2018 Jurisdiction List - JA DME
2018 Jurisdiction List
NOTE: Deleted codes are valid for dates of service on or before the date of deletion.
NOTE: Updated codes are in bold.
NOTE: The jurisdiction list includes codes that are not payable by Medicare. Please consult the Medicare contractor in whose jurisdiction a claim would be filed in order to determine coverage under Medicare.
NOTE: All Local Carrier language has been changed to Part B MAC
SEARCH TIP: Enter only the first two or three digits of the HCPCS code in the search box to display range of codes, then scroll down page to find specific code.
HCPCS | DESCRIPTION | JURISDICTION |
---|---|---|
A0021 - A0999 | Ambulance Services | Part B MAC |
A4206 - A4209 | Medical, Surgical, and Self- Administered Injection Supplies | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4210 | Needle Free Injection Device | DME MAC |
A4211 | Medical, Surgical, and Self-Administered Injection Supplies | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4212 | Non-Coring, Needle or Stylet with or without Catheter | Part B MAC |
A4213 - A4215 | Medical, Surgical, and Self-Administered Injection Supplies | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4216 - A4218 | Saline | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4220 | Refill Kit for Implantable Pump | Part B MAC |
A4221 - A4236 | Self-Administered Injection and Diabetic Supplies | DME MAC |
A4244 - A4250 | Medical, Surgical, and Self- Administered Injection Supplies | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4252 - A4259 | Diabetic Supplies | DME MAC |
A4261 | Cervical Cap for Contraceptive Use | Part B MAC |
A4262 - A4263 | Lacrimal Duct Implants | Part B MAC |
A4264 | Contraceptive Implant | Part B MAC |
A4265 | Paraffin | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4266 - A4269 | Contraceptives | Part B MAC |
A4270 | Endoscope Sheath | Part B MAC |
A4280 | Accessory for Breast Prosthesis | DME MAC |
A4281 - A4286 | Accessory for Breast Pump | DME MAC |
A4290 | Sacral Nerve Stimulation Test Lead | Part B MAC |
A4300 - A4301 | Implantable Catheter | Part B MAC |
A4305 - A4306 | Disposable Drug Delivery System | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4310 - A4358 | Incontinence Supplies/ Urinary Supplies | If provided in the physician's office for a temporary condition, the item is incident to the physician's service & billed to the Part B MAC. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device & billed to the DME MAC. |
A4360 - A4435 | Urinary Supplies | If provided in the physician's office for a temporary condition, the item is incident to the physician's service & billed to the Part B MAC. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device & billed to the DME MAC. |
A4450 - A4456 | Tape; Adhesive Remover | Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device. If other, DME MAC. |
A4458-A4459 | Enema Bag/System | DME MAC |
A4461-A4463 | Surgical Dressing Holders | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4465 - A4467 | Non-elastic Binder and Garment, Strap, Covering | DME MAC |
A4470 | Gravlee Jet Washer | Part B MAC |
A4480 | Vabra Aspirator | Part B MAC |
A4481 | Tracheostomy Supply | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4483 | Moisture Exchanger | DME MAC |
A4490 - A4510 | Surgical Stockings | DME MAC |
A4520 | Diapers | DME MAC |
A4550 | Surgical Trays | Part B MAC |
A4553 - A4554 | Underpads | DME MAC |
A4555 - A4558 | Electrodes; Lead Wires; Conductive Paste | Part B MAC if incident to a physician's service (not separately payable). If other,DME MAC. |
A4559 | Coupling Gel | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4561 - A4562 | Pessary | Part B MAC |
A4565-A4566 | Sling | Part B MAC |
A4570 | Splint | Part B MAC |
A4575 | Topical Hyperbaric Oxygen Chamber, Disposable | DME MAC |
A4580 - A4590 | Casting Supplies & Material | Part B MAC |
A4595 | TENS Supplies | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4600 | Sleeve for Intermittent Limb Compression Device | DME MAC |
A4601-A4602 | Lithium Replacement Batteries | DME MAC |
A4604 | Tubing for Positive Airway Pressure Device | DME MAC |
A4605 | Tracheal Suction Catheter | DME MAC |
A4606 | Oxygen Probe for Oximeter | DME MAC |
A4608 | Transtracheal Oxygen Catheter | DME MAC |
A4611 - A4613 | Oxygen Equipment Batteries and Supplies | DME MAC |
A4614 | Peak Flow Rate Meter | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4615 - A4629 | Oxygen & Tracheostomy Supplies | Part B MAC if incident to a physician's service (not separately payable). If other, DME MAC. |
A4630 - A4640 | DME Supplies | DME MAC |
A4641 - A4642 | Imaging Agent; Contrast Material | Part B MAC |
A4648 | Tissue Marker, Implanted | Part B MAC |
A4649 | Miscellaneous Surgical Supplies | Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A4650 | Implantable Radiation Dosimeter | Part B MAC |
A4651 - A4932 | Supplies for ESRD | DME MAC (not separately payable) |
A5051 - A5093 | Additional Ostomy Supplies | If provided in the physician's office for a temporary condition, the item is incident to the physician's service & billed to the Part B MAC. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device & billed to the DME MAC. |
A5102 - A5200 | Additional Incontinence and Ostomy Supplies | If provided in the physician's office for a temporary condition, the item is incident to the physician's service & billed to the Part B MAC. If provided in the physician's office or other place of service for a permanent condition, the item is a prosthetic device & billed to the DME MAC. |
A5500 - A5513 | Therapeutic Shoes | DME MAC |
A6000 | Non-Contact Wound Warming Cover | DME MAC |
A6010-A6024 | Surgical Dressing | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A6025 | Silicone Gel Sheet | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A6154 - A6411 | Surgical Dressing | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A6412 | Eye Patch | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A6413 | Adhesive Bandage | Part B MAC if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A6441 - A6512 | Surgical Dressings | Part B MAC if incident to a physician's service (not separately payable), or if supply for implanted prosthetic device or implanted DME. If other, DME MAC. |
A6513 | Compression Burn Mask | DME MAC |
A6530 - A6549 | Compression Gradient Stockings | DME MAC |
A6550 | Supplies for Negative Pressure Wound Therapy Electrical Pump | DME MAC |
A7000 - A7002 | Accessories for Suction Pumps | DME MAC |
A7003 - A7039 | Accessories for Nebulizers, Aspirators and Ventilators | DME MAC |
A7040 - A7041 | Chest Drainage Supplies | Part B MAC |
A7044 - A7047 | Respiratory Accessories | DME MAC |
A7048 | Vacuum Drainage Supply | Part B MAC |
A7501-A7527 | Tracheostomy Supplies | DME MAC |
A8000-A8004 | Protective Helmets | DME MAC |
A9150 | Non-Prescription Drugs | Part B MAC |
A9152 - A9153 | Vitamins | Part B MAC |
A9155 | Artificial Saliva | Part B MAC |
A9180 | Lice Infestation Treatment | Part B MAC |
A9270 | Noncovered Items or Services | DME MAC |
A9272 | Disposable Wound Suction Pump | DME MAC |
A9273 | Hot Water Bottles, Ice Caps or Collars, and Heat and/or Cold Wraps | DME MAC |
A9274 - A9278 | Glucose Monitoring | DME MAC |
A9279 | Monitoring Feature/Device | DME MAC |
A9280 | Alarm Device | DME MAC |
A9281 | Reaching/Grabbing Device | DME MAC |
A9282 | Wig | DME MAC |
A9283 | Foot Off Loading Device | DME MAC |
A9284- A9286 | Non-electric Spirometer, Inversion Devices and Hygienic Items | DME MAC |
A9300 | Exercise Equipment | DME MAC |
A9500 - A9700 | Supplies for Radiology Procedures | Part B MAC |
A9900 | Miscellaneous DME Supply or Accessory | Part B MAC if used with implanted DME. If other, DME MAC. |
A9901 | Delivery | DME MAC |
A9999 | Miscellaneous DME Supply or Accessory | Part B MAC if used with implanted DME. If other, DME MAC. |
B4034 - B9999 | Enteral and Parenteral Therapy | DME MAC |
D0120 - D9999 | Dental Procedures | Part B MAC |
E0100 - E0105 | Canes | DME MAC |
E0110 - E0118 | Crutches | DME MAC |
E0130 - E0159 | Walkers | DME MAC |
E0160 - E0175 | Commodes | DME MAC |
E0181 - E0199 | Decubitus Care Equipment | DME MAC |
E0200 - E0239 | Heat/Cold Applications | DME MAC |
E0240 - E0248 | Bath and Toilet Aids | DME MAC |
E0249 | Pad for Heating Unit | DME MAC |
E0250 - E0304 | Hospital Beds | DME MAC |
E0305 - E0326 | Hospital Bed Accessories | DME MAC |
E0328 - E0329 | Pediatric Hospital Beds | DME MAC |
E0350 - E0352 | Electronic Bowel Irrigation System | DME MAC |
E0370 | Heel Pad | DME MAC |
E0371 - E0373 | Decubitus Care Equipment | DME MAC |
E0424 - E0484 | Oxygen and Related Respiratory Equipment | DME MAC |
E0485 - E0486 | Oral Device to Reduce Airway Collapsibility | DME MAC |
E0487 | Electric Spirometer | DME MAC |
E0500 | IPPB Machine | DME MAC |
E0550 - E0585 | Compressors/Nebulizers | DME MAC |
E0600 | Suction Pump | DME MAC |
E0601 | CPAP Device | DME MAC |
E0602 - E0604 | Breast Pump | DME MAC |
E0605 | Vaporizer | DME MAC |
E0606 | Drainage Board | DME MAC |
E0607 | Home Blood Glucose Monitor | DME MAC |
E0610 - E0615 | Pacemaker Monitor | DME MAC |
E0616 | Implantable Cardiac Event Recorder | Part B MAC |
E0617 | External Defibrillator | DME MAC |
E0618 - E0619 | Apnea Monitor | DME MAC |
E0620 | Skin Piercing Device | DME MAC |
E0621 - E0636 | Patient Lifts | DME MAC |
E0637 - E0642 | Standing Devices/Lifts | DME MAC |
E0650 - E0676 | Pneumatic Compressor and Appliances | DME MAC |
E0691 - E0694 | Ultraviolet Light Therapy Systems | DME MAC |
E0700 | Safety Equipment | DME MAC |
E0705 | Transfer Board | DME MAC |
E0710 | Restraints | DME MAC |
E0720 - E0745 | Electrical Nerve Stimulators | DME MAC |
E0746 | EMG Device | Part B MAC |
E0747 - E0748 | Osteogenic Stimulators | DME MAC |
E0749 | Implantable Osteogenic Stimulators | Part B MAC |
E0755- E0770 | Stimulation Devices | DME MAC |
E0776 | IV Pole | DME MAC |
E0779 - E0780 | External Infusion Pumps | DME MAC |
E0781 | Ambulatory Infusion Pump | DME MAC |
E0782 - E0783 | Infusion Pumps, Implantable | Part B MAC |
E0784 | Infusion Pumps, Insulin | DME MAC |
E0785 - E0786 | Implantable Infusion Pump Catheter | Part B MAC |
E0791 | Parenteral Infusion Pump | DME MAC |
E0830 | Ambulatory Traction Device | DME MAC |
E0840 - E0900 | Traction Equipment | DME MAC |
E0910 - E0930 | Trapeze/Fracture Frame | DME MAC |
E0935 - E0936 | Passive Motion Exercise Device | DME MAC |
E0940 | Trapeze Equipment | DME MAC |
E0941 | Traction Equipment | DME MAC |
E0942 - E0945 | Orthopedic Devices | DME MAC |
E0946 - E0948 | Fracture Frame | DME MAC |
E0950 - E1298 | Wheelchairs | DME MAC |
E1300 - E1310 | Whirlpool Equipment | DME MAC |
E1352 - E1392 | Additional Oxygen Related Equipment | DME MAC |
E1399 | Miscellaneous DME | Part B MAC if implanted DME. If other, DME MAC. |
E1405 - E1406 | Additional Oxygen Equipment | DME MAC |
E1500 - E1699 | Artificial Kidney Machines and Accessories | DME MAC (not separately payable) |
E1700 - E1702 | TMJ Device and Supplies | DME MAC |
E1800 - E1841 | Dynamic Flexion Devices | DME MAC |
E1902 | Communication Board | DME MAC |
E2000 | Gastric Suction Pump | DME MAC |
E2100 - E2101 | Blood Glucose Monitors with Special Features | DME MAC |
E2120 | Pulse Generator for Tympanic Treatment of Inner Ear | DME MAC |
E2201 - E2397 | Wheelchair Accessories | DME MAC |
E2402 | Negative Pressure Wound Therapy Pump | DME MAC |
E2500 - E2599 | Speech Generating Device | DME MAC |
E2601 - E2633 | Wheelchair Cushions and Accessories | DME MAC |
E8000 - E8002 | Gait Trainers | DME MAC |
G0008 - G0329 | Misc. Professional Services | Part B MAC |
G0333 | Dispensing Fee | DME MAC |
G0337 - G0365 | Misc. Professional Services | Part B MAC |
G0372 | Misc. Professional Services | Part B MAC |
G0378 - G0490 G0493-G9977 | Misc. Professional Services | Part B MAC |
J0120 - J3570 | Injection | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J3590 | Unclassified Biologicals | Part B MAC |
J7030 - J7131 | Miscellaneous Drugs and Solutions | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J7175-J7179 | Clotting Factors | Part B MAC |
J7180 - J7195 | Antihemophilic Factor | Part B MAC |
J7196 - J7197 | Antithrombin III | Part B MAC |
J7198 | Anti-inhibitor; per I.U. | Part B MAC |
J7199 - J7211 | Other Hemophilia Clotting Factors | Part B MAC |
J7296 - J7307 | Contraceptives | Part B MAC |
J7308 - J7309 | Aminolevulinic Acid HCL | Part B MAC |
J7310 | Ganciclovir, Long-Acting Implant | Part B MAC |
J7311 - J7316 | Ophthalmic Drugs | Part B MAC |
J7320 - J7328 | Hyaluronan | Part B MAC |
J7330 | Autologous Cultured Chondrocytes, Implant | Part B MAC |
J7336 | Capsaicin | Part B MAC |
J7340 | Carbidopa/Levodopa | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J7342-J7345 | Ciprofloxacin Otic & Topical Aminolevulinic Acid | Part B MAC |
J7500 - J7599 | Immunosuppressive Drugs | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J7604 - J7699 | Inhalation Solutions | Part B MAC if incident to a physician's service. If other, DME MAC. |
J7799 -J7999 | NOC Drugs, Other than Inhalation Drugs | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
J8498 | Anti-emetic Drug | DME MAC |
J8499 | Prescription Drug, Oral, Non Chemotherapeutic | Part B MAC if incident to a physician's service. If other, DME MAC. |
J8501 - J8999 | Oral Anti-Cancer Drugs | DME MAC |
J9000 - J9999 | Chemotherapy Drugs | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
K0001 - K0108 | Wheelchairs | DME MAC |
K0195 | Elevating Leg Rests | DME MAC |
K0455 | Infusion Pump used for Uninterrupted Administration of Epoprostenal | DME MAC |
K0462 | Loaner Equipment | DME MAC |
K0552 - K0605 | External Infusion Pump Supplies & Continuous Glucose Monitor | DME MAC |
K0606 - K0609 | Defibrillator Accessories | DME MAC |
K0669 | Wheelchair Cushion | DME MAC |
K0672 | Soft Interface for Orthosis | DME MAC |
K0730 | Inhalation Drug Delivery System | DME MAC |
K0733 | Power Wheelchair Accessory | DME MAC |
K0738 | Oxygen Equipment | DME MAC |
K0739 | Repair or Nonroutine Service for DME | Part B MAC if implanted DME. If other, DME MAC |
K0740 | Repair or Nonroutine Service for Oxygen Equipment | DME MAC |
K0743 - K0746 | Suction Pump and Dressings | DME MAC |
K0800 - K0899 | Power Mobility Devices | DME MAC |
K0900 | Custom DME, other than Wheelchair | DME MAC |
L0112 - L4631 | Orthotics | DME MAC |
L5000 - L5999 | Lower Limb Prosthetics | DME MAC |
L6000 - L7499 | Upper Limb Prosthetics | DME MAC |
L7510 - L7520 | Repair of Prosthetic Device | Part B MAC if repair of implanted prosthetic device. If other, DME MAC. |
L7600 - L8485 | Prosthetics | DME MAC |
L8499 | Unlisted Procedure for Miscellaneous Prosthetic Services | Part B MAC if implanted prosthetic device. If other, DME MAC. |
L8500 - L8501 | Artificial Larynx; Tracheostomy Speaking Valve | DME MAC |
L8505 | Artificial Larynx Accessory | DME MAC |
L8507 | Voice Prosthesis, Patient Inserted | DME MAC |
L8509 | Voice Prosthesis, Inserted by a Licensed Health Care Provider | Part B MAC for dates of service on or after 10/01/2010. DME MAC for dates of service prior to 10/01/2010 |
L8510 | Voice Prosthesis | DME MAC |
L8511 - L8515 | Voice Prosthesis | Part B MAC if used with racheoesophageal voice prostheses inserted by a licensed health care provider. If other, DME MAC |
L8600 - L8699 | Prosthetic Implants | Part B MAC |
L9900 | Miscellaneous Orthotic or Prosthetic Component or Accessory | Part B MAC if used with implanted prosthetic device. If other, DME MAC. |
M0075 - M0301 | Medical Services | Part B MAC |
P2028 - P9615 | Laboratory Tests | Part B MAC |
Q0035 | Influenza Vaccine; Cardio- kymography | Part B MAC |
Q0081 | Infusion Therapy | Part B MAC |
Q0083 - Q0085 | Chemotherapy Administration | Part B MAC |
Q0091 | Smear Preparation | Part B MAC |
Q0092 | Portable X-ray Setup | Part B MAC |
Q0111 - Q0115 | Miscellaneous Lab Services | Part B MAC |
Q0138-Q0139 | Ferumoxytol Injection | Part B MAC |
Q0144 | Azithromycin Dihydrate | Part B MAC if incident to a physician's service. If other, DME MAC. |
Q0161 - Q0181 | Anti-emetic | DME MAC |
Q0477 - Q0509 | Ventricular Assist Devices | Part B MAC |
Q0510 - Q0514 | Drug Dispensing Fees | DME MAC |
Q0515 | Sermorelin Acetate | Part B MAC |
Q1004 - Q1005 | New Technology IOL | Part B MAC |
Q2004 | Irrigation Solution | Part B MAC |
Q2009 | Fosphenytoin | Part B MAC |
Q2017 | Teniposide | Part B MAC |
Q2026-Q2028 | Injectable Dermal Fillers | Part B MAC |
Q2034 - Q2039 | Influenza Vaccine | Part B MAC |
Q2040-Q2043 | Cellular Immunotherapy | Part B MAC |
Q2049-Q2050 | Doxorubicin | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
Q2052 | IVIG Demonstration | DME MAC |
Q3001 | Supplies for Radiology Procedures | Part B MAC |
Q3014 | Telehealth Originating Site Facility Fee | Part B MAC |
Q3027 - Q3028 | Vaccines | Part B MAC |
Q3031 | Collagen Skin Test | Part B MAC |
Q4001 - Q4051 | Splints and Casts | Part B MAC |
Q4074 | Inhalation Drug | Part B MAC if incident to a physician's service. If other, DME MAC. |
Q4081 | Epoetin | Part B MAC |
Q4082 | Drug Subject to Competitive Acquisition Program | Part B MAC |
Q4100 - Q4182 | Skin Substitutes | Part B MAC |
Q5001 - Q5010 | Hospice Services | Part B MAC |
Q5101-Q5102 | Injection | Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC. |
Q9950 - Q9954 | Imaging Agents | Part B MAC |
Q9955 - Q9957 | Microspheres | Part B MAC |
Q9958 - Q9969 | Imaging Agents | Part B MAC |
Q9982-Q9983 | Supplies for Radiology Procedures | Part B MAC |
R0070 - R0076 | Diagnostic Radiology Services | Part B MAC |
V2020 - V2025 | Frames | DME MAC |
V2100 - V2513 | Lenses | DME MAC |
V2520 - V2523 | Hydrophilic Contact Lenses | Part B MAC if incident to a physician's service. If other, DME MAC. |
V2530 - V2531 | Contact Lenses, Scleral | DME MAC |
V2599 | Contact Lens, Other Type | Part B MAC if incident to a physician's service. If other, DME MAC. |
V2600 - V2615 | Low Vision Aids | DME MAC |
V2623 - V2629 | Prosthetic Eyes | DME MAC |
V2630 - V2632 | Intraocular Lenses | Part B MAC |
V2700 - V2780 | Miscellaneous Vision Service | DME MAC |
V2781 | Progressive Lens | DME MAC |
V2782 - V2784 | Lenses | DME MAC |
V2785 | Processing--Corneal Tissue | Part B MAC |
V2786 | Lens | DME MAC |
V2787 - V2788 | Intraocular Lenses | Part B MAC |
V2790 | Amniotic Membrane | Part B MAC |
V2797 | Vision Supply | DME MAC |
V2799 | Miscellaneous Vision Service | Part B MAC if supply for an implanted prosthetic device. If other, DME MAC |
V5008 - V5299 | Hearing Services | Part B MAC |
V5336 | Repair/Modification of Augmentative Communicative System or Device | DME MAC |
V5362 - V5364 | Speech Screening | Part B MAC |