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 34 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 | ||
|---|---|---|---|---|---|---|---|---|---|---|
| S21312S | 09 | 604-605 | S22061D | 08 | 559-561 | S24113D | 23 | 949-950 | ||
| S21319A | 21 | 913-914 | S22061G | 08 | 559-561 | S24113S | 01 | 052-053 | ||
| S21319A | 24 | 963-965 | S22061K | 08 | 564-566 | S24114A | 01 | 052-053 | ||
| S21319D | 23 | 949-950 | S22061S | 08 | 551-552 | S24114A | 24 | 963-965 | ||
| S21319S | 09 | 604-605 | S22062A | 08 | 551-552 | S24114D | 23 | 949-950 | ||
| S21321A | 21 | 913-914 | S22062A | 24 | 963-965 | S24114S | 01 | 052-053 | ||
| S21321A | 24 | 963-965 | S22062B | 08 | 551-552 | S24119A | 01 | 052-053 | ||
| S21321D | 23 | 949-950 | S22062B | 24 | 963-965 | S24119A | 24 | 963-965 | ||
| S21321S | 09 | 604-605 | S22062D | 08 | 559-561 | S24119D | 23 | 949-950 | ||
| S21322A | 21 | 913-914 | S22062G | 08 | 559-561 | S24119S | 01 | 052-053 | ||
| S21322A | 24 | 963-965 | S22062K | 08 | 564-566 | S24131A | 01 | 052-053 | ||
| S21322D | 23 | 949-950 | S22062S | 08 | 551-552 | S24131A | 24 | 963-965 | ||
| S21322S | 09 | 604-605 | S22068A | 08 | 551-552 | S24131D | 23 | 949-950 | ||
| S21329A | 21 | 913-914 | S22068A | 24 | 963-965 | S24131S | 01 | 052-053 | ||
| S21329A | 24 | 963-965 | S22068B | 08 | 551-552 | S24132A | 01 | 052-053 | ||
| S21329D | 23 | 949-950 | S22068B | 24 | 963-965 | S24132A | 24 | 963-965 | ||
| S21329S | 09 | 604-605 | S22068D | 08 | 559-561 | S24132D | 23 | 949-950 | ||
| S21331A | 21 | 913-914 | S22068G | 08 | 559-561 | S24132S | 01 | 052-053 | ||
| S21331A | 24 | 963-965 | S22068K | 08 | 564-566 | S24133A | 01 | 052-053 | ||
| S21331D | 23 | 949-950 | S22068S | 08 | 551-552 | S24133A | 24 | 963-965 | ||
| S21331S | 09 | 604-605 | S22069A | 08 | 551-552 | S24133D | 23 | 949-950 | ||
| S21332A | 21 | 913-914 | S22069A | 24 | 963-965 | S24133S | 01 | 052-053 | ||
| S21332A | 24 | 963-965 | S22069B | 08 | 551-552 | S24134A | 01 | 052-053 | ||
| S21332D | 23 | 949-950 | S22069B | 24 | 963-965 | S24134A | 24 | 963-965 | ||
| S21332S | 09 | 604-605 | S22069D | 08 | 559-561 | S24134D | 23 | 949-950 | ||
| S21339A | 21 | 913-914 | S22069G | 08 | 559-561 | S24134S | 01 | 052-053 | ||
| S21339A | 24 | 963-965 | S22069K | 08 | 564-566 | S24139A | 01 | 052-053 | ||
| S21339D | 23 | 949-950 | S22069S | 08 | 551-552 | S24139A | 24 | 963-965 | ||
| S21339S | 09 | 604-605 | S22070A | 08 | 551-552 | S24139D | 23 | 949-950 | ||
| S21341A | 21 | 913-914 | S22070A | 24 | 963-965 | S24139S | 01 | 052-053 | ||
| S21341A | 24 | 963-965 | S22070B | 08 | 551-552 | S24141A | 01 | 052-053 | ||
| S21341D | 23 | 949-950 | S22070B | 24 | 963-965 | S24141A | 24 | 963-965 | ||
| S21341S | 09 | 604-605 | S22070D | 08 | 559-561 | S24141D | 23 | 949-950 | ||
| S21342A | 21 | 913-914 | S22070G | 08 | 559-561 | S24141S | 01 | 052-053 | ||
| S21342A | 24 | 963-965 | S22070K | 08 | 564-566 | S24142A | 01 | 052-053 | ||
| S21342D | 23 | 949-950 | S22070S | 08 | 551-552 | S24142A | 24 | 963-965 | ||
| S21342S | 09 | 604-605 | S22071A | 08 | 551-552 | S24142D | 23 | 949-950 | ||
| S21349A | 21 | 913-914 | S22071A | 24 | 963-965 | S24142S | 01 | 052-053 | ||
| S21349A | 24 | 963-965 | S22071B | 08 | 551-552 | S24143A | 01 | 052-053 | ||
| S21349D | 23 | 949-950 | S22071B | 24 | 963-965 | S24143A | 24 | 963-965 | ||
| S21349S | 09 | 604-605 | S22071D | 08 | 559-561 | S24143D | 23 | 949-950 | ||
| S21351A | 21 | 913-914 | S22071G | 08 | 559-561 | S24143S | 01 | 052-053 | ||
| S21351A | 24 | 963-965 | S22071K | 08 | 564-566 | S24144A | 01 | 052-053 | ||
| S21351D | 23 | 949-950 | S22071S | 08 | 551-552 | S24144A | 24 | 963-965 | ||
| S21351S | 09 | 604-605 | S22072A | 08 | 551-552 | S24144D | 23 | 949-950 | ||
| S21352A | 21 | 913-914 | S22072A | 24 | 963-965 | S24144S | 01 | 052-053 | ||
| S21352A | 24 | 963-965 | S22072B | 08 | 551-552 | S24149A | 01 | 052-053 | ||
| S21352D | 23 | 949-950 | S22072B | 24 | 963-965 | S24149A | 24 | 963-965 | ||
| S21352S | 09 | 604-605 | S22072D | 08 | 559-561 | S24149D | 23 | 949-950 | ||
| S21359A | 21 | 913-914 | S22072G | 08 | 559-561 | S24149S | 01 | 052-053 | ||
| S21359A | 24 | 963-965 | S22072K | 08 | 564-566 | S24151A | 01 | 052-053 | ||
| S21359D | 23 | 949-950 | S22072S | 08 | 551-552 | S24151A | 24 | 963-965 | ||
| S21359S | 09 | 604-605 | S22078A | 08 | 551-552 | S24151D | 23 | 949-950 | ||
| S21401A | 21 | 913-914 | S22078A | 24 | 963-965 | S24151S | 01 | 052-053 | ||
| S21401A | 24 | 963-965 | S22078B | 08 | 551-552 | S24152A | 01 | 052-053 | ||
| S21401D | 23 | 949-950 | S22078B | 24 | 963-965 | S24152A | 24 | 963-965 | ||
| S21401S | 09 | 604-605 | S22078D | 08 | 559-561 | S24152D | 23 | 949-950 | ||
| S21402A | 21 | 913-914 | S22078G | 08 | 559-561 | S24152S | 01 | 052-053 | ||
| S21402A | 24 | 963-965 | S22078K | 08 | 564-566 | S24153A | 01 | 052-053 | ||
| S21402D | 23 | 949-950 | S22078S | 08 | 551-552 | S24153A | 24 | 963-965 | ||
| S21402S | 09 | 604-605 | S22079A | 08 | 551-552 | S24153D | 23 | 949-950 | ||
| S21409A | 21 | 913-914 | S22079A | 24 | 963-965 | S24153S | 01 | 052-053 | ||
| S21409A | 24 | 963-965 | S22079B | 08 | 551-552 | S24154A | 01 | 052-053 | ||
| S21409D | 23 | 949-950 | S22079B | 24 | 963-965 | S24154A | 24 | 963-965 | ||
| S21409S | 09 | 604-605 | S22079D | 08 | 559-561 | S24154D | 23 | 949-950 | ||
| S21411A | 21 | 913-914 | S22079G | 08 | 559-561 | S24154S | 01 | 052-053 | ||
| S21411A | 24 | 963-965 | S22079K | 08 | 564-566 | S24159A | 01 | 052-053 | ||
| S21411D | 23 | 949-950 | S22079S | 08 | 551-552 | S24159A | 24 | 963-965 | ||
| S21411S | 09 | 604-605 | S22080A | 08 | 551-552 | S24159D | 23 | 949-950 | ||
| S21412A | 21 | 913-914 | S22080A | 24 | 963-965 | S24159S | 01 | 052-053 | ||
| S21412A | 24 | 963-965 | S22080B | 08 | 551-552 | S242XXA | 01 | 073-074 | ||
| S21412D | 23 | 949-950 | S22080B | 24 | 963-965 | S242XXA | 24 | 963-965 | ||
| S21412S | 09 | 604-605 | S22080D | 08 | 559-561 | S242XXD | 23 | 949-950 | ||
| S21419A | 21 | 913-914 | S22080G | 08 | 559-561 | S242XXS | 01 | 091-093 | ||
| S21419A | 24 | 963-965 | S22080K | 08 | 564-566 | S243XXA | 01 | 073-074 | ||
| S21419D | 23 | 949-950 | S22080S | 08 | 551-552 | S243XXA | 24 | 963-965 | ||
| S21419S | 09 | 604-605 | S22081A | 08 | 551-552 | S243XXD | 23 | 949-950 | ||
| S21421A | 21 | 913-914 | S22081A | 24 | 963-965 | S243XXS | 01 | 091-093 | ||
| S21421A | 24 | 963-965 | S22081B | 08 | 551-552 | S244XXA | 01 | 073-074 | ||
| S21421D | 23 | 949-950 | S22081B | 24 | 963-965 | S244XXA | 24 | 963-965 | ||
| S21421S | 09 | 604-605 | S22081D | 08 | 559-561 | S244XXD | 23 | 949-950 | ||
| S21422A | 21 | 913-914 | S22081G | 08 | 559-561 | S244XXS | 01 | 091-093 | ||
| S21422A | 24 | 963-965 | S22081K | 08 | 564-566 | S248XXA | 01 | 073-074 | ||
| S21422D | 23 | 949-950 | S22081S | 08 | 551-552 | S248XXA | 24 | 963-965 | ||
| S21422S | 09 | 604-605 | S22082A | 08 | 551-552 | S248XXD | 23 | 949-950 | ||
| S21429A | 21 | 913-914 | S22082A | 24 | 963-965 | S248XXS | 01 | 091-093 | ||
| S21429A | 24 | 963-965 | S22082B | 08 | 551-552 | S249XXA | 01 | 073-074 | ||
| S21429D | 23 | 949-950 | S22082B | 24 | 963-965 | S249XXA | 24 | 963-965 | ||
| S21429S | 09 | 604-605 | S22082D | 08 | 559-561 | S249XXD | 23 | 949-950 | ||
| S21431A | 21 | 913-914 | S22082G | 08 | 559-561 | S249XXS | 01 | 091-093 | ||
| S21431A | 24 | 963-965 | S22082K | 08 | 564-566 | S2500XA | 15 | 791 | ||
| S21431D | 23 | 949-950 | S22082S | 08 | 551-552 | S2500XA | 15 | 793 | ||
| S21431S | 09 | 604-605 | S22088A | 08 | 551-552 | S2500XA | 21 | 913-914 | ||
| S21432A | 21 | 913-914 | S22088A | 24 | 963-965 | S2500XA | 24 | 963-965 | ||
| S21432A | 24 | 963-965 | S22088B | 08 | 551-552 | S2500XD | 23 | 949-950 | ||
| S21432D | 23 | 949-950 | S22088B | 24 | 963-965 | S2500XS | 05 | 299-301 | ||
| S21432S | 09 | 604-605 | S22088D | 08 | 559-561 | S2501XA | 15 | 791 | ||
| S21439A | 21 | 913-914 | S22088G | 08 | 559-561 | S2501XA | 15 | 793 | ||
| S21439A | 24 | 963-965 | S22088K | 08 | 564-566 | S2501XA | 21 | 913-914 | ||
| S21439D | 23 | 949-950 | S22088S | 08 | 551-552 | S2501XA | 24 | 963-965 | ||
| S21439S | 09 | 604-605 | S22089A | 08 | 551-552 | S2501XD | 23 | 949-950 | ||
| S21441A | 21 | 913-914 | S22089A | 24 | 963-965 | S2501XS | 05 | 299-301 | ||
| S21441A | 24 | 963-965 | S22089B | 08 | 551-552 | S2502XA | 15 | 791 | ||
| S21441D | 23 | 949-950 | S22089B | 24 | 963-965 | S2502XA | 15 | 793 | ||
| S21441S | 09 | 604-605 | S22089D | 08 | 559-561 | S2502XA | 21 | 913-914 | ||
| S21442A | 21 | 913-914 | S22089G | 08 | 559-561 | S2502XA | 24 | 963-965 | ||
| S21442A | 24 | 963-965 | S22089K | 08 | 564-566 | S2502XD | 23 | 949-950 | ||
| S21442D | 23 | 949-950 | S22089S | 08 | 551-552 | S2502XS | 05 | 299-301 | ||
| S21442S | 09 | 604-605 | S2220XA | 08 | 564-566 | S2509XA | 15 | 791 | ||
| S21449A | 21 | 913-914 | S2220XA | 24 | 963-965 | S2509XA | 15 | 793 | ||
| S21449A | 24 | 963-965 | S2220XB | 08 | 564-566 | S2509XA | 21 | 913-914 | ||
| S21449D | 23 | 949-950 | S2220XB | 24 | 963-965 | S2509XA | 24 | 963-965 | ||
| S21449S | 09 | 604-605 | S2220XD | 08 | 559-561 | S2509XD | 23 | 949-950 | ||
| S21451A | 21 | 913-914 | S2220XG | 08 | 559-561 | S2509XS | 05 | 299-301 | ||
| S21451A | 24 | 963-965 | S2220XK | 08 | 564-566 | S25101A | 15 | 791 | ||
| S21451D | 23 | 949-950 | S2220XS | 08 | 551-552 | S25101A | 15 | 793 | ||
| S21451S | 09 | 604-605 | S2221XA | 08 | 564-566 | S25101A | 21 | 913-914 | ||
| S21452A | 21 | 913-914 | S2221XA | 24 | 963-965 | S25101A | 24 | 963-965 | ||
| S21452A | 24 | 963-965 | S2221XB | 08 | 564-566 | S25101D | 23 | 949-950 | ||
| S21452D | 23 | 949-950 | S2221XB | 24 | 963-965 | S25101S | 05 | 299-301 | ||
| S21452S | 09 | 604-605 | S2221XD | 08 | 559-561 | S25102A | 15 | 791 | ||
| S21459A | 21 | 913-914 | S2221XG | 08 | 559-561 | S25102A | 15 | 793 | ||
| S21459A | 24 | 963-965 | S2221XK | 08 | 564-566 | S25102A | 21 | 913-914 | ||
| S21459D | 23 | 949-950 | S2221XS | 08 | 551-552 | S25102A | 24 | 963-965 | ||
| S21459S | 09 | 604-605 | S2222XA | 08 | 564-566 | S25102D | 23 | 949-950 | ||
| S2190XA | 09 | 604-605 | S2222XA | 24 | 963-965 | S25102S | 05 | 299-301 | ||
| S2190XA | 24 | 963-965 | S2222XB | 08 | 564-566 | S25109A | 15 | 791 | ||
| S2190XD | 23 | 949-950 | S2222XB | 24 | 963-965 | S25109A | 15 | 793 | ||
| S2190XS | 09 | 604-605 | S2222XD | 08 | 559-561 | S25109A | 21 | 913-914 | ||
| S2191XA | 09 | 604-605 | S2222XG | 08 | 559-561 | S25109A | 24 | 963-965 | ||
| S2191XA | 24 | 963-965 | S2222XK | 08 | 564-566 | S25109D | 23 | 949-950 | ||
| S2191XD | 23 | 949-950 | S2222XS | 08 | 551-552 | S25109S | 05 | 299-301 | ||
| S2191XS | 09 | 604-605 | S2223XA | 08 | 564-566 | S25111A | 15 | 791 | ||
| S2192XA | 21 | 913-914 | S2223XA | 24 | 963-965 | S25111A | 15 | 793 | ||
| S2192XA | 24 | 963-965 | S2223XB | 08 | 564-566 | S25111A | 21 | 913-914 | ||
| S2192XD | 23 | 949-950 | S2223XB | 24 | 963-965 | S25111A | 24 | 963-965 | ||
| S2192XS | 09 | 604-605 | S2223XD | 08 | 559-561 | S25111D | 23 | 949-950 | ||
| S2193XA | 09 | 604-605 | S2223XG | 08 | 559-561 | S25111S | 05 | 299-301 | ||
| S2193XA | 24 | 963-965 | S2223XK | 08 | 564-566 | S25112A | 15 | 791 | ||
| S2193XD | 23 | 949-950 | S2223XS | 08 | 551-552 | S25112A | 15 | 793 | ||
| S2193XS | 09 | 604-605 | S2224XA | 08 | 564-566 | S25112A | 21 | 913-914 | ||
| S2194XA | 21 | 913-914 | S2224XA | 24 | 963-965 | S25112A | 24 | 963-965 | ||
| S2194XA | 24 | 963-965 | S2224XB | 08 | 564-566 | S25112D | 23 | 949-950 | ||
| S2194XD | 23 | 949-950 | S2224XB | 24 | 963-965 | S25112S | 05 | 299-301 | ||
| S2194XS | 09 | 604-605 | S2224XD | 08 | 559-561 | S25119A | 15 | 791 | ||
| S2195XA | 09 | 604-605 | S2224XG | 08 | 559-561 | S25119A | 15 | 793 | ||
| S2195XA | 24 | 963-965 | S2224XK | 08 | 564-566 | S25119A | 21 | 913-914 | ||
| S2195XD | 23 | 949-950 | S2224XS | 08 | 551-552 | S25119A | 24 | 963-965 | ||
| S2195XS | 09 | 604-605 | S2231XA | 04 | 205-206 | S25119D | 23 | 949-950 | ||
| S22000A | 08 | 551-552 | S2231XA | 24 | 963-965 | S25119S | 05 | 299-301 | ||
| S22000A | 24 | 963-965 | S2231XB | 04 | 183-185 | S25121A | 15 | 791 | ||
| S22000B | 08 | 551-552 | S2231XB | 24 | 963-965 | S25121A | 15 | 793 | ||
| S22000B | 24 | 963-965 | S2231XD | 08 | 559-561 | S25121A | 21 | 913-914 | ||
| S22000D | 08 | 559-561 | S2231XG | 08 | 559-561 | S25121A | 24 | 963-965 | ||
| S22000G | 08 | 559-561 | S2231XK | 08 | 564-566 | S25121D | 23 | 949-950 | ||
| S22000K | 08 | 564-566 | S2231XS | 08 | 551-552 | S25121S | 05 | 299-301 | ||
| S22000S | 08 | 551-552 | S2232XA | 04 | 205-206 | S25122A | 15 | 791 | ||
| S22001A | 08 | 551-552 | S2232XA | 24 | 963-965 | S25122A | 15 | 793 | ||
| S22001A | 24 | 963-965 | S2232XB | 04 | 183-185 | S25122A | 21 | 913-914 | ||
| S22001B | 08 | 551-552 | S2232XB | 24 | 963-965 | S25122A | 24 | 963-965 | ||
| S22001B | 24 | 963-965 | S2232XD | 08 | 559-561 | S25122D | 23 | 949-950 | ||
| S22001D | 08 | 559-561 | S2232XG | 08 | 559-561 | S25122S | 05 | 299-301 | ||
| S22001G | 08 | 559-561 | S2232XK | 08 | 564-566 | S25129A | 15 | 791 | ||
| S22001K | 08 | 564-566 | S2232XS | 08 | 551-552 | S25129A | 15 | 793 | ||
| S22001S | 08 | 551-552 | S2239XA | 04 | 205-206 | S25129A | 21 | 913-914 | ||
| S22002A | 08 | 551-552 | S2239XA | 24 | 963-965 | S25129A | 24 | 963-965 | ||
| S22002A | 24 | 963-965 | S2239XB | 04 | 183-185 | S25129D | 23 | 949-950 | ||
| S22002B | 08 | 551-552 | S2239XB | 24 | 963-965 | S25129S | 05 | 299-301 | ||
| S22002B | 24 | 963-965 | S2239XD | 08 | 559-561 | S25191A | 15 | 791 | ||
| S22002D | 08 | 559-561 | S2239XG | 08 | 559-561 | S25191A | 15 | 793 | ||
| S22002G | 08 | 559-561 | S2239XK | 08 | 564-566 | S25191A | 21 | 913-914 | ||
| S22002K | 08 | 564-566 | S2239XS | 08 | 551-552 | S25191A | 24 | 963-965 | ||
| S22002S | 08 | 551-552 | S2241XA | 04 | 183-185 | S25191D | 23 | 949-950 | ||
| S22008A | 08 | 551-552 | S2241XA | 24 | 963-965 | S25191S | 05 | 299-301 | ||
| S22008A | 24 | 963-965 | S2241XB | 04 | 183-185 | S25192A | 15 | 791 | ||
| S22008B | 08 | 551-552 | S2241XB | 24 | 963-965 | S25192A | 15 | 793 | ||
| S22008B | 24 | 963-965 | S2241XD | 08 | 559-561 | S25192A | 21 | 913-914 | ||
| S22008D | 08 | 559-561 | S2241XG | 08 | 559-561 | S25192A | 24 | 963-965 | ||
| S22008G | 08 | 559-561 | S2241XK | 08 | 564-566 | S25192D | 23 | 949-950 | ||
| S22008K | 08 | 564-566 | S2241XS | 08 | 551-552 | S25192S | 05 | 299-301 | ||
| S22008S | 08 | 551-552 | S2242XA | 04 | 183-185 | S25199A | 15 | 791 | ||
| S22009A | 08 | 551-552 | S2242XA | 24 | 963-965 | S25199A | 15 | 793 | ||
| S22009A | 24 | 963-965 | S2242XB | 04 | 183-185 | S25199A | 21 | 913-914 | ||
| S22009B | 08 | 551-552 | S2242XB | 24 | 963-965 | S25199A | 24 | 963-965 | ||
| S22009B | 24 | 963-965 | S2242XD | 08 | 559-561 | S25199D | 23 | 949-950 | ||
| S22009D | 08 | 559-561 | S2242XG | 08 | 559-561 | S25199S | 05 | 299-301 | ||
| S22009G | 08 | 559-561 | S2242XK | 08 | 564-566 | S2520XA | 15 | 791 | ||
| S22009K | 08 | 564-566 | S2242XS | 08 | 551-552 | S2520XA | 15 | 793 | ||
| S22009S | 08 | 551-552 | S2243XA | 04 | 183-185 | S2520XA | 21 | 913-914 | ||
| S22010A | 08 | 551-552 | S2243XA | 24 | 963-965 | S2520XA | 24 | 963-965 | ||
| S22010A | 24 | 963-965 | S2243XB | 04 | 183-185 | S2520XD | 23 | 949-950 | ||
| S22010B | 08 | 551-552 | S2243XB | 24 | 963-965 | S2520XS | 05 | 299-301 | ||
| S22010B | 24 | 963-965 | S2243XD | 08 | 559-561 | S2521XA | 15 | 791 | ||
| S22010D | 08 | 559-561 | S2243XG | 08 | 559-561 | S2521XA | 15 | 793 | ||
| S22010G | 08 | 559-561 | S2243XK | 08 | 564-566 | S2521XA | 21 | 913-914 | ||
| S22010K | 08 | 564-566 | S2243XS | 08 | 551-552 | S2521XA | 24 | 963-965 | ||
| S22010S | 08 | 551-552 | S2249XA | 04 | 183-185 | S2521XD | 23 | 949-950 | ||
| S22011A | 08 | 551-552 | S2249XA | 24 | 963-965 | S2521XS | 05 | 299-301 | ||
| S22011A | 24 | 963-965 | S2249XB | 04 | 183-185 | S2522XA | 15 | 791 | ||
| S22011B | 08 | 551-552 | S2249XB | 24 | 963-965 | S2522XA | 15 | 793 | ||
| S22011B | 24 | 963-965 | S2249XD | 08 | 559-561 | S2522XA | 21 | 913-914 | ||
| S22011D | 08 | 559-561 | S2249XG | 08 | 559-561 | S2522XA | 24 | 963-965 | ||
| S22011G | 08 | 559-561 | S2249XK | 08 | 564-566 | S2522XD | 23 | 949-950 | ||
| S22011K | 08 | 564-566 | S2249XS | 08 | 551-552 | S2522XS | 05 | 299-301 | ||
| S22011S | 08 | 551-552 | S225XXA | 04 | 183-185 | S2529XA | 15 | 791 | ||
| S22012A | 08 | 551-552 | S225XXA | 24 | 963-965 | S2529XA | 15 | 793 | ||
| S22012A | 24 | 963-965 | S225XXB | 04 | 183-185 | S2529XA | 21 | 913-914 | ||
| S22012B | 08 | 551-552 | S225XXB | 24 | 963-965 | S2529XA | 24 | 963-965 | ||
| S22012B | 24 | 963-965 | S225XXD | 08 | 559-561 | S2529XD | 23 | 949-950 | ||
| S22012D | 08 | 559-561 | S225XXG | 08 | 559-561 | S2529XS | 05 | 299-301 | ||
| S22012G | 08 | 559-561 | S225XXK | 08 | 564-566 | S25301A | 15 | 791 | ||
| S22012K | 08 | 564-566 | S225XXS | 08 | 551-552 | S25301A | 15 | 793 | ||
| S22012S | 08 | 551-552 | S229XXA | 08 | 564-566 | S25301A | 21 | 913-914 | ||
| S22018A | 08 | 551-552 | S229XXA | 24 | 963-965 | S25301A | 24 | 963-965 | ||
| S22018A | 24 | 963-965 | S229XXB | 08 | 564-566 | S25301D | 23 | 949-950 | ||
| S22018B | 08 | 551-552 | S229XXB | 24 | 963-965 | S25301S | 05 | 299-301 | ||
| S22018B | 24 | 963-965 | S229XXD | 08 | 559-561 | S25302A | 15 | 791 | ||
| S22018D | 08 | 559-561 | S229XXG | 08 | 559-561 | S25302A | 15 | 793 | ||
| S22018G | 08 | 559-561 | S229XXK | 08 | 564-566 | S25302A | 21 | 913-914 | ||
| S22018K | 08 | 564-566 | S229XXS | 08 | 551-552 | S25302A | 24 | 963-965 | ||
| S22018S | 08 | 551-552 | S230XXA | 08 | 551-552 | S25302D | 23 | 949-950 | ||
| S22019A | 08 | 551-552 | S230XXA | 24 | 963-965 | S25302S | 05 | 299-301 | ||
| S22019A | 24 | 963-965 | S230XXD | 23 | 949-950 | S25309A | 15 | 791 | ||
| S22019B | 08 | 551-552 | S230XXS | 08 | 562-563 | S25309A | 15 | 793 | ||
| S22019B | 24 | 963-965 | S23100A | 08 | 551-552 | S25309A | 21 | 913-914 | ||
| S22019D | 08 | 559-561 | S23100A | 24 | 963-965 | S25309A | 24 | 963-965 | ||
| S22019G | 08 | 559-561 | S23100D | 23 | 949-950 | S25309D | 23 | 949-950 | ||
| S22019K | 08 | 564-566 | S23100S | 08 | 562-563 | S25309S | 05 | 299-301 | ||
| S22019S | 08 | 551-552 | S23101A | 08 | 551-552 | S25311A | 15 | 791 | ||
| S22020A | 08 | 551-552 | S23101A | 24 | 963-965 | S25311A | 15 | 793 | ||
| S22020A | 24 | 963-965 | S23101D | 23 | 949-950 | S25311A | 21 | 913-914 | ||
| S22020B | 08 | 551-552 | S23101S | 08 | 562-563 | S25311A | 24 | 963-965 | ||
| S22020B | 24 | 963-965 | S23110A | 08 | 551-552 | S25311D | 23 | 949-950 | ||
| S22020D | 08 | 559-561 | S23110A | 24 | 963-965 | S25311S | 05 | 299-301 | ||
| S22020G | 08 | 559-561 | S23110D | 23 | 949-950 | S25312A | 15 | 791 | ||
| S22020K | 08 | 564-566 | S23110S | 08 | 562-563 | S25312A | 15 | 793 | ||
| S22020S | 08 | 551-552 | S23111A | 08 | 551-552 | S25312A | 21 | 913-914 | ||
| S22021A | 08 | 551-552 | S23111A | 24 | 963-965 | S25312A | 24 | 963-965 | ||
| S22021A | 24 | 963-965 | S23111D | 23 | 949-950 | S25312D | 23 | 949-950 | ||
| S22021B | 08 | 551-552 | S23111S | 08 | 562-563 | S25312S | 05 | 299-301 | ||
| S22021B | 24 | 963-965 | S23120A | 08 | 551-552 | S25319A | 15 | 791 | ||
| S22021D | 08 | 559-561 | S23120A | 24 | 963-965 | S25319A | 15 | 793 | ||
| S22021G | 08 | 559-561 | S23120D | 23 | 949-950 | S25319A | 21 | 913-914 | ||
| S22021K | 08 | 564-566 | S23120S | 08 | 562-563 | S25319A | 24 | 963-965 | ||
| S22021S | 08 | 551-552 | S23121A | 08 | 551-552 | S25319D | 23 | 949-950 | ||
| S22022A | 08 | 551-552 | S23121A | 24 | 963-965 | S25319S | 05 | 299-301 | ||
| S22022A | 24 | 963-965 | S23121D | 23 | 949-950 | S25321A | 15 | 791 | ||
| S22022B | 08 | 551-552 | S23121S | 08 | 562-563 | S25321A | 15 | 793 | ||
| S22022B | 24 | 963-965 | S23122A | 08 | 551-552 | S25321A | 21 | 913-914 | ||
| S22022D | 08 | 559-561 | S23122A | 24 | 963-965 | S25321A | 24 | 963-965 | ||
| S22022G | 08 | 559-561 | S23122D | 23 | 949-950 | S25321D | 23 | 949-950 | ||
| S22022K | 08 | 564-566 | S23122S | 08 | 562-563 | S25321S | 05 | 299-301 | ||
| S22022S | 08 | 551-552 | S23123A | 08 | 551-552 | S25322A | 15 | 791 | ||
| S22028A | 08 | 551-552 | S23123A | 24 | 963-965 | S25322A | 15 | 793 | ||
| S22028A | 24 | 963-965 | S23123D | 23 | 949-950 | S25322A | 21 | 913-914 | ||
| S22028B | 08 | 551-552 | S23123S | 08 | 562-563 | S25322A | 24 | 963-965 | ||
| S22028B | 24 | 963-965 | S23130A | 08 | 551-552 | S25322D | 23 | 949-950 | ||
| S22028D | 08 | 559-561 | S23130A | 24 | 963-965 | S25322S | 05 | 299-301 | ||
| S22028G | 08 | 559-561 | S23130D | 23 | 949-950 | S25329A | 15 | 791 | ||
| S22028K | 08 | 564-566 | S23130S | 08 | 562-563 | S25329A | 15 | 793 | ||
| S22028S | 08 | 551-552 | S23131A | 08 | 551-552 | S25329A | 21 | 913-914 | ||
| S22029A | 08 | 551-552 | S23131A | 24 | 963-965 | S25329A | 24 | 963-965 | ||
| S22029A | 24 | 963-965 | S23131D | 23 | 949-950 | S25329D | 23 | 949-950 | ||
| S22029B | 08 | 551-552 | S23131S | 08 | 562-563 | S25329S | 05 | 299-301 | ||
| S22029B | 24 | 963-965 | S23132A | 08 | 551-552 | S25391A | 15 | 791 | ||
| S22029D | 08 | 559-561 | S23132A | 24 | 963-965 | S25391A | 15 | 793 | ||
| S22029G | 08 | 559-561 | S23132D | 23 | 949-950 | S25391A | 21 | 913-914 | ||
| S22029K | 08 | 564-566 | S23132S | 08 | 562-563 | S25391A | 24 | 963-965 | ||
| S22029S | 08 | 551-552 | S23133A | 08 | 551-552 | S25391D | 23 | 949-950 | ||
| S22030A | 08 | 551-552 | S23133A | 24 | 963-965 | S25391S | 05 | 299-301 | ||
| S22030A | 24 | 963-965 | S23133D | 23 | 949-950 | S25392A | 15 | 791 | ||
| S22030B | 08 | 551-552 | S23133S | 08 | 562-563 | S25392A | 15 | 793 | ||
| S22030B | 24 | 963-965 | S23140A | 08 | 551-552 | S25392A | 21 | 913-914 | ||
| S22030D | 08 | 559-561 | S23140A | 24 | 963-965 | S25392A | 24 | 963-965 | ||
| S22030G | 08 | 559-561 | S23140D | 23 | 949-950 | S25392D | 23 | 949-950 | ||
| S22030K | 08 | 564-566 | S23140S | 08 | 562-563 | S25392S | 05 | 299-301 | ||
| S22030S | 08 | 551-552 | S23141A | 08 | 551-552 | S25399A | 15 | 791 | ||
| S22031A | 08 | 551-552 | S23141A | 24 | 963-965 | S25399A | 15 | 793 | ||
| S22031A | 24 | 963-965 | S23141D | 23 | 949-950 | S25399A | 21 | 913-914 | ||
| S22031B | 08 | 551-552 | S23141S | 08 | 562-563 | S25399A | 24 | 963-965 | ||
| S22031B | 24 | 963-965 | S23142A | 08 | 551-552 | S25399D | 23 | 949-950 | ||
| S22031D | 08 | 559-561 | S23142A | 24 | 963-965 | S25399S | 05 | 299-301 | ||
| S22031G | 08 | 559-561 | S23142D | 23 | 949-950 | S25401A | 15 | 791 | ||
| S22031K | 08 | 564-566 | S23142S | 08 | 562-563 | S25401A | 15 | 793 | ||
| S22031S | 08 | 551-552 | S23143A | 08 | 551-552 | S25401A | 21 | 913-914 | ||
| S22032A | 08 | 551-552 | S23143A | 24 | 963-965 | S25401A | 24 | 963-965 | ||
| S22032A | 24 | 963-965 | S23143D | 23 | 949-950 | S25401D | 23 | 949-950 | ||
| S22032B | 08 | 551-552 | S23143S | 08 | 562-563 | S25401S | 05 | 299-301 | ||
| S22032B | 24 | 963-965 | S23150A | 08 | 551-552 | S25402A | 15 | 791 | ||
| S22032D | 08 | 559-561 | S23150A | 24 | 963-965 | S25402A | 15 | 793 | ||
| S22032G | 08 | 559-561 | S23150D | 23 | 949-950 | S25402A | 21 | 913-914 | ||
| S22032K | 08 | 564-566 | S23150S | 08 | 562-563 | S25402A | 24 | 963-965 | ||
| S22032S | 08 | 551-552 | S23151A | 08 | 551-552 | S25402D | 23 | 949-950 | ||
| S22038A | 08 | 551-552 | S23151A | 24 | 963-965 | S25402S | 05 | 299-301 | ||
| S22038A | 24 | 963-965 | S23151D | 23 | 949-950 | S25409A | 15 | 791 | ||
| S22038B | 08 | 551-552 | S23151S | 08 | 562-563 | S25409A | 15 | 793 | ||
| S22038B | 24 | 963-965 | S23152A | 08 | 551-552 | S25409A | 21 | 913-914 | ||
| S22038D | 08 | 559-561 | S23152A | 24 | 963-965 | S25409A | 24 | 963-965 | ||
| S22038G | 08 | 559-561 | S23152D | 23 | 949-950 | S25409D | 23 | 949-950 | ||
| S22038K | 08 | 564-566 | S23152S | 08 | 562-563 | S25409S | 05 | 299-301 | ||
| S22038S | 08 | 551-552 | S23153A | 08 | 551-552 | S25411A | 15 | 791 | ||
| S22039A | 08 | 551-552 | S23153A | 24 | 963-965 | S25411A | 15 | 793 | ||
| S22039A | 24 | 963-965 | S23153D | 23 | 949-950 | S25411A | 21 | 913-914 | ||
| S22039B | 08 | 551-552 | S23153S | 08 | 562-563 | S25411A | 24 | 963-965 | ||
| S22039B | 24 | 963-965 | S23160A | 08 | 551-552 | S25411D | 23 | 949-950 | ||
| S22039D | 08 | 559-561 | S23160A | 24 | 963-965 | S25411S | 05 | 299-301 | ||
| S22039G | 08 | 559-561 | S23160D | 23 | 949-950 | S25412A | 15 | 791 | ||
| S22039K | 08 | 564-566 | S23160S | 08 | 562-563 | S25412A | 15 | 793 | ||
| S22039S | 08 | 551-552 | S23161A | 08 | 551-552 | S25412A | 21 | 913-914 | ||
| S22040A | 08 | 551-552 | S23161A | 24 | 963-965 | S25412A | 24 | 963-965 | ||
| S22040A | 24 | 963-965 | S23161D | 23 | 949-950 | S25412D | 23 | 949-950 | ||
| S22040B | 08 | 551-552 | S23161S | 08 | 562-563 | S25412S | 05 | 299-301 | ||
| S22040B | 24 | 963-965 | S23162A | 08 | 551-552 | S25419A | 15 | 791 | ||
| S22040D | 08 | 559-561 | S23162A | 24 | 963-965 | S25419A | 15 | 793 | ||
| S22040G | 08 | 559-561 | S23162D | 23 | 949-950 | S25419A | 21 | 913-914 | ||
| S22040K | 08 | 564-566 | S23162S | 08 | 562-563 | S25419A | 24 | 963-965 | ||
| S22040S | 08 | 551-552 | S23163A | 08 | 551-552 | S25419D | 23 | 949-950 | ||
| S22041A | 08 | 551-552 | S23163A | 24 | 963-965 | S25419S | 05 | 299-301 | ||
| S22041A | 24 | 963-965 | S23163D | 23 | 949-950 | S25421A | 15 | 791 | ||
| S22041B | 08 | 551-552 | S23163S | 08 | 562-563 | S25421A | 15 | 793 | ||
| S22041B | 24 | 963-965 | S23170A | 08 | 551-552 | S25421A | 21 | 913-914 | ||
| S22041D | 08 | 559-561 | S23170A | 24 | 963-965 | S25421A | 24 | 963-965 | ||
| S22041G | 08 | 559-561 | S23170D | 23 | 949-950 | S25421D | 23 | 949-950 | ||
| S22041K | 08 | 564-566 | S23170S | 08 | 562-563 | S25421S | 05 | 299-301 | ||
| S22041S | 08 | 551-552 | S23171A | 08 | 551-552 | S25422A | 15 | 791 | ||
| S22042A | 08 | 551-552 | S23171A | 24 | 963-965 | S25422A | 15 | 793 | ||
| S22042A | 24 | 963-965 | S23171D | 23 | 949-950 | S25422A | 21 | 913-914 | ||
| S22042B | 08 | 551-552 | S23171S | 08 | 562-563 | S25422A | 24 | 963-965 | ||
| S22042B | 24 | 963-965 | S2320XA | 08 | 551-552 | S25422D | 23 | 949-950 | ||
| S22042D | 08 | 559-561 | S2320XA | 24 | 963-965 | S25422S | 05 | 299-301 | ||
| S22042G | 08 | 559-561 | S2320XD | 23 | 949-950 | S25429A | 15 | 791 | ||
| S22042K | 08 | 564-566 | S2320XS | 08 | 562-563 | S25429A | 15 | 793 | ||
| S22042S | 08 | 551-552 | S2329XA | 08 | 551-552 | S25429A | 21 | 913-914 | ||
| S22048A | 08 | 551-552 | S2329XA | 24 | 963-965 | S25429A | 24 | 963-965 | ||
| S22048A | 24 | 963-965 | S2329XD | 23 | 949-950 | S25429D | 23 | 949-950 | ||
| S22048B | 08 | 551-552 | S2329XS | 08 | 562-563 | S25429S | 05 | 299-301 | ||
| S22048B | 24 | 963-965 | S233XXA | 08 | 551-552 | S25491A | 15 | 791 | ||
| S22048D | 08 | 559-561 | S233XXA | 24 | 963-965 | S25491A | 15 | 793 | ||
| S22048G | 08 | 559-561 | S233XXD | 23 | 949-950 | S25491A | 21 | 913-914 | ||
| S22048K | 08 | 564-566 | S233XXS | 08 | 562-563 | S25491A | 24 | 963-965 | ||
| S22048S | 08 | 551-552 | S2341XA | 04 | 205-206 | S25491D | 23 | 949-950 | ||
| S22049A | 08 | 551-552 | S2341XA | 24 | 963-965 | S25491S | 05 | 299-301 | ||
| S22049A | 24 | 963-965 | S2341XD | 23 | 949-950 | S25492A | 15 | 791 | ||
| S22049B | 08 | 551-552 | S2341XS | 08 | 562-563 | S25492A | 15 | 793 | ||
| S22049B | 24 | 963-965 | S23420A | 04 | 205-206 | S25492A | 21 | 913-914 | ||
| S22049D | 08 | 559-561 | S23420A | 24 | 963-965 | S25492A | 24 | 963-965 | ||
| S22049G | 08 | 559-561 | S23420D | 23 | 949-950 | S25492D | 23 | 949-950 | ||
| S22049K | 08 | 564-566 | S23420S | 08 | 562-563 | S25492S | 05 | 299-301 | ||
| S22049S | 08 | 551-552 | S23421A | 04 | 205-206 | S25499A | 15 | 791 | ||
| S22050A | 08 | 551-552 | S23421A | 24 | 963-965 | S25499A | 15 | 793 | ||
| S22050A | 24 | 963-965 | S23421D | 23 | 949-950 | S25499A | 21 | 913-914 | ||
| S22050B | 08 | 551-552 | S23421S | 08 | 562-563 | S25499A | 24 | 963-965 | ||
| S22050B | 24 | 963-965 | S23428A | 04 | 205-206 | S25499D | 23 | 949-950 | ||
| S22050D | 08 | 559-561 | S23428A | 24 | 963-965 | S25499S | 05 | 299-301 | ||
| S22050G | 08 | 559-561 | S23428D | 23 | 949-950 | S25501A | 21 | 913-914 | ||
| S22050K | 08 | 564-566 | S23428S | 08 | 562-563 | S25501A | 24 | 963-965 | ||
| S22050S | 08 | 551-552 | S23429A | 04 | 205-206 | S25501D | 23 | 949-950 | ||
| S22051A | 08 | 551-552 | S23429A | 24 | 963-965 | S25501S | 05 | 299-301 | ||
| S22051A | 24 | 963-965 | S23429D | 23 | 949-950 | S25502A | 21 | 913-914 | ||
| S22051B | 08 | 551-552 | S23429S | 08 | 562-563 | S25502A | 24 | 963-965 | ||
| S22051B | 24 | 963-965 | S238XXA | 08 | 551-552 | S25502D | 23 | 949-950 | ||
| S22051D | 08 | 559-561 | S238XXA | 24 | 963-965 | S25502S | 05 | 299-301 | ||
| S22051G | 08 | 559-561 | S238XXD | 23 | 949-950 | S25509A | 21 | 913-914 | ||
| S22051K | 08 | 564-566 | S238XXS | 08 | 562-563 | S25509A | 24 | 963-965 | ||
| S22051S | 08 | 551-552 | S239XXA | 08 | 551-552 | S25509D | 23 | 949-950 | ||
| S22052A | 08 | 551-552 | S239XXA | 24 | 963-965 | S25509S | 05 | 299-301 | ||
| S22052A | 24 | 963-965 | S239XXD | 23 | 949-950 | S25511A | 21 | 913-914 | ||
| S22052B | 08 | 551-552 | S239XXS | 08 | 562-563 | S25511A | 24 | 963-965 | ||
| S22052B | 24 | 963-965 | S240XXA | 01 | 052-053 | S25511D | 23 | 949-950 | ||
| S22052D | 08 | 559-561 | S240XXA | 24 | 963-965 | S25511S | 05 | 299-301 | ||
| S22052G | 08 | 559-561 | S240XXD | 23 | 949-950 | S25512A | 21 | 913-914 | ||
| S22052K | 08 | 564-566 | S240XXS | 01 | 052-053 | S25512A | 24 | 963-965 | ||
| S22052S | 08 | 551-552 | S24101A | 01 | 052-053 | S25512D | 23 | 949-950 | ||
| S22058A | 08 | 551-552 | S24101A | 24 | 963-965 | S25512S | 05 | 299-301 | ||
| S22058A | 24 | 963-965 | S24101D | 23 | 949-950 | S25519A | 21 | 913-914 | ||
| S22058B | 08 | 551-552 | S24101S | 01 | 052-053 | S25519A | 24 | 963-965 | ||
| S22058B | 24 | 963-965 | S24102A | 01 | 052-053 | S25519D | 23 | 949-950 | ||
| S22058D | 08 | 559-561 | S24102A | 24 | 963-965 | S25519S | 05 | 299-301 | ||
| S22058G | 08 | 559-561 | S24102D | 23 | 949-950 | S25591A | 21 | 913-914 | ||
| S22058K | 08 | 564-566 | S24102S | 01 | 052-053 | S25591A | 24 | 963-965 | ||
| S22058S | 08 | 551-552 | S24103A | 01 | 052-053 | S25591D | 23 | 949-950 | ||
| S22059A | 08 | 551-552 | S24103A | 24 | 963-965 | S25591S | 05 | 299-301 | ||
| S22059A | 24 | 963-965 | S24103D | 23 | 949-950 | S25592A | 21 | 913-914 | ||
| S22059B | 08 | 551-552 | S24103S | 01 | 052-053 | S25592A | 24 | 963-965 | ||
| S22059B | 24 | 963-965 | S24104A | 01 | 052-053 | S25592D | 23 | 949-950 | ||
| S22059D | 08 | 559-561 | S24104A | 24 | 963-965 | S25592S | 05 | 299-301 | ||
| S22059G | 08 | 559-561 | S24104D | 23 | 949-950 | S25599A | 21 | 913-914 | ||
| S22059K | 08 | 564-566 | S24104S | 01 | 052-053 | S25599A | 24 | 963-965 | ||
| S22059S | 08 | 551-552 | S24109A | 01 | 052-053 | S25599D | 23 | 949-950 | ||
| S22060A | 08 | 551-552 | S24109A | 24 | 963-965 | S25599S | 05 | 299-301 | ||
| S22060A | 24 | 963-965 | S24109D | 23 | 949-950 | S25801A | 21 | 913-914 | ||
| S22060B | 08 | 551-552 | S24109S | 01 | 052-053 | S25801A | 24 | 963-965 | ||
| S22060B | 24 | 963-965 | S24111A | 01 | 052-053 | S25801D | 23 | 949-950 | ||
| S22060D | 08 | 559-561 | S24111A | 24 | 963-965 | S25801S | 05 | 299-301 | ||
| S22060G | 08 | 559-561 | S24111D | 23 | 949-950 | S25802A | 21 | 913-914 | ||
| S22060K | 08 | 564-566 | S24111S | 01 | 052-053 | S25802A | 24 | 963-965 | ||
| S22060S | 08 | 551-552 | S24112A | 01 | 052-053 | S25802D | 23 | 949-950 | ||
| S22061A | 08 | 551-552 | S24112A | 24 | 963-965 | S25802S | 05 | 299-301 | ||
| S22061A | 24 | 963-965 | S24112D | 23 | 949-950 | S25809A | 21 | 913-914 | ||
| S22061B | 08 | 551-552 | S24112S | 01 | 052-053 | S25809A | 24 | 963-965 | ||
| S22061B | 24 | 963-965 | S24113A | 01 | 052-053 | S25809D | 23 | 949-950 | ||
| S24113A | 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 |