ICD-10-CM/PCS MS-DRG v36.0 Definitions Manual
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ICD-10-CM/PCS MS-DRG v36.0 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 35 of 70 |
| A000 B400 C7640 C84A9 D4412 E1069 F13930 G808 H18732 H47621 I2609 I70534 K05223 L03111 L98498 M151 M2759 M65152 M84375P M86669 N35813 O2292 O352XX1 O418X22 O99353 Q659 S0000XA S02611K S066X9S S13110A S21309S S2599XS S31824S S33141S S37539D S42213A S4292XK S49032D S52126N S52331Q S52611B S56419A S60476S S62102G S62351D S63063D S65012D S68111D S72062B S72335Q S72465N S79129D S82121J S82299P S82843P S85211S S90462D S92131D S92599B S98329A T2121XS T23529A T3253 T40903S T462X1S T524X1S T63632S T81718D T85828S Z85040 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S37539D | 23 | 949-950 | S40829S | 09 | 604-605 | S42033D | 08 | 559-561 | ||
| S37539S | 13 | 742-743 | S40841A | 09 | 604-605 | S42033G | 08 | 559-561 | ||
| S37539S | 13 | 760-761 | S40841A | 24 | 955-965 | S42033K | 08 | 564-566 | ||
| S37591A | 13 | 742-743 | S40841D | 23 | 949-950 | S42033P | 08 | 564-566 | ||
| S37591A | 13 | 760-761 | S40841S | 09 | 604-605 | S42033S | 08 | 559-561 | ||
| S37591D | 23 | 949-950 | S40842A | 09 | 604-605 | S42034A | 08 | 562-563 | ||
| S37591S | 13 | 742-743 | S40842A | 24 | 955-965 | S42034A | 24 | 955-965 | ||
| S37591S | 13 | 760-761 | S40842D | 23 | 949-950 | S42034B | 08 | 562-563 | ||
| S37592A | 13 | 742-743 | S40842S | 09 | 604-605 | S42034B | 24 | 955-965 | ||
| S37592A | 13 | 760-761 | S40849A | 09 | 604-605 | S42034D | 08 | 559-561 | ||
| S37592D | 23 | 949-950 | S40849A | 24 | 955-965 | S42034G | 08 | 559-561 | ||
| S37592S | 13 | 742-743 | S40849D | 23 | 949-950 | S42034K | 08 | 564-566 | ||
| S37592S | 13 | 760-761 | S40849S | 09 | 604-605 | S42034P | 08 | 564-566 | ||
| S37599A | 13 | 742-743 | S40851A | 09 | 604-605 | S42034S | 08 | 559-561 | ||
| S37599A | 13 | 760-761 | S40851A | 24 | 955-965 | S42035A | 08 | 562-563 | ||
| S37599D | 23 | 949-950 | S40851D | 23 | 949-950 | S42035A | 24 | 955-965 | ||
| S37599S | 13 | 742-743 | S40851S | 09 | 604-605 | S42035B | 08 | 562-563 | ||
| S37599S | 13 | 760-761 | S40852A | 09 | 604-605 | S42035B | 24 | 955-965 | ||
| S3760XA | 13 | 742-743 | S40852A | 24 | 955-965 | S42035D | 08 | 559-561 | ||
| S3760XA | 13 | 760-761 | S40852D | 23 | 949-950 | S42035G | 08 | 559-561 | ||
| S3760XA | 24 | 955-965 | S40852S | 09 | 604-605 | S42035K | 08 | 564-566 | ||
| S3760XD | 23 | 949-950 | S40859A | 09 | 604-605 | S42035P | 08 | 564-566 | ||
| S3760XS | 13 | 742-743 | S40859A | 24 | 955-965 | S42035S | 08 | 559-561 | ||
| S3760XS | 13 | 760-761 | S40859D | 23 | 949-950 | S42036A | 08 | 562-563 | ||
| S3762XA | 13 | 742-743 | S40859S | 09 | 604-605 | S42036A | 24 | 955-965 | ||
| S3762XA | 13 | 760-761 | S40861A | 09 | 606-607 | S42036B | 08 | 562-563 | ||
| S3762XA | 24 | 955-965 | S40861A | 24 | 955-965 | S42036B | 24 | 955-965 | ||
| S3762XD | 23 | 949-950 | S40861D | 23 | 949-950 | S42036D | 08 | 559-561 | ||
| S3762XS | 13 | 742-743 | S40861S | 09 | 604-605 | S42036G | 08 | 559-561 | ||
| S3762XS | 13 | 760-761 | S40862A | 09 | 606-607 | S42036K | 08 | 564-566 | ||
| S3763XA | 13 | 742-743 | S40862A | 24 | 955-965 | S42036P | 08 | 564-566 | ||
| S3763XA | 13 | 760-761 | S40862D | 23 | 949-950 | S42036S | 08 | 559-561 | ||
| S3763XA | 24 | 955-965 | S40862S | 09 | 604-605 | S42101A | 08 | 562-563 | ||
| S3763XD | 23 | 949-950 | S40869A | 09 | 606-607 | S42101A | 24 | 955-965 | ||
| S3763XS | 13 | 742-743 | S40869A | 24 | 955-965 | S42101B | 08 | 562-563 | ||
| S3763XS | 13 | 760-761 | S40869D | 23 | 949-950 | S42101B | 24 | 955-965 | ||
| S3769XA | 13 | 742-743 | S40869S | 09 | 604-605 | S42101D | 08 | 559-561 | ||
| S3769XA | 13 | 760-761 | S40871A | 09 | 604-605 | S42101G | 08 | 559-561 | ||
| S3769XA | 24 | 955-965 | S40871A | 24 | 955-965 | S42101K | 08 | 564-566 | ||
| S3769XD | 23 | 949-950 | S40871D | 23 | 949-950 | S42101P | 08 | 564-566 | ||
| S3769XS | 13 | 742-743 | S40871S | 09 | 604-605 | S42101S | 08 | 559-561 | ||
| S3769XS | 13 | 760-761 | S40872A | 09 | 604-605 | S42102A | 08 | 562-563 | ||
| S37812A | 10 | 643-645 | S40872A | 24 | 955-965 | S42102A | 24 | 955-965 | ||
| S37812A | 24 | 955-965 | S40872D | 23 | 949-950 | S42102B | 08 | 562-563 | ||
| S37812D | 23 | 949-950 | S40872S | 09 | 604-605 | S42102B | 24 | 955-965 | ||
| S37812S | 12 | 729-730 | S40879A | 09 | 604-605 | S42102D | 08 | 559-561 | ||
| S37812S | 13 | 742-743 | S40879A | 24 | 955-965 | S42102G | 08 | 559-561 | ||
| S37812S | 13 | 760-761 | S40879D | 23 | 949-950 | S42102K | 08 | 564-566 | ||
| S37813A | 10 | 643-645 | S40879S | 09 | 604-605 | S42102P | 08 | 564-566 | ||
| S37813A | 24 | 955-965 | S40911A | 09 | 604-605 | S42102S | 08 | 559-561 | ||
| S37813D | 23 | 949-950 | S40911A | 24 | 955-965 | S42109A | 08 | 562-563 | ||
| S37813S | 12 | 729-730 | S40911D | 23 | 949-950 | S42109A | 24 | 955-965 | ||
| S37813S | 13 | 742-743 | S40911S | 09 | 604-605 | S42109B | 08 | 562-563 | ||
| S37813S | 13 | 760-761 | S40912A | 09 | 604-605 | S42109B | 24 | 955-965 | ||
| S37818A | 10 | 643-645 | S40912A | 24 | 955-965 | S42109D | 08 | 559-561 | ||
| S37818A | 24 | 955-965 | S40912D | 23 | 949-950 | S42109G | 08 | 559-561 | ||
| S37818D | 23 | 949-950 | S40912S | 09 | 604-605 | S42109K | 08 | 564-566 | ||
| S37818S | 12 | 729-730 | S40919A | 09 | 604-605 | S42109P | 08 | 564-566 | ||
| S37818S | 13 | 742-743 | S40919A | 24 | 955-965 | S42109S | 08 | 559-561 | ||
| S37818S | 13 | 760-761 | S40919D | 23 | 949-950 | S42111A | 08 | 564-566 | ||
| S37819A | 10 | 643-645 | S40919S | 09 | 604-605 | S42111A | 24 | 955-965 | ||
| S37819A | 24 | 955-965 | S40921A | 09 | 604-605 | S42111B | 08 | 564-566 | ||
| S37819D | 23 | 949-950 | S40921A | 24 | 955-965 | S42111B | 24 | 955-965 | ||
| S37819S | 12 | 729-730 | S40921D | 23 | 949-950 | S42111D | 08 | 559-561 | ||
| S37819S | 13 | 742-743 | S40921S | 09 | 604-605 | S42111G | 08 | 559-561 | ||
| S37819S | 13 | 760-761 | S40922A | 09 | 604-605 | S42111K | 08 | 564-566 | ||
| S37822A | 12 | 729-730 | S40922A | 24 | 955-965 | S42111P | 08 | 564-566 | ||
| S37822D | 23 | 949-950 | S40922D | 23 | 949-950 | S42111S | 08 | 559-561 | ||
| S37822S | 12 | 729-730 | S40922S | 09 | 604-605 | S42112A | 08 | 564-566 | ||
| S37823A | 12 | 729-730 | S40929A | 09 | 604-605 | S42112A | 24 | 955-965 | ||
| S37823D | 23 | 949-950 | S40929A | 24 | 955-965 | S42112B | 08 | 564-566 | ||
| S37823S | 12 | 729-730 | S40929D | 23 | 949-950 | S42112B | 24 | 955-965 | ||
| S37828A | 12 | 729-730 | S40929S | 09 | 604-605 | S42112D | 08 | 559-561 | ||
| S37828D | 23 | 949-950 | S41001A | 09 | 604-605 | S42112G | 08 | 559-561 | ||
| S37828S | 12 | 729-730 | S41001A | 24 | 955-965 | S42112K | 08 | 564-566 | ||
| S37829A | 12 | 729-730 | S41001D | 23 | 949-950 | S42112P | 08 | 564-566 | ||
| S37829D | 23 | 949-950 | S41001S | 09 | 604-605 | S42112S | 08 | 559-561 | ||
| S37829S | 12 | 729-730 | S41002A | 09 | 604-605 | S42113A | 08 | 564-566 | ||
| S37892A | 12 | 729-730 | S41002A | 24 | 955-965 | S42113A | 24 | 955-965 | ||
| S37892A | 13 | 742-743 | S41002D | 23 | 949-950 | S42113B | 08 | 564-566 | ||
| S37892A | 13 | 760-761 | S41002S | 09 | 604-605 | S42113B | 24 | 955-965 | ||
| S37892A | 24 | 955-965 | S41009A | 09 | 604-605 | S42113D | 08 | 559-561 | ||
| S37892D | 23 | 949-950 | S41009A | 24 | 955-965 | S42113G | 08 | 559-561 | ||
| S37892S | 12 | 729-730 | S41009D | 23 | 949-950 | S42113K | 08 | 564-566 | ||
| S37892S | 13 | 742-743 | S41009S | 09 | 604-605 | S42113P | 08 | 564-566 | ||
| S37892S | 13 | 760-761 | S41011A | 09 | 604-605 | S42113S | 08 | 559-561 | ||
| S37893A | 12 | 729-730 | S41011A | 24 | 955-965 | S42114A | 08 | 564-566 | ||
| S37893A | 13 | 742-743 | S41011D | 23 | 949-950 | S42114A | 24 | 955-965 | ||
| S37893A | 13 | 760-761 | S41011S | 09 | 604-605 | S42114B | 08 | 564-566 | ||
| S37893A | 24 | 955-965 | S41012A | 09 | 604-605 | S42114B | 24 | 955-965 | ||
| S37893D | 23 | 949-950 | S41012A | 24 | 955-965 | S42114D | 08 | 559-561 | ||
| S37893S | 12 | 729-730 | S41012D | 23 | 949-950 | S42114G | 08 | 559-561 | ||
| S37893S | 13 | 742-743 | S41012S | 09 | 604-605 | S42114K | 08 | 564-566 | ||
| S37893S | 13 | 760-761 | S41019A | 09 | 604-605 | S42114P | 08 | 564-566 | ||
| S37898A | 12 | 729-730 | S41019A | 24 | 955-965 | S42114S | 08 | 559-561 | ||
| S37898A | 13 | 742-743 | S41019D | 23 | 949-950 | S42115A | 08 | 564-566 | ||
| S37898A | 13 | 760-761 | S41019S | 09 | 604-605 | S42115A | 24 | 955-965 | ||
| S37898A | 24 | 955-965 | S41021A | 21 | 913-914 | S42115B | 08 | 564-566 | ||
| S37898D | 23 | 949-950 | S41021A | 24 | 955-965 | S42115B | 24 | 955-965 | ||
| S37898S | 12 | 729-730 | S41021D | 23 | 949-950 | S42115D | 08 | 559-561 | ||
| S37898S | 13 | 742-743 | S41021S | 09 | 604-605 | S42115G | 08 | 559-561 | ||
| S37898S | 13 | 760-761 | S41022A | 21 | 913-914 | S42115K | 08 | 564-566 | ||
| S37899A | 12 | 729-730 | S41022A | 24 | 955-965 | S42115P | 08 | 564-566 | ||
| S37899A | 13 | 742-743 | S41022D | 23 | 949-950 | S42115S | 08 | 559-561 | ||
| S37899A | 13 | 760-761 | S41022S | 09 | 604-605 | S42116A | 08 | 564-566 | ||
| S37899A | 24 | 955-965 | S41029A | 21 | 913-914 | S42116A | 24 | 955-965 | ||
| S37899D | 23 | 949-950 | S41029A | 24 | 955-965 | S42116B | 08 | 564-566 | ||
| S37899S | 12 | 729-730 | S41029D | 23 | 949-950 | S42116B | 24 | 955-965 | ||
| S37899S | 13 | 742-743 | S41029S | 09 | 604-605 | S42116D | 08 | 559-561 | ||
| S37899S | 13 | 760-761 | S41031A | 09 | 604-605 | S42116G | 08 | 559-561 | ||
| S3790XA | 12 | 729-730 | S41031A | 24 | 955-965 | S42116K | 08 | 564-566 | ||
| S3790XA | 13 | 742-743 | S41031D | 23 | 949-950 | S42116P | 08 | 564-566 | ||
| S3790XA | 13 | 760-761 | S41031S | 09 | 604-605 | S42116S | 08 | 559-561 | ||
| S3790XA | 24 | 955-965 | S41032A | 09 | 604-605 | S42121A | 08 | 562-563 | ||
| S3790XD | 23 | 949-950 | S41032A | 24 | 955-965 | S42121A | 24 | 955-965 | ||
| S3790XS | 12 | 729-730 | S41032D | 23 | 949-950 | S42121B | 08 | 562-563 | ||
| S3790XS | 13 | 742-743 | S41032S | 09 | 604-605 | S42121B | 24 | 955-965 | ||
| S3790XS | 13 | 760-761 | S41039A | 09 | 604-605 | S42121D | 08 | 559-561 | ||
| S3792XA | 12 | 729-730 | S41039A | 24 | 955-965 | S42121G | 08 | 559-561 | ||
| S3792XA | 13 | 742-743 | S41039D | 23 | 949-950 | S42121K | 08 | 564-566 | ||
| S3792XA | 13 | 760-761 | S41039S | 09 | 604-605 | S42121P | 08 | 564-566 | ||
| S3792XA | 24 | 955-965 | S41041A | 21 | 913-914 | S42121S | 08 | 559-561 | ||
| S3792XD | 23 | 949-950 | S41041A | 24 | 955-965 | S42122A | 08 | 562-563 | ||
| S3792XS | 12 | 729-730 | S41041D | 23 | 949-950 | S42122A | 24 | 955-965 | ||
| S3792XS | 13 | 742-743 | S41041S | 09 | 604-605 | S42122B | 08 | 562-563 | ||
| S3792XS | 13 | 760-761 | S41042A | 21 | 913-914 | S42122B | 24 | 955-965 | ||
| S3793XA | 12 | 729-730 | S41042A | 24 | 955-965 | S42122D | 08 | 559-561 | ||
| S3793XA | 13 | 742-743 | S41042D | 23 | 949-950 | S42122G | 08 | 559-561 | ||
| S3793XA | 13 | 760-761 | S41042S | 09 | 604-605 | S42122K | 08 | 564-566 | ||
| S3793XA | 24 | 955-965 | S41049A | 21 | 913-914 | S42122P | 08 | 564-566 | ||
| S3793XD | 23 | 949-950 | S41049A | 24 | 955-965 | S42122S | 08 | 559-561 | ||
| S3793XS | 12 | 729-730 | S41049D | 23 | 949-950 | S42123A | 08 | 562-563 | ||
| S3793XS | 13 | 742-743 | S41049S | 09 | 604-605 | S42123A | 24 | 955-965 | ||
| S3793XS | 13 | 760-761 | S41051A | 09 | 604-605 | S42123B | 08 | 562-563 | ||
| S3799XA | 12 | 729-730 | S41051A | 24 | 955-965 | S42123B | 24 | 955-965 | ||
| S3799XA | 13 | 742-743 | S41051D | 23 | 949-950 | S42123D | 08 | 559-561 | ||
| S3799XA | 13 | 760-761 | S41051S | 09 | 604-605 | S42123G | 08 | 559-561 | ||
| S3799XA | 24 | 955-965 | S41052A | 09 | 604-605 | S42123K | 08 | 564-566 | ||
| S3799XD | 23 | 949-950 | S41052A | 24 | 955-965 | S42123P | 08 | 564-566 | ||
| S3799XS | 12 | 729-730 | S41052D | 23 | 949-950 | S42123S | 08 | 559-561 | ||
| S3799XS | 13 | 742-743 | S41052S | 09 | 604-605 | S42124A | 08 | 562-563 | ||
| S3799XS | 13 | 760-761 | S41059A | 09 | 604-605 | S42124A | 24 | 955-965 | ||
| S38001A | 12 | 729-730 | S41059A | 24 | 955-965 | S42124B | 08 | 562-563 | ||
| S38001A | 24 | 955-965 | S41059D | 23 | 949-950 | S42124B | 24 | 955-965 | ||
| S38001D | 23 | 949-950 | S41059S | 09 | 604-605 | S42124D | 08 | 559-561 | ||
| S38001S | 09 | 604-605 | S41101A | 09 | 604-605 | S42124G | 08 | 559-561 | ||
| S38002A | 13 | 742-743 | S41101A | 24 | 955-965 | S42124K | 08 | 564-566 | ||
| S38002A | 13 | 760-761 | S41101D | 23 | 949-950 | S42124P | 08 | 564-566 | ||
| S38002A | 24 | 955-965 | S41101S | 09 | 604-605 | S42124S | 08 | 559-561 | ||
| S38002D | 23 | 949-950 | S41102A | 09 | 604-605 | S42125A | 08 | 562-563 | ||
| S38002S | 09 | 604-605 | S41102A | 24 | 955-965 | S42125A | 24 | 955-965 | ||
| S3801XA | 12 | 729-730 | S41102D | 23 | 949-950 | S42125B | 08 | 562-563 | ||
| S3801XA | 24 | 955-965 | S41102S | 09 | 604-605 | S42125B | 24 | 955-965 | ||
| S3801XD | 23 | 949-950 | S41109A | 09 | 604-605 | S42125D | 08 | 559-561 | ||
| S3801XS | 09 | 604-605 | S41109A | 24 | 955-965 | S42125G | 08 | 559-561 | ||
| S3802XA | 12 | 729-730 | S41109D | 23 | 949-950 | S42125K | 08 | 564-566 | ||
| S3802XA | 24 | 955-965 | S41109S | 09 | 604-605 | S42125P | 08 | 564-566 | ||
| S3802XD | 23 | 949-950 | S41111A | 09 | 604-605 | S42125S | 08 | 559-561 | ||
| S3802XS | 09 | 604-605 | S41111A | 24 | 955-965 | S42126A | 08 | 562-563 | ||
| S3803XA | 13 | 742-743 | S41111D | 23 | 949-950 | S42126A | 24 | 955-965 | ||
| S3803XA | 13 | 760-761 | S41111S | 09 | 604-605 | S42126B | 08 | 562-563 | ||
| S3803XA | 24 | 955-965 | S41112A | 09 | 604-605 | S42126B | 24 | 955-965 | ||
| S3803XD | 23 | 949-950 | S41112A | 24 | 955-965 | S42126D | 08 | 559-561 | ||
| S3803XS | 09 | 604-605 | S41112D | 23 | 949-950 | S42126G | 08 | 559-561 | ||
| S381XXA | 21 | 913-914 | S41112S | 09 | 604-605 | S42126K | 08 | 564-566 | ||
| S381XXA | 24 | 955-965 | S41119A | 09 | 604-605 | S42126P | 08 | 564-566 | ||
| S381XXD | 23 | 949-950 | S41119A | 24 | 955-965 | S42126S | 08 | 559-561 | ||
| S381XXS | 09 | 604-605 | S41119D | 23 | 949-950 | S42131A | 08 | 562-563 | ||
| S38211A | 13 | 742-743 | S41119S | 09 | 604-605 | S42131A | 24 | 955-965 | ||
| S38211A | 13 | 760-761 | S41121A | 21 | 913-914 | S42131B | 08 | 562-563 | ||
| S38211A | 24 | 955-965 | S41121A | 24 | 955-965 | S42131B | 24 | 955-965 | ||
| S38211D | 23 | 949-950 | S41121D | 23 | 949-950 | S42131D | 08 | 559-561 | ||
| S38211S | 09 | 604-605 | S41121S | 09 | 604-605 | S42131G | 08 | 559-561 | ||
| S38212A | 13 | 742-743 | S41122A | 21 | 913-914 | S42131K | 08 | 564-566 | ||
| S38212A | 13 | 760-761 | S41122A | 24 | 955-965 | S42131P | 08 | 564-566 | ||
| S38212A | 24 | 955-965 | S41122D | 23 | 949-950 | S42131S | 08 | 559-561 | ||
| S38212D | 23 | 949-950 | S41122S | 09 | 604-605 | S42132A | 08 | 562-563 | ||
| S38212S | 09 | 604-605 | S41129A | 21 | 913-914 | S42132A | 24 | 955-965 | ||
| S38221A | 12 | 729-730 | S41129A | 24 | 955-965 | S42132B | 08 | 562-563 | ||
| S38221A | 24 | 955-965 | S41129D | 23 | 949-950 | S42132B | 24 | 955-965 | ||
| S38221D | 23 | 949-950 | S41129S | 09 | 604-605 | S42132D | 08 | 559-561 | ||
| S38221S | 09 | 604-605 | S41131A | 09 | 604-605 | S42132G | 08 | 559-561 | ||
| S38222A | 12 | 729-730 | S41131A | 24 | 955-965 | S42132K | 08 | 564-566 | ||
| S38222A | 24 | 955-965 | S41131D | 23 | 949-950 | S42132P | 08 | 564-566 | ||
| S38222D | 23 | 949-950 | S41131S | 09 | 604-605 | S42132S | 08 | 559-561 | ||
| S38222S | 09 | 604-605 | S41132A | 09 | 604-605 | S42133A | 08 | 562-563 | ||
| S38231A | 12 | 729-730 | S41132A | 24 | 955-965 | S42133A | 24 | 955-965 | ||
| S38231A | 24 | 955-965 | S41132D | 23 | 949-950 | S42133B | 08 | 562-563 | ||
| S38231D | 23 | 949-950 | S41132S | 09 | 604-605 | S42133B | 24 | 955-965 | ||
| S38231S | 09 | 604-605 | S41139A | 09 | 604-605 | S42133D | 08 | 559-561 | ||
| S38232A | 12 | 729-730 | S41139A | 24 | 955-965 | S42133G | 08 | 559-561 | ||
| S38232A | 24 | 955-965 | S41139D | 23 | 949-950 | S42133K | 08 | 564-566 | ||
| S38232D | 23 | 949-950 | S41139S | 09 | 604-605 | S42133P | 08 | 564-566 | ||
| S38232S | 09 | 604-605 | S41141A | 21 | 913-914 | S42133S | 08 | 559-561 | ||
| S383XXA | 09 | 604-605 | S41141A | 24 | 955-965 | S42134A | 08 | 562-563 | ||
| S383XXA | 24 | 955-965 | S41141D | 23 | 949-950 | S42134A | 24 | 955-965 | ||
| S383XXD | 23 | 949-950 | S41141S | 09 | 604-605 | S42134B | 08 | 562-563 | ||
| S383XXS | 09 | 604-605 | S41142A | 21 | 913-914 | S42134B | 24 | 955-965 | ||
| S39001A | 21 | 913-914 | S41142A | 24 | 955-965 | S42134D | 08 | 559-561 | ||
| S39001A | 24 | 955-965 | S41142D | 23 | 949-950 | S42134G | 08 | 559-561 | ||
| S39001D | 23 | 949-950 | S41142S | 09 | 604-605 | S42134K | 08 | 564-566 | ||
| S39001S | 21 | 913-914 | S41149A | 21 | 913-914 | S42134P | 08 | 564-566 | ||
| S39002A | 21 | 913-914 | S41149A | 24 | 955-965 | S42134S | 08 | 559-561 | ||
| S39002A | 24 | 955-965 | S41149D | 23 | 949-950 | S42135A | 08 | 562-563 | ||
| S39002D | 23 | 949-950 | S41149S | 09 | 604-605 | S42135A | 24 | 955-965 | ||
| S39002S | 21 | 913-914 | S41151A | 09 | 604-605 | S42135B | 08 | 562-563 | ||
| S39003A | 21 | 913-914 | S41151A | 24 | 955-965 | S42135B | 24 | 955-965 | ||
| S39003A | 24 | 955-965 | S41151D | 23 | 949-950 | S42135D | 08 | 559-561 | ||
| S39003D | 23 | 949-950 | S41151S | 09 | 604-605 | S42135G | 08 | 559-561 | ||
| S39003S | 21 | 913-914 | S41152A | 09 | 604-605 | S42135K | 08 | 564-566 | ||
| S39011A | 08 | 562-563 | S41152A | 24 | 955-965 | S42135P | 08 | 564-566 | ||
| S39011A | 24 | 955-965 | S41152D | 23 | 949-950 | S42135S | 08 | 559-561 | ||
| S39011D | 23 | 949-950 | S41152S | 09 | 604-605 | S42136A | 08 | 562-563 | ||
| S39011S | 08 | 562-563 | S41159A | 09 | 604-605 | S42136A | 24 | 955-965 | ||
| S39012A | 08 | 562-563 | S41159A | 24 | 955-965 | S42136B | 08 | 562-563 | ||
| S39012A | 24 | 955-965 | S41159D | 23 | 949-950 | S42136B | 24 | 955-965 | ||
| S39012D | 23 | 949-950 | S41159S | 09 | 604-605 | S42136D | 08 | 559-561 | ||
| S39012S | 08 | 562-563 | S42001A | 08 | 562-563 | S42136G | 08 | 559-561 | ||
| S39013A | 08 | 562-563 | S42001A | 24 | 955-965 | S42136K | 08 | 564-566 | ||
| S39013A | 24 | 955-965 | S42001B | 08 | 562-563 | S42136P | 08 | 564-566 | ||
| S39013D | 23 | 949-950 | S42001B | 24 | 955-965 | S42136S | 08 | 559-561 | ||
| S39013S | 08 | 562-563 | S42001D | 08 | 559-561 | S42141A | 08 | 562-563 | ||
| S39021A | 09 | 604-605 | S42001G | 08 | 559-561 | S42141A | 24 | 955-965 | ||
| S39021A | 24 | 955-965 | S42001K | 08 | 564-566 | S42141B | 08 | 562-563 | ||
| S39021D | 23 | 949-950 | S42001P | 08 | 564-566 | S42141B | 24 | 955-965 | ||
| S39021S | 09 | 604-605 | S42001S | 08 | 559-561 | S42141D | 08 | 559-561 | ||
| S39022A | 09 | 604-605 | S42002A | 08 | 562-563 | S42141G | 08 | 559-561 | ||
| S39022A | 24 | 955-965 | S42002A | 24 | 955-965 | S42141K | 08 | 564-566 | ||
| S39022D | 23 | 949-950 | S42002B | 08 | 562-563 | S42141P | 08 | 564-566 | ||
| S39022S | 09 | 604-605 | S42002B | 24 | 955-965 | S42141S | 08 | 559-561 | ||
| S39023A | 09 | 604-605 | S42002D | 08 | 559-561 | S42142A | 08 | 562-563 | ||
| S39023A | 24 | 955-965 | S42002G | 08 | 559-561 | S42142A | 24 | 955-965 | ||
| S39023D | 23 | 949-950 | S42002K | 08 | 564-566 | S42142B | 08 | 562-563 | ||
| S39023S | 09 | 604-605 | S42002P | 08 | 564-566 | S42142B | 24 | 955-965 | ||
| S39091A | 21 | 913-914 | S42002S | 08 | 559-561 | S42142D | 08 | 559-561 | ||
| S39091A | 24 | 955-965 | S42009A | 08 | 562-563 | S42142G | 08 | 559-561 | ||
| S39091D | 23 | 949-950 | S42009A | 24 | 955-965 | S42142K | 08 | 564-566 | ||
| S39091S | 21 | 913-914 | S42009B | 08 | 562-563 | S42142P | 08 | 564-566 | ||
| S39092A | 21 | 913-914 | S42009B | 24 | 955-965 | S42142S | 08 | 559-561 | ||
| S39092A | 24 | 955-965 | S42009D | 08 | 559-561 | S42143A | 08 | 562-563 | ||
| S39092D | 23 | 949-950 | S42009G | 08 | 559-561 | S42143A | 24 | 955-965 | ||
| S39092S | 21 | 913-914 | S42009K | 08 | 564-566 | S42143B | 08 | 562-563 | ||
| S39093A | 21 | 913-914 | S42009P | 08 | 564-566 | S42143B | 24 | 955-965 | ||
| S39093A | 24 | 955-965 | S42009S | 08 | 559-561 | S42143D | 08 | 559-561 | ||
| S39093D | 23 | 949-950 | S42011A | 08 | 562-563 | S42143G | 08 | 559-561 | ||
| S39093S | 21 | 913-914 | S42011A | 24 | 955-965 | S42143K | 08 | 564-566 | ||
| S3981XA | 21 | 913-914 | S42011B | 08 | 562-563 | S42143P | 08 | 564-566 | ||
| S3981XA | 24 | 955-965 | S42011B | 24 | 955-965 | S42143S | 08 | 559-561 | ||
| S3981XD | 23 | 949-950 | S42011D | 08 | 559-561 | S42144A | 08 | 562-563 | ||
| S3981XS | 21 | 913-914 | S42011G | 08 | 559-561 | S42144A | 24 | 955-965 | ||
| S3982XA | 21 | 913-914 | S42011K | 08 | 564-566 | S42144B | 08 | 562-563 | ||
| S3982XA | 24 | 955-965 | S42011P | 08 | 564-566 | S42144B | 24 | 955-965 | ||
| S3982XD | 23 | 949-950 | S42011S | 08 | 559-561 | S42144D | 08 | 559-561 | ||
| S3982XS | 21 | 913-914 | S42012A | 08 | 562-563 | S42144G | 08 | 559-561 | ||
| S3983XA | 21 | 913-914 | S42012A | 24 | 955-965 | S42144K | 08 | 564-566 | ||
| S3983XA | 24 | 955-965 | S42012B | 08 | 562-563 | S42144P | 08 | 564-566 | ||
| S3983XD | 23 | 949-950 | S42012B | 24 | 955-965 | S42144S | 08 | 559-561 | ||
| S3983XS | 21 | 913-914 | S42012D | 08 | 559-561 | S42145A | 08 | 562-563 | ||
| S39840A | 21 | 913-914 | S42012G | 08 | 559-561 | S42145A | 24 | 955-965 | ||
| S39840A | 24 | 955-965 | S42012K | 08 | 564-566 | S42145B | 08 | 562-563 | ||
| S39840D | 23 | 949-950 | S42012P | 08 | 564-566 | S42145B | 24 | 955-965 | ||
| S39840S | 21 | 913-914 | S42012S | 08 | 559-561 | S42145D | 08 | 559-561 | ||
| S39848A | 21 | 913-914 | S42013A | 08 | 562-563 | S42145G | 08 | 559-561 | ||
| S39848A | 24 | 955-965 | S42013A | 24 | 955-965 | S42145K | 08 | 564-566 | ||
| S39848D | 23 | 949-950 | S42013B | 08 | 562-563 | S42145P | 08 | 564-566 | ||
| S39848S | 21 | 913-914 | S42013B | 24 | 955-965 | S42145S | 08 | 559-561 | ||
| S3991XA | 21 | 913-914 | S42013D | 08 | 559-561 | S42146A | 08 | 562-563 | ||
| S3991XA | 24 | 955-965 | S42013G | 08 | 559-561 | S42146A | 24 | 955-965 | ||
| S3991XD | 23 | 949-950 | S42013K | 08 | 564-566 | S42146B | 08 | 562-563 | ||
| S3991XS | 21 | 913-914 | S42013P | 08 | 564-566 | S42146B | 24 | 955-965 | ||
| S3992XA | 21 | 913-914 | S42013S | 08 | 559-561 | S42146D | 08 | 559-561 | ||
| S3992XA | 24 | 955-965 | S42014A | 08 | 562-563 | S42146G | 08 | 559-561 | ||
| S3992XD | 23 | 949-950 | S42014A | 24 | 955-965 | S42146K | 08 | 564-566 | ||
| S3992XS | 21 | 913-914 | S42014B | 08 | 562-563 | S42146P | 08 | 564-566 | ||
| S3993XA | 21 | 913-914 | S42014B | 24 | 955-965 | S42146S | 08 | 559-561 | ||
| S3993XA | 24 | 955-965 | S42014D | 08 | 559-561 | S42151A | 08 | 562-563 | ||
| S3993XD | 23 | 949-950 | S42014G | 08 | 559-561 | S42151A | 24 | 955-965 | ||
| S3993XS | 21 | 913-914 | S42014K | 08 | 564-566 | S42151B | 08 | 562-563 | ||
| S3994XA | 21 | 913-914 | S42014P | 08 | 564-566 | S42151B | 24 | 955-965 | ||
| S3994XA | 24 | 955-965 | S42014S | 08 | 559-561 | S42151D | 08 | 559-561 | ||
| S3994XD | 23 | 949-950 | S42015A | 08 | 562-563 | S42151G | 08 | 559-561 | ||
| S3994XS | 21 | 913-914 | S42015A | 24 | 955-965 | S42151K | 08 | 564-566 | ||
| S40011A | 09 | 604-605 | S42015B | 08 | 562-563 | S42151P | 08 | 564-566 | ||
| S40011A | 24 | 955-965 | S42015B | 24 | 955-965 | S42151S | 08 | 559-561 | ||
| S40011D | 23 | 949-950 | S42015D | 08 | 559-561 | S42152A | 08 | 562-563 | ||
| S40011S | 09 | 604-605 | S42015G | 08 | 559-561 | S42152A | 24 | 955-965 | ||
| S40012A | 09 | 604-605 | S42015K | 08 | 564-566 | S42152B | 08 | 562-563 | ||
| S40012A | 24 | 955-965 | S42015P | 08 | 564-566 | S42152B | 24 | 955-965 | ||
| S40012D | 23 | 949-950 | S42015S | 08 | 559-561 | S42152D | 08 | 559-561 | ||
| S40012S | 09 | 604-605 | S42016A | 08 | 562-563 | S42152G | 08 | 559-561 | ||
| S40019A | 09 | 604-605 | S42016A | 24 | 955-965 | S42152K | 08 | 564-566 | ||
| S40019A | 24 | 955-965 | S42016B | 08 | 562-563 | S42152P | 08 | 564-566 | ||
| S40019D | 23 | 949-950 | S42016B | 24 | 955-965 | S42152S | 08 | 559-561 | ||
| S40019S | 09 | 604-605 | S42016D | 08 | 559-561 | S42153A | 08 | 562-563 | ||
| S40021A | 09 | 604-605 | S42016G | 08 | 559-561 | S42153A | 24 | 955-965 | ||
| S40021A | 24 | 955-965 | S42016K | 08 | 564-566 | S42153B | 08 | 562-563 | ||
| S40021D | 23 | 949-950 | S42016P | 08 | 564-566 | S42153B | 24 | 955-965 | ||
| S40021S | 09 | 604-605 | S42016S | 08 | 559-561 | S42153D | 08 | 559-561 | ||
| S40022A | 09 | 604-605 | S42017A | 08 | 562-563 | S42153G | 08 | 559-561 | ||
| S40022A | 24 | 955-965 | S42017A | 24 | 955-965 | S42153K | 08 | 564-566 | ||
| S40022D | 23 | 949-950 | S42017B | 08 | 562-563 | S42153P | 08 | 564-566 | ||
| S40022S | 09 | 604-605 | S42017B | 24 | 955-965 | S42153S | 08 | 559-561 | ||
| S40029A | 09 | 604-605 | S42017D | 08 | 559-561 | S42154A | 08 | 562-563 | ||
| S40029A | 24 | 955-965 | S42017G | 08 | 559-561 | S42154A | 24 | 955-965 | ||
| S40029D | 23 | 949-950 | S42017K | 08 | 564-566 | S42154B | 08 | 562-563 | ||
| S40029S | 09 | 604-605 | S42017P | 08 | 564-566 | S42154B | 24 | 955-965 | ||
| S40211A | 09 | 604-605 | S42017S | 08 | 559-561 | S42154D | 08 | 559-561 | ||
| S40211A | 24 | 955-965 | S42018A | 08 | 562-563 | S42154G | 08 | 559-561 | ||
| S40211D | 23 | 949-950 | S42018A | 24 | 955-965 | S42154K | 08 | 564-566 | ||
| S40211S | 09 | 604-605 | S42018B | 08 | 562-563 | S42154P | 08 | 564-566 | ||
| S40212A | 09 | 604-605 | S42018B | 24 | 955-965 | S42154S | 08 | 559-561 | ||
| S40212A | 24 | 955-965 | S42018D | 08 | 559-561 | S42155A | 08 | 562-563 | ||
| S40212D | 23 | 949-950 | S42018G | 08 | 559-561 | S42155A | 24 | 955-965 | ||
| S40212S | 09 | 604-605 | S42018K | 08 | 564-566 | S42155B | 08 | 562-563 | ||
| S40219A | 09 | 604-605 | S42018P | 08 | 564-566 | S42155B | 24 | 955-965 | ||
| S40219A | 24 | 955-965 | S42018S | 08 | 559-561 | S42155D | 08 | 559-561 | ||
| S40219D | 23 | 949-950 | S42019A | 08 | 562-563 | S42155G | 08 | 559-561 | ||
| S40219S | 09 | 604-605 | S42019A | 24 | 955-965 | S42155K | 08 | 564-566 | ||
| S40221A | 09 | 604-605 | S42019B | 08 | 562-563 | S42155P | 08 | 564-566 | ||
| S40221A | 24 | 955-965 | S42019B | 24 | 955-965 | S42155S | 08 | 559-561 | ||
| S40221D | 23 | 949-950 | S42019D | 08 | 559-561 | S42156A | 08 | 562-563 | ||
| S40221S | 09 | 604-605 | S42019G | 08 | 559-561 | S42156A | 24 | 955-965 | ||
| S40222A | 09 | 604-605 | S42019K | 08 | 564-566 | S42156B | 08 | 562-563 | ||
| S40222A | 24 | 955-965 | S42019P | 08 | 564-566 | S42156B | 24 | 955-965 | ||
| S40222D | 23 | 949-950 | S42019S | 08 | 559-561 | S42156D | 08 | 559-561 | ||
| S40222S | 09 | 604-605 | S42021A | 08 | 562-563 | S42156G | 08 | 559-561 | ||
| S40229A | 09 | 604-605 | S42021A | 24 | 955-965 | S42156K | 08 | 564-566 | ||
| S40229A | 24 | 955-965 | S42021B | 08 | 562-563 | S42156P | 08 | 564-566 | ||
| S40229D | 23 | 949-950 | S42021B | 24 | 955-965 | S42156S | 08 | 559-561 | ||
| S40229S | 09 | 604-605 | S42021D | 08 | 559-561 | S42191A | 08 | 564-566 | ||
| S40241A | 09 | 604-605 | S42021G | 08 | 559-561 | S42191A | 24 | 955-965 | ||
| S40241A | 24 | 955-965 | S42021K | 08 | 564-566 | S42191B | 08 | 564-566 | ||
| S40241D | 23 | 949-950 | S42021P | 08 | 564-566 | S42191B | 24 | 955-965 | ||
| S40241S | 09 | 604-605 | S42021S | 08 | 559-561 | S42191D | 08 | 559-561 | ||
| S40242A | 09 | 604-605 | S42022A | 08 | 562-563 | S42191G | 08 | 559-561 | ||
| S40242A | 24 | 955-965 | S42022A | 24 | 955-965 | S42191K | 08 | 564-566 | ||
| S40242D | 23 | 949-950 | S42022B | 08 | 562-563 | S42191P | 08 | 564-566 | ||
| S40242S | 09 | 604-605 | S42022B | 24 | 955-965 | S42191S | 08 | 559-561 | ||
| S40249A | 09 | 604-605 | S42022D | 08 | 559-561 | S42192A | 08 | 564-566 | ||
| S40249A | 24 | 955-965 | S42022G | 08 | 559-561 | S42192A | 24 | 955-965 | ||
| S40249D | 23 | 949-950 | S42022K | 08 | 564-566 | S42192B | 08 | 564-566 | ||
| S40249S | 09 | 604-605 | S42022P | 08 | 564-566 | S42192B | 24 | 955-965 | ||
| S40251A | 09 | 604-605 | S42022S | 08 | 559-561 | S42192D | 08 | 559-561 | ||
| S40251A | 24 | 955-965 | S42023A | 08 | 562-563 | S42192G | 08 | 559-561 | ||
| S40251D | 23 | 949-950 | S42023A | 24 | 955-965 | S42192K | 08 | 564-566 | ||
| S40251S | 09 | 604-605 | S42023B | 08 | 562-563 | S42192P | 08 | 564-566 | ||
| S40252A | 09 | 604-605 | S42023B | 24 | 955-965 | S42192S | 08 | 559-561 | ||
| S40252A | 24 | 955-965 | S42023D | 08 | 559-561 | S42199A | 08 | 564-566 | ||
| S40252D | 23 | 949-950 | S42023G | 08 | 559-561 | S42199A | 24 | 955-965 | ||
| S40252S | 09 | 604-605 | S42023K | 08 | 564-566 | S42199B | 08 | 564-566 | ||
| S40259A | 09 | 604-605 | S42023P | 08 | 564-566 | S42199B | 24 | 955-965 | ||
| S40259A | 24 | 955-965 | S42023S | 08 | 559-561 | S42199D | 08 | 559-561 | ||
| S40259D | 23 | 949-950 | S42024A | 08 | 562-563 | S42199G | 08 | 559-561 | ||
| S40259S | 09 | 604-605 | S42024A | 24 | 955-965 | S42199K | 08 | 564-566 | ||
| S40261A | 09 | 606-607 | S42024B | 08 | 562-563 | S42199P | 08 | 564-566 | ||
| S40261A | 24 | 955-965 | S42024B | 24 | 955-965 | S42199S | 08 | 559-561 | ||
| S40261D | 23 | 949-950 | S42024D | 08 | 559-561 | S42201A | 08 | 562-563 | ||
| S40261S | 09 | 604-605 | S42024G | 08 | 559-561 | S42201A | 24 | 955-965 | ||
| S40262A | 09 | 606-607 | S42024K | 08 | 564-566 | S42201B | 08 | 562-563 | ||
| S40262A | 24 | 955-965 | S42024P | 08 | 564-566 | S42201B | 24 | 955-965 | ||
| S40262D | 23 | 949-950 | S42024S | 08 | 559-561 | S42201D | 08 | 559-561 | ||
| S40262S | 09 | 604-605 | S42025A | 08 | 562-563 | S42201G | 08 | 559-561 | ||
| S40269A | 09 | 606-607 | S42025A | 24 | 955-965 | S42201K | 08 | 564-566 | ||
| S40269A | 24 | 955-965 | S42025B | 08 | 562-563 | S42201P | 08 | 564-566 | ||
| S40269D | 23 | 949-950 | S42025B | 24 | 955-965 | S42201S | 08 | 559-561 | ||
| S40269S | 09 | 604-605 | S42025D | 08 | 559-561 | S42202A | 08 | 562-563 | ||
| S40271A | 09 | 604-605 | S42025G | 08 | 559-561 | S42202A | 24 | 955-965 | ||
| S40271A | 24 | 955-965 | S42025K | 08 | 564-566 | S42202B | 08 | 562-563 | ||
| S40271D | 23 | 949-950 | S42025P | 08 | 564-566 | S42202B | 24 | 955-965 | ||
| S40271S | 09 | 604-605 | S42025S | 08 | 559-561 | S42202D | 08 | 559-561 | ||
| S40272A | 09 | 604-605 | S42026A | 08 | 562-563 | S42202G | 08 | 559-561 | ||
| S40272A | 24 | 955-965 | S42026A | 24 | 955-965 | S42202K | 08 | 564-566 | ||
| S40272D | 23 | 949-950 | S42026B | 08 | 562-563 | S42202P | 08 | 564-566 | ||
| S40272S | 09 | 604-605 | S42026B | 24 | 955-965 | S42202S | 08 | 559-561 | ||
| S40279A | 09 | 604-605 | S42026D | 08 | 559-561 | S42209A | 08 | 562-563 | ||
| S40279A | 24 | 955-965 | S42026G | 08 | 559-561 | S42209A | 24 | 955-965 | ||
| S40279D | 23 | 949-950 | S42026K | 08 | 564-566 | S42209B | 08 | 562-563 | ||
| S40279S | 09 | 604-605 | S42026P | 08 | 564-566 | S42209B | 24 | 955-965 | ||
| S40811A | 09 | 604-605 | S42026S | 08 | 559-561 | S42209D | 08 | 559-561 | ||
| S40811A | 24 | 955-965 | S42031A | 08 | 562-563 | S42209G | 08 | 559-561 | ||
| S40811D | 23 | 949-950 | S42031A | 24 | 955-965 | S42209K | 08 | 564-566 | ||
| S40811S | 09 | 604-605 | S42031B | 08 | 562-563 | S42209P | 08 | 564-566 | ||
| S40812A | 09 | 604-605 | S42031B | 24 | 955-965 | S42209S | 08 | 559-561 | ||
| S40812A | 24 | 955-965 | S42031D | 08 | 559-561 | S42211A | 08 | 562-563 | ||
| S40812D | 23 | 949-950 | S42031G | 08 | 559-561 | S42211A | 24 | 955-965 | ||
| S40812S | 09 | 604-605 | S42031K | 08 | 564-566 | S42211B | 08 | 562-563 | ||
| S40819A | 09 | 604-605 | S42031P | 08 | 564-566 | S42211B | 24 | 955-965 | ||
| S40819A | 24 | 955-965 | S42031S | 08 | 559-561 | S42211D | 08 | 559-561 | ||
| S40819D | 23 | 949-950 | S42032A | 08 | 562-563 | S42211G | 08 | 559-561 | ||
| S40819S | 09 | 604-605 | S42032A | 24 | 955-965 | S42211K | 08 | 564-566 | ||
| S40821A | 09 | 604-605 | S42032B | 08 | 562-563 | S42211P | 08 | 564-566 | ||
| S40821A | 24 | 955-965 | S42032B | 24 | 955-965 | S42211S | 08 | 559-561 | ||
| S40821D | 23 | 949-950 | S42032D | 08 | 559-561 | S42212A | 08 | 562-563 | ||
| S40821S | 09 | 604-605 | S42032G | 08 | 559-561 | S42212A | 24 | 955-965 | ||
| S40822A | 09 | 604-605 | S42032K | 08 | 564-566 | S42212B | 08 | 562-563 | ||
| S40822A | 24 | 955-965 | S42032P | 08 | 564-566 | S42212B | 24 | 955-965 | ||
| S40822D | 23 | 949-950 | S42032S | 08 | 559-561 | S42212D | 08 | 559-561 | ||
| S40822S | 09 | 604-605 | S42033A | 08 | 562-563 | S42212G | 08 | 559-561 | ||
| S40829A | 09 | 604-605 | S42033A | 24 | 955-965 | S42212K | 08 | 564-566 | ||
| S40829A | 24 | 955-965 | S42033B | 08 | 562-563 | S42212P | 08 | 564-566 | ||
| S40829D | 23 | 949-950 | S42033B | 24 | 955-965 | S42212S | 08 | 559-561 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 04 Oct 2018 16:21:08 CMS, code-revision=145, description-revision=1114 |