | S89001G | 08 | 559-561 | S89391P | 08 | 564-566 | ||
| S85919S | 05 | 299-301 | S89001K | 08 | 564-566 | S89391S | 08 | 559-561 | ||
| S85991A | 21 | 913-914 | S89001P | 08 | 564-566 | S89392A | 08 | 562-563 | ||
| S85991A | 24 | 955-965 | S89001S | 08 | 559-561 | S89392A | 24 | 955-965 | ||
| S85991D | 23 | 949-950 | S89002A | 08 | 562-563 | S89392D | 08 | 559-561 | ||
| S85991S | 05 | 299-301 | S89002A | 24 | 955-965 | S89392G | 08 | 559-561 | ||
| S85992A | 21 | 913-914 | S89002D | 08 | 559-561 | S89392K | 08 | 564-566 | ||
| S85992A | 24 | 955-965 | S89002G | 08 | 559-561 | S89392P | 08 | 564-566 | ||
| S85992D | 23 | 949-950 | S89002K | 08 | 564-566 | S89392S | 08 | 559-561 | ||
| S85992S | 05 | 299-301 | S89002P | 08 | 564-566 | S89399A | 08 | 562-563 | ||
| S89399A | 24 | 955-965 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 25 Aug 2017 11:52:25 CMS, code-revision=63, description-revision=616 |