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 59 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 | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S92504G | 08 | 559-561 | S93132D | 23 | 949-950 | S9490XS | 01 | 091-093 | ||
| S92504K | 08 | 564-566 | S93132S | 08 | 562-563 | S9491XA | 01 | 073-074 | ||
| S92504P | 08 | 564-566 | S93133A | 08 | 562-563 | S9491XA | 24 | 955-965 | ||
| S92504S | 08 | 559-561 | S93133A | 24 | 955-965 | S9491XD | 23 | 949-950 | ||
| S92505A | 08 | 562-563 | S93133D | 23 | 949-950 | S9491XS | 01 | 091-093 | ||
| S92505A | 24 | 955-965 | S93133S | 08 | 562-563 | S9492XA | 01 | 073-074 | ||
| S92505B | 08 | 562-563 | S93134A | 08 | 562-563 | S9492XA | 24 | 955-965 | ||
| S92505B | 24 | 955-965 | S93134A | 24 | 955-965 | S9492XD | 23 | 949-950 | ||
| S92505D | 08 | 559-561 | S93134D | 23 | 949-950 | S9492XS | 01 | 091-093 | ||
| S92505G | 08 | 559-561 | S93134S | 08 | 562-563 | S95001A | 21 | 913-914 | ||
| S92505K | 08 | 564-566 | S93135A | 08 | 562-563 | S95001A | 24 | 955-965 | ||
| S92505P | 08 | 564-566 | S93135A | 24 | 955-965 | S95001D | 23 | 949-950 | ||
| S92505S | 08 | 559-561 | S93135D | 23 | 949-950 | S95001S | 05 | 299-301 | ||
| S92506A | 08 | 562-563 | S93135S | 08 | 562-563 | S95002A | 21 | 913-914 | ||
| S92506A | 24 | 955-965 | S93136A | 08 | 562-563 | S95002A | 24 | 955-965 | ||
| S92506B | 08 | 562-563 | S93136A | 24 | 955-965 | S95002D | 23 | 949-950 | ||
| S92506B | 24 | 955-965 | S93136D | 23 | 949-950 | S95002S | 05 | 299-301 | ||
| S92506D | 08 | 559-561 | S93136S | 08 | 562-563 | S95009A | 21 | 913-914 | ||
| S92506G | 08 | 559-561 | S93139A | 08 | 562-563 | S95009A | 24 | 955-965 | ||
| S92506K | 08 | 564-566 | S93139A | 24 | 955-965 | S95009D | 23 | 949-950 | ||
| S92506P | 08 | 564-566 | S93139D | 23 | 949-950 | S95009S | 05 | 299-301 | ||
| S92506S | 08 | 559-561 | S93139S | 08 | 562-563 | S95011A | 21 | 913-914 | ||
| S92511A | 08 | 562-563 | S93141A | 08 | 562-563 | S95011A | 24 | 955-965 | ||
| S92511A | 24 | 955-965 | S93141A | 24 | 955-965 | S95011D | 23 | 949-950 | ||
| S92511B | 08 | 562-563 | S93141D | 23 | 949-950 | S95011S | 05 | 299-301 | ||
| S92511B | 24 | 955-965 | S93141S | 08 | 562-563 | S95012A | 21 | 913-914 | ||
| S92511D | 08 | 559-561 | S93142A | 08 | 562-563 | S95012A | 24 | 955-965 | ||
| S92511G | 08 | 559-561 | S93142A | 24 | 955-965 | S95012D | 23 | 949-950 | ||
| S92511K | 08 | 564-566 | S93142D | 23 | 949-950 | S95012S | 05 | 299-301 | ||
| S92511P | 08 | 564-566 | S93142S | 08 | 562-563 | S95019A | 21 | 913-914 | ||
| S92511S | 08 | 559-561 | S93143A | 08 | 562-563 | S95019A | 24 | 955-965 | ||
| S92512A | 08 | 562-563 | S93143A | 24 | 955-965 | S95019D | 23 | 949-950 | ||
| S92512A | 24 | 955-965 | S93143D | 23 | 949-950 | S95019S | 05 | 299-301 | ||
| S92512B | 08 | 562-563 | S93143S | 08 | 562-563 | S95091A | 21 | 913-914 | ||
| S92512B | 24 | 955-965 | S93144A | 08 | 562-563 | S95091A | 24 | 955-965 | ||
| S92512D | 08 | 559-561 | S93144A | 24 | 955-965 | S95091D | 23 | 949-950 | ||
| S92512G | 08 | 559-561 | S93144D | 23 | 949-950 | S95091S | 05 | 299-301 | ||
| S92512K | 08 | 564-566 | S93144S | 08 | 562-563 | S95092A | 21 | 913-914 | ||
| S92512P | 08 | 564-566 | S93145A | 08 | 562-563 | S95092A | 24 | 955-965 | ||
| S92512S | 08 | 559-561 | S93145A | 24 | 955-965 | S95092D | 23 | 949-950 | ||
| S92513A | 08 | 562-563 | S93145D | 23 | 949-950 | S95092S | 05 | 299-301 | ||
| S92513A | 24 | 955-965 | S93145S | 08 | 562-563 | S95099A | 21 | 913-914 | ||
| S92513B | 08 | 562-563 | S93146A | 08 | 562-563 | S95099A | 24 | 955-965 | ||
| S92513B | 24 | 955-965 | S93146A | 24 | 955-965 | S95099D | 23 | 949-950 | ||
| S92513D | 08 | 559-561 | S93146D | 23 | 949-950 | S95099S | 05 | 299-301 | ||
| S92513G | 08 | 559-561 | S93146S | 08 | 562-563 | S95101A | 21 | 913-914 | ||
| S92513K | 08 | 564-566 | S93149A | 08 | 562-563 | S95101A | 24 | 955-965 | ||
| S92513P | 08 | 564-566 | S93149A | 24 | 955-965 | S95101D | 23 | 949-950 | ||
| S92513S | 08 | 559-561 | S93149D | 23 | 949-950 | S95101S | 05 | 299-301 | ||
| S92514A | 08 | 562-563 | S93149S | 08 | 562-563 | S95102A | 21 | 913-914 | ||
| S92514A | 24 | 955-965 | S93301A | 08 | 562-563 | S95102A | 24 | 955-965 | ||
| S92514B | 08 | 562-563 | S93301A | 24 | 955-965 | S95102D | 23 | 949-950 | ||
| S92514B | 24 | 955-965 | S93301D | 23 | 949-950 | S95102S | 05 | 299-301 | ||
| S92514D | 08 | 559-561 | S93301S | 08 | 562-563 | S95109A | 21 | 913-914 | ||
| S92514G | 08 | 559-561 | S93302A | 08 | 562-563 | S95109A | 24 | 955-965 | ||
| S92514K | 08 | 564-566 | S93302A | 24 | 955-965 | S95109D | 23 | 949-950 | ||
| S92514P | 08 | 564-566 | S93302D | 23 | 949-950 | S95109S | 05 | 299-301 | ||
| S92514S | 08 | 559-561 | S93302S | 08 | 562-563 | S95111A | 21 | 913-914 | ||
| S92515A | 08 | 562-563 | S93303A | 08 | 562-563 | S95111A | 24 | 955-965 | ||
| S92515A | 24 | 955-965 | S93303A | 24 | 955-965 | S95111D | 23 | 949-950 | ||
| S92515B | 08 | 562-563 | S93303D | 23 | 949-950 | S95111S | 05 | 299-301 | ||
| S92515B | 24 | 955-965 | S93303S | 08 | 562-563 | S95112A | 21 | 913-914 | ||
| S92515D | 08 | 559-561 | S93304A | 08 | 562-563 | S95112A | 24 | 955-965 | ||
| S92515G | 08 | 559-561 | S93304A | 24 | 955-965 | S95112D | 23 | 949-950 | ||
| S92515K | 08 | 564-566 | S93304D | 23 | 949-950 | S95112S | 05 | 299-301 | ||
| S92515P | 08 | 564-566 | S93304S | 08 | 562-563 | S95119A | 21 | 913-914 | ||
| S92515S | 08 | 559-561 | S93305A | 08 | 562-563 | S95119A | 24 | 955-965 | ||
| S92516A | 08 | 562-563 | S93305A | 24 | 955-965 | S95119D | 23 | 949-950 | ||
| S92516A | 24 | 955-965 | S93305D | 23 | 949-950 | S95119S | 05 | 299-301 | ||
| S92516B | 08 | 562-563 | S93305S | 08 | 562-563 | S95191A | 21 | 913-914 | ||
| S92516B | 24 | 955-965 | S93306A | 08 | 562-563 | S95191A | 24 | 955-965 | ||
| S92516D | 08 | 559-561 | S93306A | 24 | 955-965 | S95191D | 23 | 949-950 | ||
| S92516G | 08 | 559-561 | S93306D | 23 | 949-950 | S95191S | 05 | 299-301 | ||
| S92516K | 08 | 564-566 | S93306S | 08 | 562-563 | S95192A | 21 | 913-914 | ||
| S92516P | 08 | 564-566 | S93311A | 08 | 562-563 | S95192A | 24 | 955-965 | ||
| S92516S | 08 | 559-561 | S93311A | 24 | 955-965 | S95192D | 23 | 949-950 | ||
| S92521A | 08 | 562-563 | S93311D | 23 | 949-950 | S95192S | 05 | 299-301 | ||
| S92521A | 24 | 955-965 | S93311S | 08 | 562-563 | S95199A | 21 | 913-914 | ||
| S92521B | 08 | 562-563 | S93312A | 08 | 562-563 | S95199A | 24 | 955-965 | ||
| S92521B | 24 | 955-965 | S93312A | 24 | 955-965 | S95199D | 23 | 949-950 | ||
| S92521D | 08 | 559-561 | S93312D | 23 | 949-950 | S95199S | 05 | 299-301 | ||
| S92521G | 08 | 559-561 | S93312S | 08 | 562-563 | S95201A | 21 | 913-914 | ||
| S92521K | 08 | 564-566 | S93313A | 08 | 562-563 | S95201A | 24 | 955-965 | ||
| S92521P | 08 | 564-566 | S93313A | 24 | 955-965 | S95201D | 23 | 949-950 | ||
| S92521S | 08 | 559-561 | S93313D | 23 | 949-950 | S95201S | 05 | 299-301 | ||
| S92522A | 08 | 562-563 | S93313S | 08 | 562-563 | S95202A | 21 | 913-914 | ||
| S92522A | 24 | 955-965 | S93314A | 08 | 562-563 | S95202A | 24 | 955-965 | ||
| S92522B | 08 | 562-563 | S93314A | 24 | 955-965 | S95202D | 23 | 949-950 | ||
| S92522B | 24 | 955-965 | S93314D | 23 | 949-950 | S95202S | 05 | 299-301 | ||
| S92522D | 08 | 559-561 | S93314S | 08 | 562-563 | S95209A | 21 | 913-914 | ||
| S92522G | 08 | 559-561 | S93315A | 08 | 562-563 | S95209A | 24 | 955-965 | ||
| S92522K | 08 | 564-566 | S93315A | 24 | 955-965 | S95209D | 23 | 949-950 | ||
| S92522P | 08 | 564-566 | S93315D | 23 | 949-950 | S95209S | 05 | 299-301 | ||
| S92522S | 08 | 559-561 | S93315S | 08 | 562-563 | S95211A | 21 | 913-914 | ||
| S92523A | 08 | 562-563 | S93316A | 08 | 562-563 | S95211A | 24 | 955-965 | ||
| S92523A | 24 | 955-965 | S93316A | 24 | 955-965 | S95211D | 23 | 949-950 | ||
| S92523B | 08 | 562-563 | S93316D | 23 | 949-950 | S95211S | 05 | 299-301 | ||
| S92523B | 24 | 955-965 | S93316S | 08 | 562-563 | S95212A | 21 | 913-914 | ||
| S92523D | 08 | 559-561 | S93321A | 08 | 562-563 | S95212A | 24 | 955-965 | ||
| S92523G | 08 | 559-561 | S93321A | 24 | 955-965 | S95212D | 23 | 949-950 | ||
| S92523K | 08 | 564-566 | S93321D | 23 | 949-950 | S95212S | 05 | 299-301 | ||
| S92523P | 08 | 564-566 | S93321S | 08 | 562-563 | S95219A | 21 | 913-914 | ||
| S92523S | 08 | 559-561 | S93322A | 08 | 562-563 | S95219A | 24 | 955-965 | ||
| S92524A | 08 | 562-563 | S93322A | 24 | 955-965 | S95219D | 23 | 949-950 | ||
| S92524A | 24 | 955-965 | S93322D | 23 | 949-950 | S95219S | 05 | 299-301 | ||
| S92524B | 08 | 562-563 | S93322S | 08 | 562-563 | S95291A | 21 | 913-914 | ||
| S92524B | 24 | 955-965 | S93323A | 08 | 562-563 | S95291A | 24 | 955-965 | ||
| S92524D | 08 | 559-561 | S93323A | 24 | 955-965 | S95291D | 23 | 949-950 | ||
| S92524G | 08 | 559-561 | S93323D | 23 | 949-950 | S95291S | 05 | 299-301 | ||
| S92524K | 08 | 564-566 | S93323S | 08 | 562-563 | S95292A | 21 | 913-914 | ||
| S92524P | 08 | 564-566 | S93324A | 08 | 562-563 | S95292A | 24 | 955-965 | ||
| S92524S | 08 | 559-561 | S93324A | 24 | 955-965 | S95292D | 23 | 949-950 | ||
| S92525A | 08 | 562-563 | S93324D | 23 | 949-950 | S95292S | 05 | 299-301 | ||
| S92525A | 24 | 955-965 | S93324S | 08 | 562-563 | S95299A | 21 | 913-914 | ||
| S92525B | 08 | 562-563 | S93325A | 08 | 562-563 | S95299A | 24 | 955-965 | ||
| S92525B | 24 | 955-965 | S93325A | 24 | 955-965 | S95299D | 23 | 949-950 | ||
| S92525D | 08 | 559-561 | S93325D | 23 | 949-950 | S95299S | 05 | 299-301 | ||
| S92525G | 08 | 559-561 | S93325S | 08 | 562-563 | S95801A | 21 | 913-914 | ||
| S92525K | 08 | 564-566 | S93326A | 08 | 562-563 | S95801A | 24 | 955-965 | ||
| S92525P | 08 | 564-566 | S93326A | 24 | 955-965 | S95801D | 23 | 949-950 | ||
| S92525S | 08 | 559-561 | S93326D | 23 | 949-950 | S95801S | 05 | 299-301 | ||
| S92526A | 08 | 562-563 | S93326S | 08 | 562-563 | S95802A | 21 | 913-914 | ||
| S92526A | 24 | 955-965 | S93331A | 08 | 562-563 | S95802A | 24 | 955-965 | ||
| S92526B | 08 | 562-563 | S93331A | 24 | 955-965 | S95802D | 23 | 949-950 | ||
| S92526B | 24 | 955-965 | S93331D | 23 | 949-950 | S95802S | 05 | 299-301 | ||
| S92526D | 08 | 559-561 | S93331S | 08 | 562-563 | S95809A | 21 | 913-914 | ||
| S92526G | 08 | 559-561 | S93332A | 08 | 562-563 | S95809A | 24 | 955-965 | ||
| S92526K | 08 | 564-566 | S93332A | 24 | 955-965 | S95809D | 23 | 949-950 | ||
| S92526P | 08 | 564-566 | S93332D | 23 | 949-950 | S95809S | 05 | 299-301 | ||
| S92526S | 08 | 559-561 | S93332S | 08 | 562-563 | S95811A | 21 | 913-914 | ||
| S92531A | 08 | 562-563 | S93333A | 08 | 562-563 | S95811A | 24 | 955-965 | ||
| S92531A | 24 | 955-965 | S93333A | 24 | 955-965 | S95811D | 23 | 949-950 | ||
| S92531B | 08 | 562-563 | S93333D | 23 | 949-950 | S95811S | 05 | 299-301 | ||
| S92531B | 24 | 955-965 | S93333S | 08 | 562-563 | S95812A | 21 | 913-914 | ||
| S92531D | 08 | 559-561 | S93334A | 08 | 562-563 | S95812A | 24 | 955-965 | ||
| S92531G | 08 | 559-561 | S93334A | 24 | 955-965 | S95812D | 23 | 949-950 | ||
| S92531K | 08 | 564-566 | S93334D | 23 | 949-950 | S95812S | 05 | 299-301 | ||
| S92531P | 08 | 564-566 | S93334S | 08 | 562-563 | S95819A | 21 | 913-914 | ||
| S92531S | 08 | 559-561 | S93335A | 08 | 562-563 | S95819A | 24 | 955-965 | ||
| S92532A | 08 | 562-563 | S93335A | 24 | 955-965 | S95819D | 23 | 949-950 | ||
| S92532A | 24 | 955-965 | S93335D | 23 | 949-950 | S95819S | 05 | 299-301 | ||
| S92532B | 08 | 562-563 | S93335S | 08 | 562-563 | S95891A | 21 | 913-914 | ||
| S92532B | 24 | 955-965 | S93336A | 08 | 562-563 | S95891A | 24 | 955-965 | ||
| S92532D | 08 | 559-561 | S93336A | 24 | 955-965 | S95891D | 23 | 949-950 | ||
| S92532G | 08 | 559-561 | S93336D | 23 | 949-950 | S95891S | 05 | 299-301 | ||
| S92532K | 08 | 564-566 | S93336S | 08 | 562-563 | S95892A | 21 | 913-914 | ||
| S92532P | 08 | 564-566 | S93401A | 08 | 562-563 | S95892A | 24 | 955-965 | ||
| S92532S | 08 | 559-561 | S93401A | 24 | 955-965 | S95892D | 23 | 949-950 | ||
| S92533A | 08 | 562-563 | S93401D | 23 | 949-950 | S95892S | 05 | 299-301 | ||
| S92533A | 24 | 955-965 | S93401S | 08 | 562-563 | S95899A | 21 | 913-914 | ||
| S92533B | 08 | 562-563 | S93402A | 08 | 562-563 | S95899A | 24 | 955-965 | ||
| S92533B | 24 | 955-965 | S93402A | 24 | 955-965 | S95899D | 23 | 949-950 | ||
| S92533D | 08 | 559-561 | S93402D | 23 | 949-950 | S95899S | 05 | 299-301 | ||
| S92533G | 08 | 559-561 | S93402S | 08 | 562-563 | S95901A | 21 | 913-914 | ||
| S92533K | 08 | 564-566 | S93409A | 08 | 562-563 | S95901A | 24 | 955-965 | ||
| S92533P | 08 | 564-566 | S93409A | 24 | 955-965 | S95901D | 23 | 949-950 | ||
| S92533S | 08 | 559-561 | S93409D | 23 | 949-950 | S95901S | 05 | 299-301 | ||
| S92534A | 08 | 562-563 | S93409S | 08 | 562-563 | S95902A | 21 | 913-914 | ||
| S92534A | 24 | 955-965 | S93411A | 08 | 562-563 | S95902A | 24 | 955-965 | ||
| S92534B | 08 | 562-563 | S93411A | 24 | 955-965 | S95902D | 23 | 949-950 | ||
| S92534B | 24 | 955-965 | S93411D | 23 | 949-950 | S95902S | 05 | 299-301 | ||
| S92534D | 08 | 559-561 | S93411S | 08 | 562-563 | S95909A | 21 | 913-914 | ||
| S92534G | 08 | 559-561 | S93412A | 08 | 562-563 | S95909A | 24 | 955-965 | ||
| S92534K | 08 | 564-566 | S93412A | 24 | 955-965 | S95909D | 23 | 949-950 | ||
| S92534P | 08 | 564-566 | S93412D | 23 | 949-950 | S95909S | 05 | 299-301 | ||
| S92534S | 08 | 559-561 | S93412S | 08 | 562-563 | S95911A | 21 | 913-914 | ||
| S92535A | 08 | 562-563 | S93419A | 08 | 562-563 | S95911A | 24 | 955-965 | ||
| S92535A | 24 | 955-965 | S93419A | 24 | 955-965 | S95911D | 23 | 949-950 | ||
| S92535B | 08 | 562-563 | S93419D | 23 | 949-950 | S95911S | 05 | 299-301 | ||
| S92535B | 24 | 955-965 | S93419S | 08 | 562-563 | S95912A | 21 | 913-914 | ||
| S92535D | 08 | 559-561 | S93421A | 08 | 562-563 | S95912A | 24 | 955-965 | ||
| S92535G | 08 | 559-561 | S93421A | 24 | 955-965 | S95912D | 23 | 949-950 | ||
| S92535K | 08 | 564-566 | S93421D | 23 | 949-950 | S95912S | 05 | 299-301 | ||
| S92535P | 08 | 564-566 | S93421S | 08 | 562-563 | S95919A | 21 | 913-914 | ||
| S92535S | 08 | 559-561 | S93422A | 08 | 562-563 | S95919A | 24 | 955-965 | ||
| S92536A | 08 | 562-563 | S93422A | 24 | 955-965 | S95919D | 23 | 949-950 | ||
| S92536A | 24 | 955-965 | S93422D | 23 | 949-950 | S95919S | 05 | 299-301 | ||
| S92536B | 08 | 562-563 | S93422S | 08 | 562-563 | S95991A | 21 | 913-914 | ||
| S92536B | 24 | 955-965 | S93429A | 08 | 562-563 | S95991A | 24 | 955-965 | ||
| S92536D | 08 | 559-561 | S93429A | 24 | 955-965 | S95991D | 23 | 949-950 | ||
| S92536G | 08 | 559-561 | S93429D | 23 | 949-950 | S95991S | 05 | 299-301 | ||
| S92536K | 08 | 564-566 | S93429S | 08 | 562-563 | S95992A | 21 | 913-914 | ||
| S92536P | 08 | 564-566 | S93431A | 08 | 562-563 | S95992A | 24 | 955-965 | ||
| S92536S | 08 | 559-561 | S93431A | 24 | 955-965 | S95992D | 23 | 949-950 | ||
| S92591A | 08 | 562-563 | S93431D | 23 | 949-950 | S95992S | 05 | 299-301 | ||
| S92591A | 24 | 955-965 | S93431S | 08 | 562-563 | S95999A | 21 | 913-914 | ||
| S92591B | 08 | 562-563 | S93432A | 08 | 562-563 | S95999A | 24 | 955-965 | ||
| S92591B | 24 | 955-965 | S93432A | 24 | 955-965 | S95999D | 23 | 949-950 | ||
| S92591D | 08 | 559-561 | S93432D | 23 | 949-950 | S95999S | 05 | 299-301 | ||
| S92591G | 08 | 559-561 | S93432S | 08 | 562-563 | S96001A | 21 | 913-914 | ||
| S92591K | 08 | 564-566 | S93439A | 08 | 562-563 | S96001A | 24 | 955-965 | ||
| S92591P | 08 | 564-566 | S93439A | 24 | 955-965 | S96001D | 23 | 949-950 | ||
| S92591S | 08 | 559-561 | S93439D | 23 | 949-950 | S96001S | 21 | 913-914 | ||
| S92592A | 08 | 562-563 | S93439S | 08 | 562-563 | S96002A | 21 | 913-914 | ||
| S92592A | 24 | 955-965 | S93491A | 08 | 562-563 | S96002A | 24 | 955-965 | ||
| S92592B | 08 | 562-563 | S93491A | 24 | 955-965 | S96002D | 23 | 949-950 | ||
| S92592B | 24 | 955-965 | S93491D | 23 | 949-950 | S96002S | 21 | 913-914 | ||
| S92592D | 08 | 559-561 | S93491S | 08 | 562-563 | S96009A | 21 | 913-914 | ||
| S92592G | 08 | 559-561 | S93492A | 08 | 562-563 | S96009A | 24 | 955-965 | ||
| S92592K | 08 | 564-566 | S93492A | 24 | 955-965 | S96009D | 23 | 949-950 | ||
| S92592P | 08 | 564-566 | S93492D | 23 | 949-950 | S96009S | 21 | 913-914 | ||
| S92592S | 08 | 559-561 | S93492S | 08 | 562-563 | S96011A | 08 | 562-563 | ||
| S92599A | 08 | 562-563 | S93499A | 08 | 562-563 | S96011A | 24 | 955-965 | ||
| S92599A | 24 | 955-965 | S93499A | 24 | 955-965 | S96011D | 23 | 949-950 | ||
| S92599B | 08 | 562-563 | S93499D | 23 | 949-950 | S96011S | 08 | 562-563 | ||
| S92599B | 24 | 955-965 | S93499S | 08 | 562-563 | S96012A | 08 | 562-563 | ||
| S92599D | 08 | 559-561 | S93501A | 08 | 562-563 | S96012A | 24 | 955-965 | ||
| S92599G | 08 | 559-561 | S93501A | 24 | 955-965 | S96012D | 23 | 949-950 | ||
| S92599K | 08 | 564-566 | S93501D | 23 | 949-950 | S96012S | 08 | 562-563 | ||
| S92599P | 08 | 564-566 | S93501S | 08 | 562-563 | S96019A | 08 | 562-563 | ||
| S92599S | 08 | 559-561 | S93502A | 08 | 562-563 | S96019A | 24 | 955-965 | ||
| S92811A | 08 | 562-563 | S93502A | 24 | 955-965 | S96019D | 23 | 949-950 | ||
| S92811A | 24 | 955-965 | S93502D | 23 | 949-950 | S96019S | 08 | 562-563 | ||
| S92811B | 08 | 562-563 | S93502S | 08 | 562-563 | S96021A | 08 | 564-566 | ||
| S92811B | 24 | 955-965 | S93503A | 08 | 562-563 | S96021A | 24 | 955-965 | ||
| S92811D | 08 | 559-561 | S93503A | 24 | 955-965 | S96021D | 23 | 949-950 | ||
| S92811G | 08 | 559-561 | S93503D | 23 | 949-950 | S96021S | 09 | 604-605 | ||
| S92811K | 08 | 564-566 | S93503S | 08 | 562-563 | S96022A | 08 | 564-566 | ||
| S92811P | 08 | 564-566 | S93504A | 08 | 562-563 | S96022A | 24 | 955-965 | ||
| S92811S | 08 | 559-561 | S93504A | 24 | 955-965 | S96022D | 23 | 949-950 | ||
| S92812A | 08 | 562-563 | S93504D | 23 | 949-950 | S96022S | 09 | 604-605 | ||
| S92812A | 24 | 955-965 | S93504S | 08 | 562-563 | S96029A | 08 | 564-566 | ||
| S92812B | 08 | 562-563 | S93505A | 08 | 562-563 | S96029A | 24 | 955-965 | ||
| S92812B | 24 | 955-965 | S93505A | 24 | 955-965 | S96029D | 23 | 949-950 | ||
| S92812D | 08 | 559-561 | S93505D | 23 | 949-950 | S96029S | 09 | 604-605 | ||
| S92812G | 08 | 559-561 | S93505S | 08 | 562-563 | S96091A | 21 | 913-914 | ||
| S92812K | 08 | 564-566 | S93506A | 08 | 562-563 | S96091A | 24 | 955-965 | ||
| S92812P | 08 | 564-566 | S93506A | 24 | 955-965 | S96091D | 23 | 949-950 | ||
| S92812S | 08 | 559-561 | S93506D | 23 | 949-950 | S96091S | 21 | 913-914 | ||
| S92819A | 08 | 562-563 | S93506S | 08 | 562-563 | S96092A | 21 | 913-914 | ||
| S92819A | 24 | 955-965 | S93509A | 08 | 562-563 | S96092A | 24 | 955-965 | ||
| S92819B | 08 | 562-563 | S93509A | 24 | 955-965 | S96092D | 23 | 949-950 | ||
| S92819B | 24 | 955-965 | S93509D | 23 | 949-950 | S96092S | 21 | 913-914 | ||
| S92819D | 08 | 559-561 | S93509S | 08 | 562-563 | S96099A | 21 | 913-914 | ||
| S92819G | 08 | 559-561 | S93511A | 08 | 562-563 | S96099A | 24 | 955-965 | ||
| S92819K | 08 | 564-566 | S93511A | 24 | 955-965 | S96099D | 23 | 949-950 | ||
| S92819P | 08 | 564-566 | S93511D | 23 | 949-950 | S96099S | 21 | 913-914 | ||
| S92819S | 08 | 559-561 | S93511S | 08 | 562-563 | S96101A | 21 | 913-914 | ||
| S92901A | 08 | 562-563 | S93512A | 08 | 562-563 | S96101A | 24 | 955-965 | ||
| S92901A | 24 | 955-965 | S93512A | 24 | 955-965 | S96101D | 23 | 949-950 | ||
| S92901B | 08 | 562-563 | S93512D | 23 | 949-950 | S96101S | 21 | 913-914 | ||
| S92901B | 24 | 955-965 | S93512S | 08 | 562-563 | S96102A | 21 | 913-914 | ||
| S92901D | 08 | 559-561 | S93513A | 08 | 562-563 | S96102A | 24 | 955-965 | ||
| S92901G | 08 | 559-561 | S93513A | 24 | 955-965 | S96102D | 23 | 949-950 | ||
| S92901K | 08 | 564-566 | S93513D | 23 | 949-950 | S96102S | 21 | 913-914 | ||
| S92901P | 08 | 564-566 | S93513S | 08 | 562-563 | S96109A | 21 | 913-914 | ||
| S92901S | 08 | 559-561 | S93514A | 08 | 562-563 | S96109A | 24 | 955-965 | ||
| S92902A | 08 | 562-563 | S93514A | 24 | 955-965 | S96109D | 23 | 949-950 | ||
| S92902A | 24 | 955-965 | S93514D | 23 | 949-950 | S96109S | 21 | 913-914 | ||
| S92902B | 08 | 562-563 | S93514S | 08 | 562-563 | S96111A | 08 | 562-563 | ||
| S92902B | 24 | 955-965 | S93515A | 08 | 562-563 | S96111A | 24 | 955-965 | ||
| S92902D | 08 | 559-561 | S93515A | 24 | 955-965 | S96111D | 23 | 949-950 | ||
| S92902G | 08 | 559-561 | S93515D | 23 | 949-950 | S96111S | 08 | 562-563 | ||
| S92902K | 08 | 564-566 | S93515S | 08 | 562-563 | S96112A | 08 | 562-563 | ||
| S92902P | 08 | 564-566 | S93516A | 08 | 562-563 | S96112A | 24 | 955-965 | ||
| S92902S | 08 | 559-561 | S93516A | 24 | 955-965 | S96112D | 23 | 949-950 | ||
| S92909A | 08 | 562-563 | S93516D | 23 | 949-950 | S96112S | 08 | 562-563 | ||
| S92909A | 24 | 955-965 | S93516S | 08 | 562-563 | S96119A | 08 | 562-563 | ||
| S92909B | 08 | 562-563 | S93519A | 08 | 562-563 | S96119A | 24 | 955-965 | ||
| S92909B | 24 | 955-965 | S93519A | 24 | 955-965 | S96119D | 23 | 949-950 | ||
| S92909D | 08 | 559-561 | S93519D | 23 | 949-950 | S96119S | 08 | 562-563 | ||
| S92909G | 08 | 559-561 | S93519S | 08 | 562-563 | S96121A | 08 | 564-566 | ||
| S92909K | 08 | 564-566 | S93521A | 08 | 562-563 | S96121A | 24 | 955-965 | ||
| S92909P | 08 | 564-566 | S93521A | 24 | 955-965 | S96121D | 23 | 949-950 | ||
| S92909S | 08 | 559-561 | S93521D | 23 | 949-950 | S96121S | 09 | 604-605 | ||
| S92911A | 08 | 562-563 | S93521S | 08 | 562-563 | S96122A | 08 | 564-566 | ||
| S92911A | 24 | 955-965 | S93522A | 08 | 562-563 | S96122A | 24 | 955-965 | ||
| S92911B | 08 | 562-563 | S93522A | 24 | 955-965 | S96122D | 23 | 949-950 | ||
| S92911B | 24 | 955-965 | S93522D | 23 | 949-950 | S96122S | 09 | 604-605 | ||
| S92911D | 08 | 559-561 | S93522S | 08 | 562-563 | S96129A | 08 | 564-566 | ||
| S92911G | 08 | 559-561 | S93523A | 08 | 562-563 | S96129A | 24 | 955-965 | ||
| S92911K | 08 | 564-566 | S93523A | 24 | 955-965 | S96129D | 23 | 949-950 | ||
| S92911P | 08 | 564-566 | S93523D | 23 | 949-950 | S96129S | 09 | 604-605 | ||
| S92911S | 08 | 559-561 | S93523S | 08 | 562-563 | S96191A | 21 | 913-914 | ||
| S92912A | 08 | 562-563 | S93524A | 08 | 562-563 | S96191A | 24 | 955-965 | ||
| S92912A | 24 | 955-965 | S93524A | 24 | 955-965 | S96191D | 23 | 949-950 | ||
| S92912B | 08 | 562-563 | S93524D | 23 | 949-950 | S96191S | 21 | 913-914 | ||
| S92912B | 24 | 955-965 | S93524S | 08 | 562-563 | S96192A | 21 | 913-914 | ||
| S92912D | 08 | 559-561 | S93525A | 08 | 562-563 | S96192A | 24 | 955-965 | ||
| S92912G | 08 | 559-561 | S93525A | 24 | 955-965 | S96192D | 23 | 949-950 | ||
| S92912K | 08 | 564-566 | S93525D | 23 | 949-950 | S96192S | 21 | 913-914 | ||
| S92912P | 08 | 564-566 | S93525S | 08 | 562-563 | S96199A | 21 | 913-914 | ||
| S92912S | 08 | 559-561 | S93526A | 08 | 562-563 | S96199A | 24 | 955-965 | ||
| S92919A | 08 | 562-563 | S93526A | 24 | 955-965 | S96199D | 23 | 949-950 | ||
| S92919A | 24 | 955-965 | S93526D | 23 | 949-950 | S96199S | 21 | 913-914 | ||
| S92919B | 08 | 562-563 | S93526S | 08 | 562-563 | S96201A | 21 | 913-914 | ||
| S92919B | 24 | 955-965 | S93529A | 08 | 562-563 | S96201A | 24 | 955-965 | ||
| S92919D | 08 | 559-561 | S93529A | 24 | 955-965 | S96201D | 23 | 949-950 | ||
| S92919G | 08 | 559-561 | S93529D | 23 | 949-950 | S96201S | 21 | 913-914 | ||
| S92919K | 08 | 564-566 | S93529S | 08 | 562-563 | S96202A | 21 | 913-914 | ||
| S92919P | 08 | 564-566 | S93601A | 08 | 562-563 | S96202A | 24 | 955-965 | ||
| S92919S | 08 | 559-561 | S93601A | 24 | 955-965 | S96202D | 23 | 949-950 | ||
| S9301XA | 08 | 562-563 | S93601D | 23 | 949-950 | S96202S | 21 | 913-914 | ||
| S9301XA | 24 | 955-965 | S93601S | 08 | 562-563 | S96209A | 21 | 913-914 | ||
| S9301XD | 23 | 949-950 | S93602A | 08 | 562-563 | S96209A | 24 | 955-965 | ||
| S9301XS | 08 | 562-563 | S93602A | 24 | 955-965 | S96209D | 23 | 949-950 | ||
| S9302XA | 08 | 562-563 | S93602D | 23 | 949-950 | S96209S | 21 | 913-914 | ||
| S9302XA | 24 | 955-965 | S93602S | 08 | 562-563 | S96211A | 08 | 562-563 | ||
| S9302XD | 23 | 949-950 | S93609A | 08 | 562-563 | S96211A | 24 | 955-965 | ||
| S9302XS | 08 | 562-563 | S93609A | 24 | 955-965 | S96211D | 23 | 949-950 | ||
| S9303XA | 08 | 562-563 | S93609D | 23 | 949-950 | S96211S | 08 | 562-563 | ||
| S9303XA | 24 | 955-965 | S93609S | 08 | 562-563 | S96212A | 08 | 562-563 | ||
| S9303XD | 23 | 949-950 | S93611A | 08 | 562-563 | S96212A | 24 | 955-965 | ||
| S9303XS | 08 | 562-563 | S93611A | 24 | 955-965 | S96212D | 23 | 949-950 | ||
| S9304XA | 08 | 562-563 | S93611D | 23 | 949-950 | S96212S | 08 | 562-563 | ||
| S9304XA | 24 | 955-965 | S93611S | 08 | 562-563 | S96219A | 08 | 562-563 | ||
| S9304XD | 23 | 949-950 | S93612A | 08 | 562-563 | S96219A | 24 | 955-965 | ||
| S9304XS | 08 | 562-563 | S93612A | 24 | 955-965 | S96219D | 23 | 949-950 | ||
| S9305XA | 08 | 562-563 | S93612D | 23 | 949-950 | S96219S | 08 | 562-563 | ||
| S9305XA | 24 | 955-965 | S93612S | 08 | 562-563 | S96221A | 08 | 564-566 | ||
| S9305XD | 23 | 949-950 | S93619A | 08 | 562-563 | S96221A | 24 | 955-965 | ||
| S9305XS | 08 | 562-563 | S93619A | 24 | 955-965 | S96221D | 23 | 949-950 | ||
| S9306XA | 08 | 562-563 | S93619D | 23 | 949-950 | S96221S | 09 | 604-605 | ||
| S9306XA | 24 | 955-965 | S93619S | 08 | 562-563 | S96222A | 08 | 564-566 | ||
| S9306XD | 23 | 949-950 | S93621A | 08 | 562-563 | S96222A | 24 | 955-965 | ||
| S9306XS | 08 | 562-563 | S93621A | 24 | 955-965 | S96222D | 23 | 949-950 | ||
| S93101A | 08 | 562-563 | S93621D | 23 | 949-950 | S96222S | 09 | 604-605 | ||
| S93101A | 24 | 955-965 | S93621S | 08 | 562-563 | S96229A | 08 | 564-566 | ||
| S93101D | 23 | 949-950 | S93622A | 08 | 562-563 | S96229A | 24 | 955-965 | ||
| S93101S | 08 | 562-563 | S93622A | 24 | 955-965 | S96229D | 23 | 949-950 | ||
| S93102A | 08 | 562-563 | S93622D | 23 | 949-950 | S96229S | 09 | 604-605 | ||
| S93102A | 24 | 955-965 | S93622S | 08 | 562-563 | S96291A | 21 | 913-914 | ||
| S93102D | 23 | 949-950 | S93629A | 08 | 562-563 | S96291A | 24 | 955-965 | ||
| S93102S | 08 | 562-563 | S93629A | 24 | 955-965 | S96291D | 23 | 949-950 | ||
| S93103A | 08 | 562-563 | S93629D | 23 | 949-950 | S96291S | 21 | 913-914 | ||
| S93103A | 24 | 955-965 | S93629S | 08 | 562-563 | S96292A | 21 | 913-914 | ||
| S93103D | 23 | 949-950 | S93691A | 08 | 562-563 | S96292A | 24 | 955-965 | ||
| S93103S | 08 | 562-563 | S93691A | 24 | 955-965 | S96292D | 23 | 949-950 | ||
| S93104A | 08 | 562-563 | S93691D | 23 | 949-950 | S96292S | 21 | 913-914 | ||
| S93104A | 24 | 955-965 | S93691S | 08 | 562-563 | S96299A | 21 | 913-914 | ||
| S93104D | 23 | 949-950 | S93692A | 08 | 562-563 | S96299A | 24 | 955-965 | ||
| S93104S | 08 | 562-563 | S93692A | 24 | 955-965 | S96299D | 23 | 949-950 | ||
| S93105A | 08 | 562-563 | S93692D | 23 | 949-950 | S96299S | 21 | 913-914 | ||
| S93105A | 24 | 955-965 | S93692S | 08 | 562-563 | S96801A | 21 | 913-914 | ||
| S93105D | 23 | 949-950 | S93699A | 08 | 562-563 | S96801A | 24 | 955-965 | ||
| S93105S | 08 | 562-563 | S93699A | 24 | 955-965 | S96801D | 23 | 949-950 | ||
| S93106A | 08 | 562-563 | S93699D | 23 | 949-950 | S96801S | 21 | 913-914 | ||
| S93106A | 24 | 955-965 | S93699S | 08 | 562-563 | S96802A | 21 | 913-914 | ||
| S93106D | 23 | 949-950 | S9400XA | 01 | 073-074 | S96802A | 24 | 955-965 | ||
| S93106S | 08 | 562-563 | S9400XA | 24 | 955-965 | S96802D | 23 | 949-950 | ||
| S93111A | 08 | 562-563 | S9400XD | 23 | 949-950 | S96802S | 21 | 913-914 | ||
| S93111A | 24 | 955-965 | S9400XS | 01 | 091-093 | S96809A | 21 | 913-914 | ||
| S93111D | 23 | 949-950 | S9401XA | 01 | 073-074 | S96809A | 24 | 955-965 | ||
| S93111S | 08 | 562-563 | S9401XA | 24 | 955-965 | S96809D | 23 | 949-950 | ||
| S93112A | 08 | 562-563 | S9401XD | 23 | 949-950 | S96809S | 21 | 913-914 | ||
| S93112A | 24 | 955-965 | S9401XS | 01 | 091-093 | S96811A | 08 | 562-563 | ||
| S93112D | 23 | 949-950 | S9402XA | 01 | 073-074 | S96811A | 24 | 955-965 | ||
| S93112S | 08 | 562-563 | S9402XA | 24 | 955-965 | S96811D | 23 | 949-950 | ||
| S93113A | 08 | 562-563 | S9402XD | 23 | 949-950 | S96811S | 08 | 562-563 | ||
| S93113A | 24 | 955-965 | S9402XS | 01 | 091-093 | S96812A | 08 | 562-563 | ||
| S93113D | 23 | 949-950 | S9410XA | 01 | 073-074 | S96812A | 24 | 955-965 | ||
| S93113S | 08 | 562-563 | S9410XA | 24 | 955-965 | S96812D | 23 | 949-950 | ||
| S93114A | 08 | 562-563 | S9410XD | 23 | 949-950 | S96812S | 08 | 562-563 | ||
| S93114A | 24 | 955-965 | S9410XS | 01 | 091-093 | S96819A | 08 | 562-563 | ||
| S93114D | 23 | 949-950 | S9411XA | 01 | 073-074 | S96819A | 24 | 955-965 | ||
| S93114S | 08 | 562-563 | S9411XA | 24 | 955-965 | S96819D | 23 | 949-950 | ||
| S93115A | 08 | 562-563 | S9411XD | 23 | 949-950 | S96819S | 08 | 562-563 | ||
| S93115A | 24 | 955-965 | S9411XS | 01 | 091-093 | S96821A | 08 | 564-566 | ||
| S93115D | 23 | 949-950 | S9412XA | 01 | 073-074 | S96821A | 24 | 955-965 | ||
| S93115S | 08 | 562-563 | S9412XA | 24 | 955-965 | S96821D | 23 | 949-950 | ||
| S93116A | 08 | 562-563 | S9412XD | 23 | 949-950 | S96821S | 09 | 604-605 | ||
| S93116A | 24 | 955-965 | S9412XS | 01 | 091-093 | S96822A | 08 | 564-566 | ||
| S93116D | 23 | 949-950 | S9420XA | 01 | 073-074 | S96822A | 24 | 955-965 | ||
| S93116S | 08 | 562-563 | S9420XA | 24 | 955-965 | S96822D | 23 | 949-950 | ||
| S93119A | 08 | 562-563 | S9420XD | 23 | 949-950 | S96822S | 09 | 604-605 | ||
| S93119A | 24 | 955-965 | S9420XS | 01 | 091-093 | S96829A | 08 | 564-566 | ||
| S93119D | 23 | 949-950 | S9421XA | 01 | 073-074 | S96829A | 24 | 955-965 | ||
| S93119S | 08 | 562-563 | S9421XA | 24 | 955-965 | S96829D | 23 | 949-950 | ||
| S93121A | 08 | 562-563 | S9421XD | 23 | 949-950 | S96829S | 09 | 604-605 | ||
| S93121A | 24 | 955-965 | S9421XS | 01 | 091-093 | S96891A | 21 | 913-914 | ||
| S93121D | 23 | 949-950 | S9422XA | 01 | 073-074 | S96891A | 24 | 955-965 | ||
| S93121S | 08 | 562-563 | S9422XA | 24 | 955-965 | S96891D | 23 | 949-950 | ||
| S93122A | 08 | 562-563 | S9422XD | 23 | 949-950 | S96891S | 21 | 913-914 | ||
| S93122A | 24 | 955-965 | S9422XS | 01 | 091-093 | S96892A | 21 | 913-914 | ||
| S93122D | 23 | 949-950 | S9430XA | 01 | 073-074 | S96892A | 24 | 955-965 | ||
| S93122S | 08 | 562-563 | S9430XA | 24 | 955-965 | S96892D | 23 | 949-950 | ||
| S93123A | 08 | 562-563 | S9430XD | 23 | 949-950 | S96892S | 21 | 913-914 | ||
| S93123A | 24 | 955-965 | S9430XS | 01 | 091-093 | S96899A | 21 | 913-914 | ||
| S93123D | 23 | 949-950 | S9431XA | 01 | 073-074 | S96899A | 24 | 955-965 | ||
| S93123S | 08 | 562-563 | S9431XA | 24 | 955-965 | S96899D | 23 | 949-950 | ||
| S93124A | 08 | 562-563 | S9431XD | 23 | 949-950 | S96899S | 21 | 913-914 | ||
| S93124A | 24 | 955-965 | S9431XS | 01 | 091-093 | S96901A | 21 | 913-914 | ||
| S93124D | 23 | 949-950 | S9432XA | 01 | 073-074 | S96901A | 24 | 955-965 | ||
| S93124S | 08 | 562-563 | S9432XA | 24 | 955-965 | S96901D | 23 | 949-950 | ||
| S93125A | 08 | 562-563 | S9432XD | 23 | 949-950 | S96901S | 21 | 913-914 | ||
| S93125A | 24 | 955-965 | S9432XS | 01 | 091-093 | S96902A | 21 | 913-914 | ||
| S93125D | 23 | 949-950 | S948X1A | 01 | 073-074 | S96902A | 24 | 955-965 | ||
| S93125S | 08 | 562-563 | S948X1A | 24 | 955-965 | S96902D | 23 | 949-950 | ||
| S93126A | 08 | 562-563 | S948X1D | 23 | 949-950 | S96902S | 21 | 913-914 | ||
| S93126A | 24 | 955-965 | S948X1S | 01 | 091-093 | S96909A | 21 | 913-914 | ||
| S93126D | 23 | 949-950 | S948X2A | 01 | 073-074 | S96909A | 24 | 955-965 | ||
| S93126S | 08 | 562-563 | S948X2A | 24 | 955-965 | S96909D | 23 | 949-950 | ||
| S93129A | 08 | 562-563 | S948X2D | 23 | 949-950 | S96909S | 21 | 913-914 | ||
| S93129A | 24 | 955-965 | S948X2S | 01 | 091-093 | S96911A | 08 | 562-563 | ||
| S93129D | 23 | 949-950 | S948X9A | 01 | 073-074 | S96911A | 24 | 955-965 | ||
| S93129S | 08 | 562-563 | S948X9A | 24 | 955-965 | S96911D | 23 | 949-950 | ||
| S93131A | 08 | 562-563 | S948X9D | 23 | 949-950 | S96911S | 08 | 562-563 | ||
| S93131A | 24 | 955-965 | S948X9S | 01 | 091-093 | S96912A | 08 | 562-563 | ||
| S93131D | 23 | 949-950 | S9490XA | 01 | 073-074 | S96912A | 24 | 955-965 | ||
| S93131S | 08 | 562-563 | S9490XA | 24 | 955-965 | S96912D | 23 | 949-950 | ||
| S93132A | 08 | 562-563 | S9490XD | 23 | 949-950 | S96912S | 08 | 562-563 | ||
| S93132A | 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 |