ICD-10-CM/PCS MS-DRG v40.0 Definitions Manual
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DRAFT
ICD-10-CM/PCS MS-DRG v40.0 Definitions Manual |
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| Diagnosis Code/MDC/MS-DRG Index |
| Page 33 of 75 |
| A000 B302 C577 C8442 D309 E093393 E1344 F19280 G9761 H21341 H52203 I369 I70221 J682 K7031 L89200 M06812 M23203 M4841XS M71811 M84529D M87842 N468 O1214 O336XX3 O368234 O714 P913 R062 S0092XA S0303XA S069X2A S14106D S21312S S25809S S31811D S32499S S37012A S42123D S42449D S46329S S52045R S52291A S52552B S56112S S60359A S61509A S62321G S62660D S63637S S66529S S72024G S72114B S72326D S72451B S7711XD S82045J S82251P S8261XA S83521A S89309D S92044S S92426G S96802A T20219S T23229S T25739S T391X5S T444X2S T498X3S T602X4S T7805XS T83728S Z315 Z96641 |
| DX | MDC | MS-DRG | DX | MDC | MS-DRG | DX | MDC | MS-DRG | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S14106D | 23 | 949-950 | S15229D | 23 | 949-950 | S20352D | 23 | 949-950 | ||
| S14106S | 01 | 052-053 | S15229S | 05 | 299-301 | S20352S | 09 | 604-605 | ||
| S14107A | 01 | 052-053 | S15291A | 15 | 791 | S20353A | 09 | 604-605 | ||
| S14107A | 24 | 963-965 | S15291A | 15 | 793 | S20353A | 24 | 963-965 | ||
| S14107D | 23 | 949-950 | S15291A | 21 | 913-914 | S20353D | 23 | 949-950 | ||
| S14107S | 01 | 052-053 | S15291A | 24 | 963-965 | S20353S | 09 | 604-605 | ||
| S14108A | 01 | 052-053 | S15291D | 23 | 949-950 | S20354A | 09 | 604-605 | ||
| S14108A | 24 | 963-965 | S15291S | 05 | 299-301 | S20354A | 24 | 963-965 | ||
| S14108D | 23 | 949-950 | S15292A | 15 | 791 | S20354D | 23 | 949-950 | ||
| S14108S | 01 | 052-053 | S15292A | 15 | 793 | S20354S | 09 | 604-605 | ||
| S14109A | 01 | 052-053 | S15292A | 21 | 913-914 | S20359A | 09 | 604-605 | ||
| S14109A | 24 | 963-965 | S15292A | 24 | 963-965 | S20359A | 24 | 963-965 | ||
| S14109D | 23 | 949-950 | S15292D | 23 | 949-950 | S20359D | 23 | 949-950 | ||
| S14109S | 01 | 052-053 | S15292S | 05 | 299-301 | S20359S | 09 | 604-605 | ||
| S14111A | 01 | 052-053 | S15299A | 15 | 791 | S20361A | 09 | 606-607 | ||
| S14111A | 24 | 963-965 | S15299A | 15 | 793 | S20361A | 24 | 963-965 | ||
| S14111D | 23 | 949-950 | S15299A | 21 | 913-914 | S20361D | 23 | 949-950 | ||
| S14111S | 01 | 052-053 | S15299A | 24 | 963-965 | S20361S | 09 | 604-605 | ||
| S14112A | 01 | 052-053 | S15299D | 23 | 949-950 | S20362A | 09 | 606-607 | ||
| S14112A | 24 | 963-965 | S15299S | 05 | 299-301 | S20362A | 24 | 963-965 | ||
| S14112D | 23 | 949-950 | S15301A | 15 | 791 | S20362D | 23 | 949-950 | ||
| S14112S | 01 | 052-053 | S15301A | 15 | 793 | S20362S | 09 | 604-605 | ||
| S14113A | 01 | 052-053 | S15301A | 21 | 913-914 | S20363A | 09 | 606-607 | ||
| S14113A | 24 | 963-965 | S15301A | 24 | 963-965 | S20363A | 24 | 963-965 | ||
| S14113D | 23 | 949-950 | S15301D | 23 | 949-950 | S20363D | 23 | 949-950 | ||
| S14113S | 01 | 052-053 | S15301S | 05 | 299-301 | S20363S | 09 | 604-605 | ||
| S14114A | 01 | 052-053 | S15302A | 15 | 791 | S20364A | 09 | 606-607 | ||
| S14114A | 24 | 963-965 | S15302A | 15 | 793 | S20364A | 24 | 963-965 | ||
| S14114D | 23 | 949-950 | S15302A | 21 | 913-914 | S20364D | 23 | 949-950 | ||
| S14114S | 01 | 052-053 | S15302A | 24 | 963-965 | S20364S | 09 | 604-605 | ||
| S14115A | 01 | 052-053 | S15302D | 23 | 949-950 | S20369A | 09 | 606-607 | ||
| S14115A | 24 | 963-965 | S15302S | 05 | 299-301 | S20369A | 24 | 963-965 | ||
| S14115D | 23 | 949-950 | S15309A | 15 | 791 | S20369D | 23 | 949-950 | ||
| S14115S | 01 | 052-053 | S15309A | 15 | 793 | S20369S | 09 | 604-605 | ||
| S14116A | 01 | 052-053 | S15309A | 21 | 913-914 | S20371A | 09 | 604-605 | ||
| S14116A | 24 | 963-965 | S15309A | 24 | 963-965 | S20371A | 24 | 963-965 | ||
| S14116D | 23 | 949-950 | S15309D | 23 | 949-950 | S20371D | 23 | 949-950 | ||
| S14116S | 01 | 052-053 | S15309S | 05 | 299-301 | S20371S | 09 | 604-605 | ||
| S14117A | 01 | 052-053 | S15311A | 15 | 791 | S20372A | 09 | 604-605 | ||
| S14117A | 24 | 963-965 | S15311A | 15 | 793 | S20372A | 24 | 963-965 | ||
| S14117D | 23 | 949-950 | S15311A | 21 | 913-914 | S20372D | 23 | 949-950 | ||
| S14117S | 01 | 052-053 | S15311A | 24 | 963-965 | S20372S | 09 | 604-605 | ||
| S14118A | 01 | 052-053 | S15311D | 23 | 949-950 | S20373A | 09 | 604-605 | ||
| S14118A | 24 | 963-965 | S15311S | 05 | 299-301 | S20373A | 24 | 963-965 | ||
| S14118D | 23 | 949-950 | S15312A | 15 | 791 | S20373D | 23 | 949-950 | ||
| S14118S | 01 | 052-053 | S15312A | 15 | 793 | S20373S | 09 | 604-605 | ||
| S14119A | 01 | 052-053 | S15312A | 21 | 913-914 | S20374A | 09 | 604-605 | ||
| S14119A | 24 | 963-965 | S15312A | 24 | 963-965 | S20374A | 24 | 963-965 | ||
| S14119D | 23 | 949-950 | S15312D | 23 | 949-950 | S20374D | 23 | 949-950 | ||
| S14119S | 01 | 052-053 | S15312S | 05 | 299-301 | S20374S | 09 | 604-605 | ||
| S14121A | 01 | 052-053 | S15319A | 15 | 791 | S20379A | 09 | 604-605 | ||
| S14121A | 24 | 963-965 | S15319A | 15 | 793 | S20379A | 24 | 963-965 | ||
| S14121D | 23 | 949-950 | S15319A | 21 | 913-914 | S20379D | 23 | 949-950 | ||
| S14121S | 01 | 052-053 | S15319A | 24 | 963-965 | S20379S | 09 | 604-605 | ||
| S14122A | 01 | 052-053 | S15319D | 23 | 949-950 | S20401A | 09 | 604-605 | ||
| S14122A | 24 | 963-965 | S15319S | 05 | 299-301 | S20401A | 24 | 963-965 | ||
| S14122D | 23 | 949-950 | S15321A | 15 | 791 | S20401D | 23 | 949-950 | ||
| S14122S | 01 | 052-053 | S15321A | 15 | 793 | S20401S | 09 | 604-605 | ||
| S14123A | 01 | 052-053 | S15321A | 21 | 913-914 | S20402A | 09 | 604-605 | ||
| S14123A | 24 | 963-965 | S15321A | 24 | 963-965 | S20402A | 24 | 963-965 | ||
| S14123D | 23 | 949-950 | S15321D | 23 | 949-950 | S20402D | 23 | 949-950 | ||
| S14123S | 01 | 052-053 | S15321S | 05 | 299-301 | S20402S | 09 | 604-605 | ||
| S14124A | 01 | 052-053 | S15322A | 15 | 791 | S20409A | 09 | 604-605 | ||
| S14124A | 24 | 963-965 | S15322A | 15 | 793 | S20409A | 24 | 963-965 | ||
| S14124D | 23 | 949-950 | S15322A | 21 | 913-914 | S20409D | 23 | 949-950 | ||
| S14124S | 01 | 052-053 | S15322A | 24 | 963-965 | S20409S | 09 | 604-605 | ||
| S14125A | 01 | 052-053 | S15322D | 23 | 949-950 | S20411A | 09 | 604-605 | ||
| S14125A | 24 | 963-965 | S15322S | 05 | 299-301 | S20411A | 24 | 963-965 | ||
| S14125D | 23 | 949-950 | S15329A | 15 | 791 | S20411D | 23 | 949-950 | ||
| S14125S | 01 | 052-053 | S15329A | 15 | 793 | S20411S | 09 | 604-605 | ||
| S14126A | 01 | 052-053 | S15329A | 21 | 913-914 | S20412A | 09 | 604-605 | ||
| S14126A | 24 | 963-965 | S15329A | 24 | 963-965 | S20412A | 24 | 963-965 | ||
| S14126D | 23 | 949-950 | S15329D | 23 | 949-950 | S20412D | 23 | 949-950 | ||
| S14126S | 01 | 052-053 | S15329S | 05 | 299-301 | S20412S | 09 | 604-605 | ||
| S14127A | 01 | 052-053 | S15391A | 15 | 791 | S20419A | 09 | 604-605 | ||
| S14127A | 24 | 963-965 | S15391A | 15 | 793 | S20419A | 24 | 963-965 | ||
| S14127D | 23 | 949-950 | S15391A | 21 | 913-914 | S20419D | 23 | 949-950 | ||
| S14127S | 01 | 052-053 | S15391A | 24 | 963-965 | S20419S | 09 | 604-605 | ||
| S14128A | 01 | 052-053 | S15391D | 23 | 949-950 | S20421A | 09 | 606-607 | ||
| S14128A | 24 | 963-965 | S15391S | 05 | 299-301 | S20421A | 24 | 963-965 | ||
| S14128D | 23 | 949-950 | S15392A | 15 | 791 | S20421D | 23 | 949-950 | ||
| S14128S | 01 | 052-053 | S15392A | 15 | 793 | S20421S | 09 | 604-605 | ||
| S14129A | 01 | 052-053 | S15392A | 21 | 913-914 | S20422A | 09 | 606-607 | ||
| S14129A | 24 | 963-965 | S15392A | 24 | 963-965 | S20422A | 24 | 963-965 | ||
| S14129D | 23 | 949-950 | S15392D | 23 | 949-950 | S20422D | 23 | 949-950 | ||
| S14129S | 01 | 052-053 | S15392S | 05 | 299-301 | S20422S | 09 | 604-605 | ||
| S14131A | 01 | 052-053 | S15399A | 15 | 791 | S20429A | 09 | 606-607 | ||
| S14131A | 24 | 963-965 | S15399A | 15 | 793 | S20429A | 24 | 963-965 | ||
| S14131D | 23 | 949-950 | S15399A | 21 | 913-914 | S20429D | 23 | 949-950 | ||
| S14131S | 01 | 052-053 | S15399A | 24 | 963-965 | S20429S | 09 | 604-605 | ||
| S14132A | 01 | 052-053 | S15399D | 23 | 949-950 | S20441A | 09 | 604-605 | ||
| S14132A | 24 | 963-965 | S15399S | 05 | 299-301 | S20441A | 24 | 963-965 | ||
| S14132D | 23 | 949-950 | S158XXA | Pre | 011-013 | S20441D | 23 | 949-950 | ||
| S14132S | 01 | 052-053 | S158XXA | 21 | 913-914 | S20441S | 09 | 604-605 | ||
| S14133A | 01 | 052-053 | S158XXA | 24 | 963-965 | S20442A | 09 | 604-605 | ||
| S14133A | 24 | 963-965 | S158XXD | 23 | 949-950 | S20442A | 24 | 963-965 | ||
| S14133D | 23 | 949-950 | S158XXS | 05 | 299-301 | S20442D | 23 | 949-950 | ||
| S14133S | 01 | 052-053 | S159XXA | Pre | 011-013 | S20442S | 09 | 604-605 | ||
| S14134A | 01 | 052-053 | S159XXA | 21 | 913-914 | S20449A | 09 | 604-605 | ||
| S14134A | 24 | 963-965 | S159XXA | 24 | 963-965 | S20449A | 24 | 963-965 | ||
| S14134D | 23 | 949-950 | S159XXD | 23 | 949-950 | S20449D | 23 | 949-950 | ||
| S14134S | 01 | 052-053 | S159XXS | 05 | 299-301 | S20449S | 09 | 604-605 | ||
| S14135A | 01 | 052-053 | S161XXA | 08 | 551-552 | S20451A | 09 | 604-605 | ||
| S14135A | 24 | 963-965 | S161XXA | 24 | 963-965 | S20451A | 24 | 963-965 | ||
| S14135D | 23 | 949-950 | S161XXD | 23 | 949-950 | S20451D | 23 | 949-950 | ||
| S14135S | 01 | 052-053 | S161XXS | 08 | 562-563 | S20451S | 09 | 604-605 | ||
| S14136A | 01 | 052-053 | S162XXA | Pre | 011-013 | S20452A | 09 | 604-605 | ||
| S14136A | 24 | 963-965 | S162XXA | 09 | 604-605 | S20452A | 24 | 963-965 | ||
| S14136D | 23 | 949-950 | S162XXA | 24 | 963-965 | S20452D | 23 | 949-950 | ||
| S14136S | 01 | 052-053 | S162XXD | 23 | 949-950 | S20452S | 09 | 604-605 | ||
| S14137A | 01 | 052-053 | S162XXS | 09 | 604-605 | S20459A | 09 | 604-605 | ||
| S14137A | 24 | 963-965 | S168XXA | Pre | 011-013 | S20459A | 24 | 963-965 | ||
| S14137D | 23 | 949-950 | S168XXA | 21 | 913-914 | S20459D | 23 | 949-950 | ||
| S14137S | 01 | 052-053 | S168XXA | 24 | 963-965 | S20459S | 09 | 604-605 | ||
| S14138A | 01 | 052-053 | S168XXD | 23 | 949-950 | S20461A | 09 | 606-607 | ||
| S14138A | 24 | 963-965 | S168XXS | 21 | 913-914 | S20461A | 24 | 963-965 | ||
| S14138D | 23 | 949-950 | S169XXA | Pre | 011-013 | S20461D | 23 | 949-950 | ||
| S14138S | 01 | 052-053 | S169XXA | 21 | 913-914 | S20461S | 09 | 604-605 | ||
| S14139A | 01 | 052-053 | S169XXA | 24 | 963-965 | S20462A | 09 | 606-607 | ||
| S14139A | 24 | 963-965 | S169XXD | 23 | 949-950 | S20462A | 24 | 963-965 | ||
| S14139D | 23 | 949-950 | S169XXS | 21 | 913-914 | S20462D | 23 | 949-950 | ||
| S14139S | 01 | 052-053 | S170XXA | Pre | 011-013 | S20462S | 09 | 604-605 | ||
| S14141A | 01 | 052-053 | S170XXA | 21 | 913-914 | S20469A | 09 | 606-607 | ||
| S14141A | 24 | 963-965 | S170XXA | 24 | 963-965 | S20469A | 24 | 963-965 | ||
| S14141D | 23 | 949-950 | S170XXD | 23 | 949-950 | S20469D | 23 | 949-950 | ||
| S14141S | 01 | 052-053 | S170XXS | 09 | 604-605 | S20469S | 09 | 604-605 | ||
| S14142A | 01 | 052-053 | S178XXA | Pre | 011-013 | S20471A | 09 | 604-605 | ||
| S14142A | 24 | 963-965 | S178XXA | 21 | 913-914 | S20471A | 24 | 963-965 | ||
| S14142D | 23 | 949-950 | S178XXA | 24 | 963-965 | S20471D | 23 | 949-950 | ||
| S14142S | 01 | 052-053 | S178XXD | 23 | 949-950 | S20471S | 09 | 604-605 | ||
| S14143A | 01 | 052-053 | S178XXS | 09 | 604-605 | S20472A | 09 | 604-605 | ||
| S14143A | 24 | 963-965 | S179XXA | Pre | 011-013 | S20472A | 24 | 963-965 | ||
| S14143D | 23 | 949-950 | S179XXA | 21 | 913-914 | S20472D | 23 | 949-950 | ||
| S14143S | 01 | 052-053 | S179XXA | 24 | 963-965 | S20472S | 09 | 604-605 | ||
| S14144A | 01 | 052-053 | S179XXD | 23 | 949-950 | S20479A | 09 | 604-605 | ||
| S14144A | 24 | 963-965 | S179XXS | 09 | 604-605 | S20479A | 24 | 963-965 | ||
| S14144D | 23 | 949-950 | S1980XA | Pre | 011-013 | S20479D | 23 | 949-950 | ||
| S14144S | 01 | 052-053 | S1980XA | 21 | 913-914 | S20479S | 09 | 604-605 | ||
| S14145A | 01 | 052-053 | S1980XA | 24 | 963-965 | S2090XA | 09 | 604-605 | ||
| S14145A | 24 | 963-965 | S1980XD | 23 | 949-950 | S2090XA | 24 | 963-965 | ||
| S14145D | 23 | 949-950 | S1980XS | 21 | 913-914 | S2090XD | 23 | 949-950 | ||
| S14145S | 01 | 052-053 | S1981XA | Pre | 011-013 | S2090XS | 09 | 604-605 | ||
| S14146A | 01 | 052-053 | S1981XA | 21 | 913-914 | S2091XA | 09 | 604-605 | ||
| S14146A | 24 | 963-965 | S1981XA | 24 | 963-965 | S2091XA | 24 | 963-965 | ||
| S14146D | 23 | 949-950 | S1981XD | 23 | 949-950 | S2091XD | 23 | 949-950 | ||
| S14146S | 01 | 052-053 | S1981XS | 21 | 913-914 | S2091XS | 09 | 604-605 | ||
| S14147A | 01 | 052-053 | S1982XA | Pre | 011-013 | S2092XA | 09 | 606-607 | ||
| S14147A | 24 | 963-965 | S1982XA | 21 | 913-914 | S2092XA | 24 | 963-965 | ||
| S14147D | 23 | 949-950 | S1982XA | 24 | 963-965 | S2092XD | 23 | 949-950 | ||
| S14147S | 01 | 052-053 | S1982XD | 23 | 949-950 | S2092XS | 09 | 604-605 | ||
| S14148A | 01 | 052-053 | S1982XS | 21 | 913-914 | S2094XA | 09 | 604-605 | ||
| S14148A | 24 | 963-965 | S1983XA | Pre | 011-013 | S2094XA | 24 | 963-965 | ||
| S14148D | 23 | 949-950 | S1983XA | 21 | 913-914 | S2094XD | 23 | 949-950 | ||
| S14148S | 01 | 052-053 | S1983XA | 24 | 963-965 | S2094XS | 09 | 604-605 | ||
| S14149A | 01 | 052-053 | S1983XD | 23 | 949-950 | S2095XA | 09 | 604-605 | ||
| S14149A | 24 | 963-965 | S1983XS | 21 | 913-914 | S2095XA | 24 | 963-965 | ||
| S14149D | 23 | 949-950 | S1984XA | Pre | 011-013 | S2095XD | 23 | 949-950 | ||
| S14149S | 01 | 052-053 | S1984XA | 21 | 913-914 | S2095XS | 09 | 604-605 | ||
| S14151A | 01 | 052-053 | S1984XA | 24 | 963-965 | S2096XA | 09 | 606-607 | ||
| S14151A | 24 | 963-965 | S1984XD | 23 | 949-950 | S2096XA | 24 | 963-965 | ||
| S14151D | 23 | 949-950 | S1984XS | 21 | 913-914 | S2096XD | 23 | 949-950 | ||
| S14151S | 01 | 052-053 | S1985XA | Pre | 011-013 | S2096XS | 09 | 604-605 | ||
| S14152A | 01 | 052-053 | S1985XA | 21 | 913-914 | S2097XA | 09 | 604-605 | ||
| S14152A | 24 | 963-965 | S1985XA | 24 | 963-965 | S2097XA | 24 | 963-965 | ||
| S14152D | 23 | 949-950 | S1985XD | 23 | 949-950 | S2097XD | 23 | 949-950 | ||
| S14152S | 01 | 052-053 | S1985XS | 21 | 913-914 | S2097XS | 09 | 604-605 | ||
| S14153A | 01 | 052-053 | S1989XA | Pre | 011-013 | S21001A | 09 | 604-605 | ||
| S14153A | 24 | 963-965 | S1989XA | 21 | 913-914 | S21001A | 24 | 963-965 | ||
| S14153D | 23 | 949-950 | S1989XA | 24 | 963-965 | S21001D | 23 | 949-950 | ||
| S14153S | 01 | 052-053 | S1989XD | 23 | 949-950 | S21001S | 09 | 604-605 | ||
| S14154A | 01 | 052-053 | S1989XS | 21 | 913-914 | S21002A | 09 | 604-605 | ||
| S14154A | 24 | 963-965 | S199XXA | Pre | 011-013 | S21002A | 24 | 963-965 | ||
| S14154D | 23 | 949-950 | S199XXA | 21 | 913-914 | S21002D | 23 | 949-950 | ||
| S14154S | 01 | 052-053 | S199XXA | 24 | 963-965 | S21002S | 09 | 604-605 | ||
| S14155A | 01 | 052-053 | S199XXD | 23 | 949-950 | S21009A | 09 | 604-605 | ||
| S14155A | 24 | 963-965 | S199XXS | 21 | 913-914 | S21009A | 24 | 963-965 | ||
| S14155D | 23 | 949-950 | S2000XA | 09 | 604-605 | S21009D | 23 | 949-950 | ||
| S14155S | 01 | 052-053 | S2000XA | 24 | 963-965 | S21009S | 09 | 604-605 | ||
| S14156A | 01 | 052-053 | S2000XD | 23 | 949-950 | S21011A | 09 | 604-605 | ||
| S14156A | 24 | 963-965 | S2000XS | 09 | 604-605 | S21011A | 24 | 963-965 | ||
| S14156D | 23 | 949-950 | S2001XA | 09 | 604-605 | S21011D | 23 | 949-950 | ||
| S14156S | 01 | 052-053 | S2001XA | 24 | 963-965 | S21011S | 09 | 604-605 | ||
| S14157A | 01 | 052-053 | S2001XD | 23 | 949-950 | S21012A | 09 | 604-605 | ||
| S14157A | 24 | 963-965 | S2001XS | 09 | 604-605 | S21012A | 24 | 963-965 | ||
| S14157D | 23 | 949-950 | S2002XA | 09 | 604-605 | S21012D | 23 | 949-950 | ||
| S14157S | 01 | 052-053 | S2002XA | 24 | 963-965 | S21012S | 09 | 604-605 | ||
| S14158A | 01 | 052-053 | S2002XD | 23 | 949-950 | S21019A | 09 | 604-605 | ||
| S14158A | 24 | 963-965 | S2002XS | 09 | 604-605 | S21019A | 24 | 963-965 | ||
| S14158D | 23 | 949-950 | S20101A | 09 | 604-605 | S21019D | 23 | 949-950 | ||
| S14158S | 01 | 052-053 | S20101A | 24 | 963-965 | S21019S | 09 | 604-605 | ||
| S14159A | 01 | 052-053 | S20101D | 23 | 949-950 | S21021A | 09 | 604-605 | ||
| S14159A | 24 | 963-965 | S20101S | 09 | 604-605 | S21021A | 24 | 963-965 | ||
| S14159D | 23 | 949-950 | S20102A | 09 | 604-605 | S21021D | 23 | 949-950 | ||
| S14159S | 01 | 052-053 | S20102A | 24 | 963-965 | S21021S | 09 | 604-605 | ||
| S142XXA | 01 | 073-074 | S20102D | 23 | 949-950 | S21022A | 09 | 604-605 | ||
| S142XXA | 24 | 963-965 | S20102S | 09 | 604-605 | S21022A | 24 | 963-965 | ||
| S142XXD | 23 | 949-950 | S20109A | 09 | 604-605 | S21022D | 23 | 949-950 | ||
| S142XXS | 01 | 091-093 | S20109A | 24 | 963-965 | S21022S | 09 | 604-605 | ||
| S143XXA | 01 | 073-074 | S20109D | 23 | 949-950 | S21029A | 09 | 604-605 | ||
| S143XXA | 15 | 791 | S20109S | 09 | 604-605 | S21029A | 24 | 963-965 | ||
| S143XXA | 15 | 793 | S20111A | 09 | 604-605 | S21029D | 23 | 949-950 | ||
| S143XXA | 24 | 963-965 | S20111A | 24 | 963-965 | S21029S | 09 | 604-605 | ||
| S143XXD | 23 | 949-950 | S20111D | 23 | 949-950 | S21031A | 09 | 604-605 | ||
| S143XXS | 01 | 091-093 | S20111S | 09 | 604-605 | S21031A | 24 | 963-965 | ||
| S144XXA | 01 | 073-074 | S20112A | 09 | 604-605 | S21031D | 23 | 949-950 | ||
| S144XXA | 24 | 963-965 | S20112A | 24 | 963-965 | S21031S | 09 | 604-605 | ||
| S144XXD | 23 | 949-950 | S20112D | 23 | 949-950 | S21032A | 09 | 604-605 | ||
| S144XXS | 01 | 091-093 | S20112S | 09 | 604-605 | S21032A | 24 | 963-965 | ||
| S145XXA | 01 | 073-074 | S20119A | 09 | 604-605 | S21032D | 23 | 949-950 | ||
| S145XXA | 24 | 963-965 | S20119A | 24 | 963-965 | S21032S | 09 | 604-605 | ||
| S145XXD | 23 | 949-950 | S20119D | 23 | 949-950 | S21039A | 09 | 604-605 | ||
| S145XXS | 01 | 091-093 | S20119S | 09 | 604-605 | S21039A | 24 | 963-965 | ||
| S148XXA | 01 | 073-074 | S20121A | 09 | 606-607 | S21039D | 23 | 949-950 | ||
| S148XXA | 24 | 963-965 | S20121A | 24 | 963-965 | S21039S | 09 | 604-605 | ||
| S148XXD | 23 | 949-950 | S20121D | 23 | 949-950 | S21041A | 09 | 604-605 | ||
| S148XXS | 01 | 091-093 | S20121S | 09 | 604-605 | S21041A | 24 | 963-965 | ||
| S149XXA | 01 | 073-074 | S20122A | 09 | 606-607 | S21041D | 23 | 949-950 | ||
| S149XXA | 24 | 963-965 | S20122A | 24 | 963-965 | S21041S | 09 | 604-605 | ||
| S149XXD | 23 | 949-950 | S20122D | 23 | 949-950 | S21042A | 09 | 604-605 | ||
| S149XXS | 01 | 091-093 | S20122S | 09 | 604-605 | S21042A | 24 | 963-965 | ||
| S15001A | 15 | 791 | S20129A | 09 | 606-607 | S21042D | 23 | 949-950 | ||
| S15001A | 15 | 793 | S20129A | 24 | 963-965 | S21042S | 09 | 604-605 | ||
| S15001A | 21 | 913-914 | S20129D | 23 | 949-950 | S21049A | 09 | 604-605 | ||
| S15001A | 24 | 963-965 | S20129S | 09 | 604-605 | S21049A | 24 | 963-965 | ||
| S15001D | 23 | 949-950 | S20141A | 09 | 604-605 | S21049D | 23 | 949-950 | ||
| S15001S | 05 | 299-301 | S20141A | 24 | 963-965 | S21049S | 09 | 604-605 | ||
| S15002A | 15 | 791 | S20141D | 23 | 949-950 | S21051A | 09 | 604-605 | ||
| S15002A | 15 | 793 | S20141S | 09 | 604-605 | S21051A | 24 | 963-965 | ||
| S15002A | 21 | 913-914 | S20142A | 09 | 604-605 | S21051D | 23 | 949-950 | ||
| S15002A | 24 | 963-965 | S20142A | 24 | 963-965 | S21051S | 09 | 604-605 | ||
| S15002D | 23 | 949-950 | S20142D | 23 | 949-950 | S21052A | 09 | 604-605 | ||
| S15002S | 05 | 299-301 | S20142S | 09 | 604-605 | S21052A | 24 | 963-965 | ||
| S15009A | 15 | 791 | S20149A | 09 | 604-605 | S21052D | 23 | 949-950 | ||
| S15009A | 15 | 793 | S20149A | 24 | 963-965 | S21052S | 09 | 604-605 | ||
| S15009A | 21 | 913-914 | S20149D | 23 | 949-950 | S21059A | 09 | 604-605 | ||
| S15009A | 24 | 963-965 | S20149S | 09 | 604-605 | S21059A | 24 | 963-965 | ||
| S15009D | 23 | 949-950 | S20151A | 09 | 604-605 | S21059D | 23 | 949-950 | ||
| S15009S | 05 | 299-301 | S20151A | 24 | 963-965 | S21059S | 09 | 604-605 | ||
| S15011A | 15 | 791 | S20151D | 23 | 949-950 | S21101A | 09 | 604-605 | ||
| S15011A | 15 | 793 | S20151S | 09 | 604-605 | S21101A | 24 | 963-965 | ||
| S15011A | 21 | 913-914 | S20152A | 09 | 604-605 | S21101D | 23 | 949-950 | ||
| S15011A | 24 | 963-965 | S20152A | 24 | 963-965 | S21101S | 09 | 604-605 | ||
| S15011D | 23 | 949-950 | S20152D | 23 | 949-950 | S21102A | 09 | 604-605 | ||
| S15011S | 05 | 299-301 | S20152S | 09 | 604-605 | S21102A | 24 | 963-965 | ||
| S15012A | 15 | 791 | S20159A | 09 | 604-605 | S21102D | 23 | 949-950 | ||
| S15012A | 15 | 793 | S20159A | 24 | 963-965 | S21102S | 09 | 604-605 | ||
| S15012A | 21 | 913-914 | S20159D | 23 | 949-950 | S21109A | 09 | 604-605 | ||
| S15012A | 24 | 963-965 | S20159S | 09 | 604-605 | S21109A | 24 | 963-965 | ||
| S15012D | 23 | 949-950 | S20161A | 09 | 606-607 | S21109D | 23 | 949-950 | ||
| S15012S | 05 | 299-301 | S20161A | 24 | 963-965 | S21109S | 09 | 604-605 | ||
| S15019A | 15 | 791 | S20161D | 23 | 949-950 | S21111A | 09 | 604-605 | ||
| S15019A | 15 | 793 | S20161S | 09 | 604-605 | S21111A | 24 | 963-965 | ||
| S15019A | 21 | 913-914 | S20162A | 09 | 606-607 | S21111D | 23 | 949-950 | ||
| S15019A | 24 | 963-965 | S20162A | 24 | 963-965 | S21111S | 09 | 604-605 | ||
| S15019D | 23 | 949-950 | S20162D | 23 | 949-950 | S21112A | 09 | 604-605 | ||
| S15019S | 05 | 299-301 | S20162S | 09 | 604-605 | S21112A | 24 | 963-965 | ||
| S15021A | 15 | 791 | S20169A | 09 | 606-607 | S21112D | 23 | 949-950 | ||
| S15021A | 15 | 793 | S20169A | 24 | 963-965 | S21112S | 09 | 604-605 | ||
| S15021A | 21 | 913-914 | S20169D | 23 | 949-950 | S21119A | 09 | 604-605 | ||
| S15021A | 24 | 963-965 | S20169S | 09 | 604-605 | S21119A | 24 | 963-965 | ||
| S15021D | 23 | 949-950 | S20171A | 09 | 604-605 | S21119D | 23 | 949-950 | ||
| S15021S | 05 | 299-301 | S20171A | 24 | 963-965 | S21119S | 09 | 604-605 | ||
| S15022A | 15 | 791 | S20171D | 23 | 949-950 | S21121A | 21 | 913-914 | ||
| S15022A | 15 | 793 | S20171S | 09 | 604-605 | S21121A | 24 | 963-965 | ||
| S15022A | 21 | 913-914 | S20172A | 09 | 604-605 | S21121D | 23 | 949-950 | ||
| S15022A | 24 | 963-965 | S20172A | 24 | 963-965 | S21121S | 09 | 604-605 | ||
| S15022D | 23 | 949-950 | S20172D | 23 | 949-950 | S21122A | 21 | 913-914 | ||
| S15022S | 05 | 299-301 | S20172S | 09 | 604-605 | S21122A | 24 | 963-965 | ||
| S15029A | 15 | 791 | S20179A | 09 | 604-605 | S21122D | 23 | 949-950 | ||
| S15029A | 15 | 793 | S20179A | 24 | 963-965 | S21122S | 09 | 604-605 | ||
| S15029A | 21 | 913-914 | S20179D | 23 | 949-950 | S21129A | 21 | 913-914 | ||
| S15029A | 24 | 963-965 | S20179S | 09 | 604-605 | S21129A | 24 | 963-965 | ||
| S15029D | 23 | 949-950 | S2020XA | 09 | 604-605 | S21129D | 23 | 949-950 | ||
| S15029S | 05 | 299-301 | S2020XA | 24 | 963-965 | S21129S | 09 | 604-605 | ||
| S15091A | 15 | 791 | S2020XD | 23 | 949-950 | S21131A | 09 | 604-605 | ||
| S15091A | 15 | 793 | S2020XS | 09 | 604-605 | S21131A | 24 | 963-965 | ||
| S15091A | 21 | 913-914 | S20211A | 09 | 604-605 | S21131D | 23 | 949-950 | ||
| S15091A | 24 | 963-965 | S20211A | 24 | 963-965 | S21131S | 09 | 604-605 | ||
| S15091D | 23 | 949-950 | S20211D | 23 | 949-950 | S21132A | 09 | 604-605 | ||
| S15091S | 05 | 299-301 | S20211S | 09 | 604-605 | S21132A | 24 | 963-965 | ||
| S15092A | 15 | 791 | S20212A | 09 | 604-605 | S21132D | 23 | 949-950 | ||
| S15092A | 15 | 793 | S20212A | 24 | 963-965 | S21132S | 09 | 604-605 | ||
| S15092A | 21 | 913-914 | S20212D | 23 | 949-950 | S21139A | 09 | 604-605 | ||
| S15092A | 24 | 963-965 | S20212S | 09 | 604-605 | S21139A | 24 | 963-965 | ||
| S15092D | 23 | 949-950 | S20213A | 09 | 604-605 | S21139D | 23 | 949-950 | ||
| S15092S | 05 | 299-301 | S20213A | 24 | 963-965 | S21139S | 09 | 604-605 | ||
| S15099A | 15 | 791 | S20213D | 23 | 949-950 | S21141A | 21 | 913-914 | ||
| S15099A | 15 | 793 | S20213S | 09 | 604-605 | S21141A | 24 | 963-965 | ||
| S15099A | 21 | 913-914 | S20214A | 09 | 604-605 | S21141D | 23 | 949-950 | ||
| S15099A | 24 | 963-965 | S20214A | 24 | 963-965 | S21141S | 09 | 604-605 | ||
| S15099D | 23 | 949-950 | S20214D | 23 | 949-950 | S21142A | 21 | 913-914 | ||
| S15099S | 05 | 299-301 | S20214S | 09 | 604-605 | S21142A | 24 | 963-965 | ||
| S15101A | Pre | 011-013 | S20219A | 09 | 604-605 | S21142D | 23 | 949-950 | ||
| S15101A | 21 | 913-914 | S20219A | 24 | 963-965 | S21142S | 09 | 604-605 | ||
| S15101A | 24 | 963-965 | S20219D | 23 | 949-950 | S21149A | 21 | 913-914 | ||
| S15101D | 23 | 949-950 | S20219S | 09 | 604-605 | S21149A | 24 | 963-965 | ||
| S15101S | 05 | 299-301 | S20221A | 09 | 604-605 | S21149D | 23 | 949-950 | ||
| S15102A | Pre | 011-013 | S20221A | 24 | 963-965 | S21149S | 09 | 604-605 | ||
| S15102A | 21 | 913-914 | S20221D | 23 | 949-950 | S21151A | 09 | 604-605 | ||
| S15102A | 24 | 963-965 | S20221S | 09 | 604-605 | S21151A | 24 | 963-965 | ||
| S15102D | 23 | 949-950 | S20222A | 09 | 604-605 | S21151D | 23 | 949-950 | ||
| S15102S | 05 | 299-301 | S20222A | 24 | 963-965 | S21151S | 09 | 604-605 | ||
| S15109A | Pre | 011-013 | S20222D | 23 | 949-950 | S21152A | 09 | 604-605 | ||
| S15109A | 21 | 913-914 | S20222S | 09 | 604-605 | S21152A | 24 | 963-965 | ||
| S15109A | 24 | 963-965 | S20223A | 09 | 604-605 | S21152D | 23 | 949-950 | ||
| S15109D | 23 | 949-950 | S20223A | 24 | 963-965 | S21152S | 09 | 604-605 | ||
| S15109S | 05 | 299-301 | S20223D | 23 | 949-950 | S21159A | 09 | 604-605 | ||
| S15111A | Pre | 011-013 | S20223S | 09 | 604-605 | S21159A | 24 | 963-965 | ||
| S15111A | 21 | 913-914 | S20224A | 09 | 604-605 | S21159D | 23 | 949-950 | ||
| S15111A | 24 | 963-965 | S20224A | 24 | 963-965 | S21159S | 09 | 604-605 | ||
| S15111D | 23 | 949-950 | S20224D | 23 | 949-950 | S21201A | 09 | 604-605 | ||
| S15111S | 05 | 299-301 | S20224S | 09 | 604-605 | S21201A | 24 | 963-965 | ||
| S15112A | Pre | 011-013 | S20229A | 09 | 604-605 | S21201D | 23 | 949-950 | ||
| S15112A | 21 | 913-914 | S20229A | 24 | 963-965 | S21201S | 09 | 604-605 | ||
| S15112A | 24 | 963-965 | S20229D | 23 | 949-950 | S21202A | 09 | 604-605 | ||
| S15112D | 23 | 949-950 | S20229S | 09 | 604-605 | S21202A | 24 | 963-965 | ||
| S15112S | 05 | 299-301 | S20301A | 09 | 604-605 | S21202D | 23 | 949-950 | ||
| S15119A | Pre | 011-013 | S20301A | 24 | 963-965 | S21202S | 09 | 604-605 | ||
| S15119A | 21 | 913-914 | S20301D | 23 | 949-950 | S21209A | 09 | 604-605 | ||
| S15119A | 24 | 963-965 | S20301S | 09 | 604-605 | S21209A | 24 | 963-965 | ||
| S15119D | 23 | 949-950 | S20302A | 09 | 604-605 | S21209D | 23 | 949-950 | ||
| S15119S | 05 | 299-301 | S20302A | 24 | 963-965 | S21209S | 09 | 604-605 | ||
| S15121A | Pre | 011-013 | S20302D | 23 | 949-950 | S21211A | 09 | 604-605 | ||
| S15121A | 21 | 913-914 | S20302S | 09 | 604-605 | S21211A | 24 | 963-965 | ||
| S15121A | 24 | 963-965 | S20303A | 09 | 604-605 | S21211D | 23 | 949-950 | ||
| S15121D | 23 | 949-950 | S20303A | 24 | 963-965 | S21211S | 09 | 604-605 | ||
| S15121S | 05 | 299-301 | S20303D | 23 | 949-950 | S21212A | 09 | 604-605 | ||
| S15122A | Pre | 011-013 | S20303S | 09 | 604-605 | S21212A | 24 | 963-965 | ||
| S15122A | 21 | 913-914 | S20304A | 09 | 604-605 | S21212D | 23 | 949-950 | ||
| S15122A | 24 | 963-965 | S20304A | 24 | 963-965 | S21212S | 09 | 604-605 | ||
| S15122D | 23 | 949-950 | S20304D | 23 | 949-950 | S21219A | 09 | 604-605 | ||
| S15122S | 05 | 299-301 | S20304S | 09 | 604-605 | S21219A | 24 | 963-965 | ||
| S15129A | Pre | 011-013 | S20309A | 09 | 604-605 | S21219D | 23 | 949-950 | ||
| S15129A | 21 | 913-914 | S20309A | 24 | 963-965 | S21219S | 09 | 604-605 | ||
| S15129A | 24 | 963-965 | S20309D | 23 | 949-950 | S21221A | 09 | 604-605 | ||
| S15129D | 23 | 949-950 | S20309S | 09 | 604-605 | S21221A | 24 | 963-965 | ||
| S15129S | 05 | 299-301 | S20311A | 09 | 604-605 | S21221D | 23 | 949-950 | ||
| S15191A | Pre | 011-013 | S20311A | 24 | 963-965 | S21221S | 09 | 604-605 | ||
| S15191A | 21 | 913-914 | S20311D | 23 | 949-950 | S21222A | 09 | 604-605 | ||
| S15191A | 24 | 963-965 | S20311S | 09 | 604-605 | S21222A | 24 | 963-965 | ||
| S15191D | 23 | 949-950 | S20312A | 09 | 604-605 | S21222D | 23 | 949-950 | ||
| S15191S | 05 | 299-301 | S20312A | 24 | 963-965 | S21222S | 09 | 604-605 | ||
| S15192A | Pre | 011-013 | S20312D | 23 | 949-950 | S21229A | 09 | 604-605 | ||
| S15192A | 21 | 913-914 | S20312S | 09 | 604-605 | S21229A | 24 | 963-965 | ||
| S15192A | 24 | 963-965 | S20313A | 09 | 604-605 | S21229D | 23 | 949-950 | ||
| S15192D | 23 | 949-950 | S20313A | 24 | 963-965 | S21229S | 09 | 604-605 | ||
| S15192S | 05 | 299-301 | S20313D | 23 | 949-950 | S21231A | 09 | 604-605 | ||
| S15199A | Pre | 011-013 | S20313S | 09 | 604-605 | S21231A | 24 | 963-965 | ||
| S15199A | 21 | 913-914 | S20314A | 09 | 604-605 | S21231D | 23 | 949-950 | ||
| S15199A | 24 | 963-965 | S20314A | 24 | 963-965 | S21231S | 09 | 604-605 | ||
| S15199D | 23 | 949-950 | S20314D | 23 | 949-950 | S21232A | 09 | 604-605 | ||
| S15199S | 05 | 299-301 | S20314S | 09 | 604-605 | S21232A | 24 | 963-965 | ||
| S15201A | 15 | 791 | S20319A | 09 | 604-605 | S21232D | 23 | 949-950 | ||
| S15201A | 15 | 793 | S20319A | 24 | 963-965 | S21232S | 09 | 604-605 | ||
| S15201A | 21 | 913-914 | S20319D | 23 | 949-950 | S21239A | 09 | 604-605 | ||
| S15201A | 24 | 963-965 | S20319S | 09 | 604-605 | S21239A | 24 | 963-965 | ||
| S15201D | 23 | 949-950 | S20321A | 09 | 606-607 | S21239D | 23 | 949-950 | ||
| S15201S | 05 | 299-301 | S20321A | 24 | 963-965 | S21239S | 09 | 604-605 | ||
| S15202A | 15 | 791 | S20321D | 23 | 949-950 | S21241A | 09 | 604-605 | ||
| S15202A | 15 | 793 | S20321S | 09 | 604-605 | S21241A | 24 | 963-965 | ||
| S15202A | 21 | 913-914 | S20322A | 09 | 606-607 | S21241D | 23 | 949-950 | ||
| S15202A | 24 | 963-965 | S20322A | 24 | 963-965 | S21241S | 09 | 604-605 | ||
| S15202D | 23 | 949-950 | S20322D | 23 | 949-950 | S21242A | 09 | 604-605 | ||
| S15202S | 05 | 299-301 | S20322S | 09 | 604-605 | S21242A | 24 | 963-965 | ||
| S15209A | 15 | 791 | S20323A | 09 | 606-607 | S21242D | 23 | 949-950 | ||
| S15209A | 15 | 793 | S20323A | 24 | 963-965 | S21242S | 09 | 604-605 | ||
| S15209A | 21 | 913-914 | S20323D | 23 | 949-950 | S21249A | 09 | 604-605 | ||
| S15209A | 24 | 963-965 | S20323S | 09 | 604-605 | S21249A | 24 | 963-965 | ||
| S15209D | 23 | 949-950 | S20324A | 09 | 606-607 | S21249D | 23 | 949-950 | ||
| S15209S | 05 | 299-301 | S20324A | 24 | 963-965 | S21249S | 09 | 604-605 | ||
| S15211A | 15 | 791 | S20324D | 23 | 949-950 | S21251A | 09 | 604-605 | ||
| S15211A | 15 | 793 | S20324S | 09 | 604-605 | S21251A | 24 | 963-965 | ||
| S15211A | 21 | 913-914 | S20329A | 09 | 606-607 | S21251D | 23 | 949-950 | ||
| S15211A | 24 | 963-965 | S20329A | 24 | 963-965 | S21251S | 09 | 604-605 | ||
| S15211D | 23 | 949-950 | S20329D | 23 | 949-950 | S21252A | 09 | 604-605 | ||
| S15211S | 05 | 299-301 | S20329S | 09 | 604-605 | S21252A | 24 | 963-965 | ||
| S15212A | 15 | 791 | S20341A | 09 | 604-605 | S21252D | 23 | 949-950 | ||
| S15212A | 15 | 793 | S20341A | 24 | 963-965 | S21252S | 09 | 604-605 | ||
| S15212A | 21 | 913-914 | S20341D | 23 | 949-950 | S21259A | 09 | 604-605 | ||
| S15212A | 24 | 963-965 | S20341S | 09 | 604-605 | S21259A | 24 | 963-965 | ||
| S15212D | 23 | 949-950 | S20342A | 09 | 604-605 | S21259D | 23 | 949-950 | ||
| S15212S | 05 | 299-301 | S20342A | 24 | 963-965 | S21259S | 09 | 604-605 | ||
| S15219A | 15 | 791 | S20342D | 23 | 949-950 | S21301A | 21 | 913-914 | ||
| S15219A | 15 | 793 | S20342S | 09 | 604-605 | S21301A | 24 | 963-965 | ||
| S15219A | 21 | 913-914 | S20343A | 09 | 604-605 | S21301D | 23 | 949-950 | ||
| S15219A | 24 | 963-965 | S20343A | 24 | 963-965 | S21301S | 09 | 604-605 | ||
| S15219D | 23 | 949-950 | S20343D | 23 | 949-950 | S21302A | 21 | 913-914 | ||
| S15219S | 05 | 299-301 | S20343S | 09 | 604-605 | S21302A | 24 | 963-965 | ||
| S15221A | 15 | 791 | S20344A | 09 | 604-605 | S21302D | 23 | 949-950 | ||
| S15221A | 15 | 793 | S20344A | 24 | 963-965 | S21302S | 09 | 604-605 | ||
| S15221A | 21 | 913-914 | S20344D | 23 | 949-950 | S21309A | 21 | 913-914 | ||
| S15221A | 24 | 963-965 | S20344S | 09 | 604-605 | S21309A | 24 | 963-965 | ||
| S15221D | 23 | 949-950 | S20349A | 09 | 604-605 | S21309D | 23 | 949-950 | ||
| S15221S | 05 | 299-301 | S20349A | 24 | 963-965 | S21309S | 09 | 604-605 | ||
| S15222A | 15 | 791 | S20349D | 23 | 949-950 | S21311A | 21 | 913-914 | ||
| S15222A | 15 | 793 | S20349S | 09 | 604-605 | S21311A | 24 | 963-965 | ||
| S15222A | 21 | 913-914 | S20351A | 09 | 604-605 | S21311D | 23 | 949-950 | ||
| S15222A | 24 | 963-965 | S20351A | 24 | 963-965 | S21311S | 09 | 604-605 | ||
| S15222D | 23 | 949-950 | S20351D | 23 | 949-950 | S21312A | 21 | 913-914 | ||
| S15222S | 05 | 299-301 | S20351S | 09 | 604-605 | S21312A | 24 | 963-965 | ||
| S15229A | 15 | 791 | S20352A | 09 | 604-605 | S21312D | 23 | 949-950 | ||
| S15229A | 15 | 793 | S20352A | 24 | 963-965 | |||||
| S15229A | 21 | 913-914 | ||||||||
| S15229A | 24 | 963-965 |
|
Centers for Medicare & Medicaid Services, 7500 Security Boulevard Baltimore, MD 21244 16 Mar 2022 17:08:13 CMS, code-revision=333, description-revision=1331 |