2019 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

X
 
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; Con- ductive 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 - A4563 Pessary; Vaginal Insert 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 - A5514 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 - A6457 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.
A6460 - A6461 Surgical Dressing Part B MAC
A6501 - A6512 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
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 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 - G0067 Misc. Professional Services Part B MAC
G0068 - G0070 Infusion Drug Professional Servic DME MAC
G0071 - 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
G0491 - G9987
Misc. Professional Services Part B MAC
J0120 - J1094 Injection Part B MAC Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.
J1095 Ophthalmic Drug Part B MAC
J1100 - J2786 Injection Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.
J2787 Ophthalmic Drug Part B MAC
J2788 - J3570 Injection Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME MAC.
J3590 - J3591 Unclassified Biologicals Part B MAC
J7030 - J7131 Miscellaneous Drugs and Solutions Part B MAC if incident to a physician's Solutions service or used in an implanted infusion pump. If other, DME MAC.
J7170 - 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
J7318 - J7329 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
L8510 Voice Prosthesis DME MAC
L8511 - L8515 Voice Prosthesis Part B MAC if used with tracheoesophageal voice prostheses inserted by a licensed health care provider. If other, DME MAC
L8600 - L8699 Prosthetic Implants Part B MAC
L8701 - L8702 Assist Device DME MAC
L9900 Miscellaneous Orthotic or Prosthetic Component or Accessory Part B MAC if used with implanted prosthetic device. If other, DME MAC.
M0075 - M1071 Medical Services Part B MAC
P2028 - P9615 Laboratory Tests Part B MAC
Q0035 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
Q2041 - 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 - Q4204 Skin Substitutes Part B MAC
Q5001 - Q5010 Hospice Services Part B MAC
Q5101-Q5111 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 - Q9983 Imaging Agents & Radiology Supplies Part B MAC
Q9991-Q9992 Injection Part B MAC if incident to a physician's service or used in an implanted infusion pump. If other, DME 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

 

Last Updated Jan 23, 2019