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wdt_ID wdt_created_by wdt_created_at wdt_last_edited_by wdt_last_edited_at Effective Termed Code type Code Brand name Code description Vendor Authorization is Required When:
4042 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0100 CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE SHP
4043 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0105 CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL M SHP
4044 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0110 CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MA SHP
4045 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0111 CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATER SHP
4046 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0112 CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR SHP
4047 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0113 CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, SHP
4048 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0114 CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR SHP
4049 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0116 CRUTCH UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FI SHP
4050 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0117 CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, E SHP
4051 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0118 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WIT SHP
4052 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0130 WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT SHP
4053 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0135 WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIG SHP
4054 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0140 WALKER, WITH TRUNK SUPPORT, ADJUSTABLE OR FIXED HE SHP
4055 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 HCPC E0141 WALKER, RIGID, WHEELED, ADJUSTABLE OR FIXED HEIGHT SHP
4056 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 3/31/2024 HCPC J3262 ACTEMRA INJECTION, TOCILIZUMAB 1 MG Magellan Billed with one of the following Places of Service or Types of Bill 01,03,04,05,06,07,08,09,11,12,13,14,15,16,17,18,19,20,22,24,25,26,31,32,33,34,41,42,49,50,51,52,53,54,55,56,57,60,62,65,71,72,81,99,831,137,135,131,132,133,134,138,631,832,833,834,835,837
4057 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2014-01-01 3/31/2024 HCPC J0129 ORENCIA INJECTION, ABATACEPT 10 MG USED MEDICARE ADM SUPV PHYS Magellan Billed with one of the following Places of Service or Types of Bill 01,03,04,05,06,07,08,09,11,12,13,14,15,16,17,18,19,20,22,24,25,26,31,32,33,34,41,42,49,50,51,52,53,54,55,56,57,60,62,65,71,72,81,99,831,137,135,131,132,133,134,138,631,832,833,834,835,837
4058 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2016-12-02 CPT 0001U RED BLOOD CELL ANTIGEN TYPING, DNA, HUMAN ERYTHROCYTE ANTIGEN GENE ANALYSIS OF 35 ANTIGENS FROM 11 BLOOD GROUPS, UTILIZING WHOLE BLOOD, COMMON RBC ALLELES REPORTED SHP
4059 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2016-12-02 CPT 0002U ONCOLOGY (COLORECTAL), QUANTITATIVE ASSESSMENT OF THREE URINE METABOLITES (ASCORBIC ACID, SUCCINIC ACID AND CARNITINE) BY LIQUID CHROMATOGRAPHY WITH TANDEM MASS SPECTROMETRY (LC-MS/MS) USING MULTIPLE REACTION MONITORING ACQUISITION, ALGORITHM REPORTED AS SHP
4060 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0022 SKILLED NURSING FACILITY - PPS SHP
4061 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0024 IP REHAB FACILITY - PPS SHP
4062 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0100 ALL- INCLUSIVE ROOM & BOARD PLUS ANCILLARY SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4063 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0101 ALL-INCLUSIVE R andB SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4064 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0110 PVT - GENERAL CLASSIFICATION SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4065 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0111 PVT - MEDICAL/SURGICAL/GYN SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4066 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0112 PVT - OB SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4067 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0113 PVT - PEDIATRIC SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4068 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0117 PVT - ONCOLOGY SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4069 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0118 PVT - REHABILITATION SHP
4070 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0119 PVT - OTHER SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4071 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0120 SEMI - GENERAL CLASSIFICATION SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4072 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0121 SEMI - MEDICAL/SURGICAL/GYN SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4073 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0122 SEMI - OB SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4074 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0123 SEMI - PEDIATRIC SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4075 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0124 SEMI - PSYCHIATRIC SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,891,892,893,894,895,897,861,862,863,864,865,867
4076 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0127 SEMI - ONCOLOGY SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4077 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0128 SEMI - REHABILITATION SHP
4078 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0128 SEMI - REHABILITATION SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4079 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0129 SEMI - OTHER SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4080 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0130 3 and 4 BED - GENERAL CLASSIFICATION SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4081 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0131 3 and 4 BED - MEDICAL/SURGICAL/GYN SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4082 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0132 3 and 4 BED - OB SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4083 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0133 3 and 4 BED - PEDIATRIC SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4084 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0134 3 & 4 BED - PSYCHIATRIC SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,891,892,893,894,895,897,861,862,863,864,865,867
4085 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0137 3 and 4 BED - ONCOLOGY SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4086 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0138 3 and 4 BED - REHABILITATION SHP
4087 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0138 3 and 4 BED - REHABILITATION SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4088 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0139 3 and 4 BED - OTHER SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4089 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0140 PVT/DLX - GENERAL CLASSIFICATION SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4090 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0141 PVT/DLX - MEDICAL/SURGICAL/GYN SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
4091 aveak 04/03/2024 05:41 PM aveak 04/03/2024 05:41 PM 2017-01-01 REV 0142 PVT/DLX - OB SHP Billed with one of the following Types of Bill: 111,112,113,114,115,117,118,119,181,182,183,184,185,187,188,189,211,212,213,214,215,217,218,219,221,222,223,224,225,227,228,229,251,252,253,254,255,257,258,259,261,262,263,264,265,267,268,269,271,272,273,274
Effective Termed Code type Code Brand name Code description Vendor Authorization is Required When: