HCPCS Code Section: HCPCS A Codes

Paraffin, per pound Short Description: Paraffin Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 1986 Effective Date: January 1, 2002 …

Permanent implantable contraceptive intratubal occlusion device(s) and delivery system Short Description: Intratubal occlusion device Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: …

Permanent, long term, non-dissolvable lacrimal duct implant, each Short Description: Permanent tear duct plug Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: …

Sacral nerve stimulation test lead, each Short Description: Sacral nerve stim test lead Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2001 …

Temporary, absorbable lacrimal duct implant, each Short Description: Temporary tear duct plug Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, …

Locking ring for breast pump, replacement Short Description: Replcmnt breastpump lok ring Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, 2003 Effective …

Cervical cap for contraceptive use Short Description: Cervical cap contraceptive Coverage Code: Non-covered by Medicare statute Action Code: No maintenance for this code Date Added: January 1, 1999 Effective …

Polycarbonate bottle for use with breast pump, replacement Short Description: Replcmnt breast pump bottle Coverage Code: Carrier judgment Action Code: No maintenance for this code Date Added: January 1, …

Lancets, per box of 100 Short Description: Lancets per box Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 1985 Effective …

Breast shield and splash protector for use with breast pump, replacement Short Description: Replcmnt breast pump shield Coverage Code: Carrier judgment Action Code: No maintenance for this code Date …