Prior authorization codes
Mountain Health CO-OP
Active CPT codes that appear on the extracted prior authorization list for this health plan.
| Code | Procedure / Service | Effective | Revised | Confidence | Source |
|---|---|---|---|---|---|
| 0013U | Genetic Testing Oncology (solid organ neoplasia), gene rearrangement detection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0014U | Genetic Testing Hematology (hematolymphoid neoplasia), gene rearrangement | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0016U | Genetic Testing Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0017U | Genetic Testing Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0018U | Genetic Testing Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0023U | Genetic Testing Oncology (acute myelogenous leukemia), DNA, genotyping of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0026U | Genetic Testing Oncology (thyroid), DNA and mRNA of 112 genes, next-generation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0027U | Genetic Testing JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0029U | Genetic Testing Drug metabolism (adverse drug reactions and drug response) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0030U | Genetic Testing Drug metabolism (warfarin drug response), targeted sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0032U | Genetic Testing COMT (catechol-O-methyltransferase)(drug metabolism) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0033U | Genetic Testing HTR2A (5-hydroxytryptamine receptor 2A), HTR2C (5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0036U | Genetic Testing Exome (ie, somatic mutations), paired formalin-fixed paraffin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0037U | Genetic Testing Targeted genomic sequence analysis, solid organ neoplasm, DNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0040U | Genetic Testing BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0045U | Genetic Testing Oncology (breast ductal carcinoma in situ), mRNA, gene expression | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0046U | Genetic Testing FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0047U | Genetic Testing Oncology (prostate), mRNA, gene expression profiling by real-time | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0048U | Genetic Testing Oncology (solid organ neoplasia), DNA, targeted sequencing of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0049U | Genetic Testing NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0050U | Genetic Testing Targeted genomic sequence analysis panel, acute myelogenous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0053U | Genetic Testing Oncology (prostate cancer), FISH analysis of 4 genes (ASAP1, HDAC9 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0056U | Genetic Testing Hematology (acute myelogenous leukemia), DNA, whole genome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0069U | Genetic Testing Oncology (colorectal), microRNA, RT-PCR expression profiling of miR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0070U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0071U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0072U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0073U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0074U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0075U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0076U | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0078U | Genetic Testing Pain management (opioid-use disorder) genotyping panel, 16 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0079U | Genetic Testing Comparative DNA analysis using multiple selected single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0087U | Transplant Cardiology (heart transplant), mRNA gene expression profiling by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0094U | Genetic Testing Genome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0101U | Genetic Testing Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0102U | Genetic Testing Hereditary breast cancer-related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0103U | Genetic Testing Hereditary ovarian cancer (eg, hereditary ovarian cancer, hereditary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0111U | Genetic Testing Oncology (colon cancer), targeted KRAS (codons 12, 13, and 61) and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0113U | Genetic Testing Oncology (prostate), measurement of PCA3 and TMPRSS2-ERG in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0129U | Genetic Testing Hereditary breast cancer–related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0130U | Genetic Testing Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0131U | Genetic Testing Hereditary breast cancer-related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0132U | Genetic Testing Hereditary ovarian cancer-related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0133U | Genetic Testing Hereditary prostate cancer-related disorders, targeted mRNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0134U | Genetic Testing Hereditary pan cancer (eg, hereditary breast and ovarian cancer | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0135U | Genetic Testing Hereditary gynecological cancer (eg, hereditary breast and ovarian | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0136U | Genetic Testing ATM (ataxia telangiectasia mutated) (eg, ataxia telangiectasia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0137U | Genetic Testing PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0138U | Genetic Testing BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0152U | Genetic Testing Infectious disease (bacteria, fungi, parasites, and DNA viruses), DNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0154U | Genetic Testing Oncology (urothelial cancer), RNA, analysis by real- time RT-PCR of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0155U | Genetic Testing Oncology (breast cancer), DNA, PIK3CA (phosphatidylinositol-4,5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0157U | Genetic Testing APC (APC regulator of WNT signaling pathway) (eg, familial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0158U | Genetic Testing MLH1 (mutL homolog 1) (eg, hereditary non- polyposis colorectal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0159U | Genetic Testing MSH2 (mutS homolog 2) (eg, hereditary colon cancer, Lynch | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0160U | Genetic Testing MSH6 (mutS homolog 6) (eg, hereditary colon cancer, Lynch | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0161U | Genetic Testing PMS2 (PMS1 homolog 2, mismatch repair system component) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0162U | Genetic Testing Hereditary colon cancer (Lynch syndrome), targeted mRNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0163T | Surgical - Spine Revision including replacement of total disc arthroplasty (artificial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0164U | Investigational Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0171U | Genetic Testing Targeted genomic sequence analysis panel, acute myeloid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0176U | Investigational Cytolethal distending toxin B (CdtB) and vinculin IgG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0177U | Genetic Testing Oncology (breast cancer), DNA, PIK3CA (phosphatidylinositol-4,5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 01999 | Surgical - Misc. UNLISTED ANESTH PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0203U | Genetic Testing Autoimmune (inflammatory bowel disease), mRNA, gene expression | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0204U | Genetic Testing Oncology (thyroid), mRNA, gene expression analysis of 593 genes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0209U | Genetic Testing Cytogenomic constitutional (genome-wide) analysis, interrogation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0212U | Genetic Testing Rare diseases (constitutional/heritable disorders), whole genome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0213U | Genetic Testing Rare diseases (constitutional/heritable disorders), whole genome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0214U | Genetic Testing Rare diseases (constitutional/heritable disorders), whole exome and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0215U | Genetic Testing Rare diseases (constitutional/heritable disorders), whole exome and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0216U | Genetic Testing Neurology (inherited ataxias), genomic DNA sequence analysis of 12 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0217U | Genetic Testing Neurology (inherited ataxias), genomic DNA sequence analysis of 51 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0218U | Genetic Testing Neurology (muscular dystrophy), DMD gene sequence analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0229U | Genetic Testing BCAT1 (Branched chain amino acid transaminase 1) or IKZF1 (IKAROS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0230T | Pain Management Injection(s), anesthetic agent and/or steroid, transforaminal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0230U | Genetic Testing AR (androgen receptor) (eg, spinal and bulbar muscular atrophy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0231T | Pain Management Injection(s), anesthetic agent and/or steroid, transforaminal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0232U | Genetic Testing CSTB (cystatin B) (eg, progressive myoclonic epilepsy type 1A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0233U | Genetic Testing FXN (frataxin) (eg, Friedreich ataxia), gene analysis, including small | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0234U | Genetic Testing MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome), full gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0235U | Genetic Testing PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0236U | Genetic Testing SMN1 (survival of motor neuron 1, telomeric) and SMN2 (survival of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0237U | Genetic Testing Cardiac ion channelopathies (eg, Brugada syndrome, long QT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0238U | Genetic Testing Oncology (Lynch syndrome), genomic DNA sequence analysis of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0239U | Genetic Testing Targeted genomic sequence analysis panel, solid organ neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0242U | Genetic Testing Targeted genomic sequence analysis panel, solid organ neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0253U | Investigational Reproductive medicine (endometrial receptivity analysis), RNA gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0254U | Reproductive medicine (preimplantation genetic assessment) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0260U | Genetic Testing Rare diseases (constitutional/heritable disorders), identification of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0261U | Investigational Oncology (colorectal cancer), image analysis with artificial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0264U | Genetic Testing Rare diseases (constitutional/heritable disorders), identification of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0266U | Genetic Testing Unexplained constitutional or other heritable disorders or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0268U | Genetic Testing Hematology (atypical hemolytic uremic syndrome [aHUS]) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0269T | Investigational Revision or removal of carotid sinus baroreflex activation device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0269U | Genetic Testing Hematology (autosomal dominant congenital thrombocytopenia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0270T | Investigational Revision or removal of carotid sinus baroreflex activation device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0270U | Genetic Testing Hematology (congenital coagulation disorders), genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0271U | Genetic Testing Hematology (congenital neutropenia), genomic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0272U | Genetic Testing Hematology (genetic bleeding disorders), genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0273U | Genetic Testing Hematology (genetic hyperfibrinolysis, delayed bleeding), genomic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0274U | Genetic Testing Hematology (genetic platelet disorders), genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0275T | Investigational Percutaneous laminotomy/laminectomy (interlaminar approach) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0276U | Genetic Testing Hematology (inherited thrombocytopenia), genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0277U | Genetic Testing Hematology (genetic platelet function disorder), genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0278T | Investigational Transcutaneous electrical modulation pain reprocessing (e.g | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0278U | Genetic Testing Hematology (genetic thrombosis), genomic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0287U | Genetic Testing Oncology (thyroid), DNA and mRNA, next- generation sequencing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0298U | Genetic Testing Oncology (pan tumor), whole transcriptome sequencing of paired | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0299U | Genetic Testing Oncology (pan tumor), whole genome optical genome mapping of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0300U | Genetic Testing Oncology (pan tumor), whole genome sequencing and optical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0306U | Genetic Testing Oncology (minimal residual disease [MRD]), next- generation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0307U | Genetic Testing Oncology (minimal residual disease [MRD]), next- generation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0314U | Genetic Testing Oncology (cutaneous melanoma), mRNA gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0315U | Genetic Testing Oncology (cutaneous squamous cell carcinoma), mRNA gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0317U | Investigational Oncology (lung cancer), four-probe FISH (3q29, 3p22.1, 10q22.3 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0318U | Genetic Testing Pediatrics (congenital epigenetic disorders), whole genome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0323U | Genetic Testing Infectious agent detection by nucleic acid (DNA and RNA), central | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0331U | Genetic Testing Oncology (hematolymphoid neoplasia), optical for copy number | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0332U | Genetic Testing Oncology (pan-tumor), genetic profiling of 8 DNA- regulatory | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0333U | Genetic Testing Oncology (liver), surveillance for hepatocellular carcinoma (HCC) in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0335U | Genetic Testing Rare diseases (constitutional/heritable disorders), whole genome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0343U | Genetic Testing Oncology (prostate), exosome-based analysis of 442 small | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0344U | Investigational Hepatology (nonalcoholic fatty liver disease [NAFLD]) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0346U | Investigational Beta amyloid, Aβ40 and Aβ42 by liquid chromatography with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0347U | Genetic Testing Drug metabolism or processing (multiple conditions), whole blood | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0348U | Genetic Testing Drug metabolism or processing (multiple conditions), whole blood | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0349U | Genetic Testing Drug metabolism or processing (multiple conditions), whole blood | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0350U | Genetic Testing Drug metabolism or processing (multiple conditions), whole blood | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0356U | Genetic Testing Oncology (oropharyngeal), evaluation of 17 DNA biomarkers using | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0358U | Investigational Neurology (mild cognitive impairment), analysis of β- amyloid 1-42 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0359U | Investigational Oncology (prostate cancer), analysis of all prostate- specific | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0360U | Investigational Oncology (lung), enzyme-linked immunosorbent assay (ELISA) of 7 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0361U | Investigational Neurofilament light chain, digital immunoassay, plasma | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0363U | Genetic Testing Oncology (urothelial), mRNA, gene-expression profiling by real-time | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0372U | Investigational Infectious disease (genitourinary pathogens), antibiotic-resistance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0379U | Genetic Testing Targeted genomic sequence analysis panel, solid organ neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0388U | Oncology (non-small cell lung cancer), next-generation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0396U | Obstetrics (pre-implantation genetic testing), evaluation of 300000 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0424U | Oncology (prostate), exosome-based analysis of 53 small | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0425U | Genome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0426U | Genome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0428U | Oncology (breast), targeted hybrid-capture genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0434U | Drug metabolism (adverse drug reactions and drug response) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0436U | Oncology (lung), plasma analysis of 388 proteins, using aptamer | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0438U | Drug metabolism (adverse drug reactions and drug response) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0537T | Pharmacy CAR-T THERAPY HRVG BLD DRV T LMPHCYT PR DAY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0538T | TRANSPORTATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0539T | Pharmacy CAR-T THERAPY RECEIPT & PREP CAR-T CELLS FOR ADMIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0540T | Pharmacy CAR-T THERAPY AUTOLOGOUS CELL ADMINISTRATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 0614T | Investigational Removal and replacement of substernal implantable defibrillator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 1108G | p.R248C [c.742C>T], p.S249C [c.746C>G], p.G370C [c. >T] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 1118A | p.Y373C [c. >G], FGFR3-TACC3v1, and FGFR3-TACC3 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11920 | Cosmetic Potential Tattooing, intradermal introduction of insoluble opaque pigments to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11921 | Cosmetic Potential Tattooing, intradermal introduction of insoluble opaque pigments to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11922 | Cosmetic Potential Tattooing, intradermal introduction of insoluble opaque pigments to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11950 | Cosmetic Potential Subcutaneous injection of filling material (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11951 | Cosmetic Potential Subcutaneous injection of filling material (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11952 | Cosmetic Potential Subcutaneous injection of filling material (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11954 | Cosmetic Potential Subcutaneous injection of filling material (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 11980 | Pharmacy IMPLANT,HORMONE,SUBCUTANEOUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 1298C | ) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15150 | Bioengineered Wound Tissue cultured skin autograft, trunk, arms, legs | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15151 | Bioengineered Wound Tissue cultured skin autograft, trunk, arms, legs | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15152 | Bioengineered Wound Tissue cultured skin autograft, trunk, arms, legs; each additional 100 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15155 | Bioengineered Wound Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15156 | Bioengineered Wound Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15157 | Bioengineered Wound Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15220 | Bioengineered Wound FULL THICK GRFT FREE W/DIR CLSR SCALP,ARMS,LEGS 20 CM/< | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15221 | Bioengineered Wound FULL THICK GRFT FREE W/DIR CLSR SCALP,ARMS,LEGS EA ADDL 20 CM/< | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15271 | Bioengineered Wound Application of skin substitute graft to trunk, arms, legs, total wound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15272 | Bioengineered Wound Application of skin substitute graft to trunk, arms, legs, total wound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15273 | Bioengineered Wound Application of skin substitute graft to trunk, arms, legs, total wound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15274 | Bioengineered Wound Application of skin substitute graft to trunk, arms, legs, total wound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15275 | Bioengineered Wound Application of skin substitute graft to face, scalp, eyelids, mouth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15276 | Bioengineered Wound Application of skin substitute graft to face, scalp, eyelids, mouth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15277 | Bioengineered Wound Application of skin substitute graft to face, scalp, eyelids, mouth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15278 | Bioengineered Wound Application of skin substitute graft to face, scalp, eyelids, mouth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15734 | Wound Healing MUSCLE-SKIN FLAP,TRUNK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15756 | Investigational Free muscle or myocutaneous flap with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15769 | Cosmetic Potential Grafting of autologous soft tissue, other, harvested by direct excision | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15771 | Cosmetic Potential Grafting of autologous fat harvested by liposuction technique to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15772 | Cosmetic Potential Grafting of autologous fat harvested by liposuction technique to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15773 | Cosmetic Potential Grafting of autologous fat harvested by liposuction technique to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15774 | Cosmetic Potential Grafting of autologous fat harvested by liposuction technique to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15822 | Cosmetic Potential Blepharoplasty, upper eyelid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 15823 | Cosmetic Potential Blepharoplasty, upper eyelid; with excessive skin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 1635G | gene analysis (ie, p.C420R, p.E542K, p.E545A, p.E545D [g. >T | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 17106 | Cosmetic Potential Destruction of cutaneous vascular proliferative lesions (eg, laser | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 17107 | Cosmetic Potential Destruction of cutaneous vascular proliferative lesions (eg, laser | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 17108 | Cosmetic Potential Destruction of cutaneous vascular proliferative lesions (eg, laser | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 17999 | Transplant Unlisted procedure, skin, mucous membrane and subcutaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19105 | Procedure - Oncology Ablation, cryosurgical, of fibroadenoma, including ultrasound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19294 | Radiation Preparation of tumor cavity, with placement of a radiation therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19296 | Radiation Placement of radiotherapy afterloading expandable catheter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19297 | Radiation Placement of radiotherapy afterloading expandable catheter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19298 | Radiation Placement of radiotherapy after loading brachytherapy catheters | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19303 | Cosmetic Potential Mastectomy, simple, complete | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19304 | Surgical - Breast Mastectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19318 | Surgical - Breast Breast reduction | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19325 | Surgical - Breast Breast augmentation with implant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19328 | Surgical - Breast Removal of intact breast implant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19330 | Surgical - Breast Removal of ruptured breast implant, including implant contents (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19340 | Surgical - Breast Insertion of breast implant on same day of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19342 | Surgical - Breast Insertion or replacement of breast implant on | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19350 | Surgical - Breast Nipple/areola reconstruction | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19355 | Surgical - Breast Correction of inverted nipples | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19357 | Surgical - Breast Tissue expander placement in breast reconstruction, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19361 | Surgical - Breast Breast reconstruction with latissimus dorsi flap | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19364 | Surgical - Breast Breast reconstruction with free flap (eg, fTRAM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19367 | Surgical - Breast Breast reconstruction; with single-pedicled transverse rectus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19368 | Surgical - Breast Breast reconstruction; with single-pedicled transverse rectus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19369 | Surgical - Breast Breast reconstruction; with bipedicled transverse rectus abdominis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19370 | Surgical - Breast SURGERY OF BREAST CAPSULE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19371 | Surgical - Breast REMOVAL OF BREAST CAPSULE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19380 | Surgical - Breast Revision of reconstructed breast (eg, significant removal of tissue, re | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19396 | Surgical - Breast Preparation of moulage for custom breast implant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 19499 | Procedure - Oncology Unlisted procedure, breast [when specified as destruction of breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20555 | Radiation Placement of needles or catheters into muscle and/or soft tissue for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20700 | Radiation MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20701 | Radiation REMOVAL DEEP DRUG DELIVERY DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20930 | Surgical - Spine Allograft, morselized, or placement of osteopromotive material, for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20931 | Surgical - Spine Allograft, structural, for spine surgery only (List separately in addition | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20932 | Surgical - Spine Allograft, includes templating, cutting, placement and internal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20933 | Surgical - Spine Allograft, includes templating, cutting, placement and internal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20934 | Surgical - Spine Allograft, includes templating, cutting, placement and internal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20936 | Surgical - Spine Autograft for spine surgery only (includes harvesting the graft); local | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20937 | Surgical - Spine Autograft for spine surgery only (includes harvesting the graft) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20938 | Surgical - Spine Autograft for spine surgery only (includes harvesting the graft) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20939 | Surgical - Spine Bone marrow aspiration for bone grafting, spine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20974 | Surgical - Spine Electrical stimulation to aid bone healing; noninvasive | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20979 | Durable Medical Low intensity ultrasound stimulation to aid bone healing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20982 | Procedure - Oncology Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20983 | Procedure - Oncology Ablation therapy for reduction or eradication of 1 or more bone | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 20999 | Transplant Unlisted procedure, musculoskeletal system, general [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21010 | Procedure - ENT INCISION OF JAW JOINT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21050 | Procedure - ENT REMV JAW JOINT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21081 | Procedure - ENT PREP FACE/ORAL PROST MANDIBULAR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21083 | Cosmetic Potential Impression and custom preparation; palatal lift | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21085 | Cosmetic Potential PREP FACE/ORAL PROST ORAL SPLINT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21086 | Durable Medical Impression and custom preparation; auricular prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21141 | Cosmetic Potential Reconstruction midface, LeFort I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21142 | Cosmetic Potential Reconstruction midface, LeFort I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21143 | Cosmetic Potential Reconstruction midface, LeFort I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21145 | Cosmetic Potential Reconstruction midface, LeFort I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21146 | Cosmetic Potential Reconstruction midface, LeFort I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21147 | Cosmetic Potential Reconstruction midface, LeFort I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21150 | Cosmetic Potential Reconstruction midface, LeFort II | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21151 | Cosmetic Potential Reconstruction midface, LeFort II | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21154 | Cosmetic Potential Reconstruction midface, LeFort III | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21155 | Cosmetic Potential Reconstruction midface, LeFort III | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21159 | Cosmetic Potential Reconstruction midface, LeFort III (extra and intracranial) with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21160 | Cosmetic Potential Reconstruction midface, LeFort III (extra and intracranial) with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21172 | Cosmetic Potential Reconstruction superior-lateral orbital rim and lower forehead | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21175 | Cosmetic Potential Reconstruction, bifrontal, superior-lateral orbital rims and lower | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21179 | Cosmetic Potential Reconstruction, entire or majority of forehead | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21180 | Cosmetic Potential Reconstruction, entire or majority of forehead | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21182 | Cosmetic Potential Reconstruction of orbital walls, rims, forehead, nasoethmoid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21183 | Cosmetic Potential Reconstruction of orbital walls, rims, forehead, nasoethmoid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21184 | Cosmetic Potential Reconstruction of orbital walls, rims, forehead, nasoethmoid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21188 | Cosmetic Potential Reconstruction midface, osteotomies (other than LeFort type) and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21193 | Surgical - Maxilofacial Reconstruction of mandibular rami, horizontal, vertical, C, or L | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21194 | Cosmetic Potential Mandibular/Maxillary (Orthognathic) Surgery - Reconstruction of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21195 | Surgical - Maxilofacial Reconstruction of mandibular rami and/or body, sagittal split | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21196 | Surgical - Maxilofacial Reconstruction of mandibular rami and/or body, sagittal split; with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21198 | Surgical - Maxilofacial Osteotomy, mandible, segmental | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21199 | Surgical - Maxilofacial Osteotomy, mandible, segmental; with genioglossus advancement | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21206 | Surgical - Maxilofacial Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21208 | Cosmetic Potential Osteoplasty, facial bones; augmentation (autograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21209 | Cosmetic Potential Osteoplasty, facial bones; reduction | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21210 | Cosmetic Potential Graft, bone; nasal, maxillary or malar areas (includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21215 | Cosmetic Potential Graft, bone; mandible (includes obtaining graft) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21230 | Cosmetic Potential Graft; rib cartilage, autogenous, to face, chin, nose | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21235 | Cosmetic Potential Graft; ear cartilage, autogenous, to nose or ear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21240 | Cosmetic Potential RECONSTRUCTION OF JAW JOINT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21244 | Cosmetic Potential Reconstruction of mandible, extraoral, with transosteal bone plate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21245 | Cosmetic Potential Reconstruction of mandible or maxilla | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21246 | Cosmetic Potential Reconstruction of mandible or maxilla | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21247 | Cosmetic Potential Reconstruction of mandibular condyle with bone | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21248 | Cosmetic Potential RECONSTR JAW,PART-ENDO IMPLNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21249 | Cosmetic Potential RECONSTR JAW,FULL,ENDO IMPLNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21255 | Cosmetic Potential Reconstruction of zygomatic arch and glenoid fossa | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21256 | Cosmetic Potential Reconstruction of orbit with osteotomies (extracranial) and with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21270 | Cosmetic Potential Malar augmentation, prosthetic material | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21275 | Cosmetic Potential Secondary revision of orbitocraniofacial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21295 | Cosmetic Potential REVISN JAW MUSCLE/BONE,EXTRAORAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21296 | Cosmetic Potential REVISN JAW MUSCLE/BONE,INTRAORAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21299 | Cosmetic Potential CRANIO/MAXILLOFACIAL SURG UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21499 | Cosmetic Potential HEAD SURGERY PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21685 | Surgical - ENT Hyoid myotomy and suspension | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21740 | Cosmetic Potential Reconstructive repair of pectus excavatum or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21742 | Cosmetic Potential Reconstructive repair of pectus excavatum or carinatum; minimally | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21743 | Cosmetic Potential Reconstructive repair of pectus excavatum or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 21899 | Investigational Potential NECK/CHEST PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 2211T | analysis, common variants (ie, HTR2A rs7997012 [c.614- >C] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22206 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 3 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22207 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 3 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22208 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 3 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22210 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 1 vertebral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22212 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 1 vertebral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22214 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 1 vertebral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22216 | Surgical - Spine Osteotomy of spine, posterior or posterolateral approach, 1 vertebral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22220 | Surgical - Spine Osteotomy of spine, including discectomy, anterior approach, single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22222 | Surgical - Spine Osteotomy of spine, including discectomy, anterior approach, single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22224 | Surgical - Spine Osteotomy of spine, including discectomy, anterior approach, single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22226 | Surgical - Spine Osteotomy of spine, including discectomy, anterior approach, single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22510 | Surgical - Spine Percutaneous vertebroplasty (bone biopsy included when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22511 | Surgical - Spine Percutaneous vertebroplasty (bone biopsy included when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22512 | Surgical - Spine Percutaneous vertebroplasty (bone biopsy included when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22513 | Surgical - Spine Percutaneous vertebral augmentation, including cavity creation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22514 | Surgical - Spine Percutaneous vertebral augmentation, including cavity creation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22515 | Surgical - Spine Percutaneous vertebral augmentation, including cavity creation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22526 | Surgical - Spine Percutaneous intradiscal electrothermal annuloplasty, unilateral or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22527 | Surgical - Spine Percutaneous intradiscal electrothermal annuloplasty, unilateral or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22532 | Surgical - Spine Arthrodesis, lateral extracavitary technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22533 | Surgical - Spine Arthrodesis, lateral extracavitary technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22534 | Surgical - Spine Arthrodesis, lateral extracavitary technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22548 | Surgical - Spine Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22551 | Surgical - Spine Arthrodesis, anterior interbody, including disc space preparation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22552 | Surgical - Spine Arthrodesis, anterior interbody, including disc space preparation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22554 | Surgical - Spine Arthrodesis, anterior interbody technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22556 | Surgical - Spine Arthrodesis, anterior interbody technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22558 | Surgical - Spine Arthrodesis, anterior interbody technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22585 | Surgical - Spine Arthrodesis, anterior interbody technique, including minimal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22586 | Surgical - Spine Arthrodesis, pre-sacral interbody technique, including disc space | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22590 | Surgical - Spine Arthrodesis, posterior technique, craniocervical (occiput-C2) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22595 | Surgical - Spine Arthrodesis, posterior technique, atlas-axis (C1-C2) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22600 | Surgical - Spine Arthrodesis, posterior or posterolateral technique, single level | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22610 | Surgical - Spine Arthrodesis, posterior or posterolateral technique, single level | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22612 | Surgical - Spine Arthrodesis, posterior or posterolateral technique, single level | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22614 | Surgical - Spine Arthrodesis, posterior or posterolateral technique, single level; each | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22630 | Surgical - Spine Arthrodesis, posterior interbody technique, including laminectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22632 | Surgical - Spine Arthrodesis, posterior interbody technique, including laminectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22633 | Surgical - Spine Arthrodesis, combined posterior or posterolateral technique with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22634 | Surgical - Spine Arthrodesis, combined posterior or posterolateral technique with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22800 | Surgical - Spine Arthrodesis, posterior, for spinal deformity, with or without cast; up to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22802 | Surgical - Spine Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22804 | Surgical - Spine Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22808 | Surgical - Spine Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22810 | Surgical - Spine Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22812 | Surgical - Spine Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22818 | Surgical - Spine Kyphectomy, circumferential exposure of spine and resection of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22819 | Surgical - Spine Kyphectomy, circumferential exposure of spine and resection of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22830 | Surgical - Spine Exploration of spinal fusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22840 | Surgical - Spine Posterior non-segmental instrumentation (eg, Harrington rod | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22841 | Surgical - Spine Internal spinal fixation by wiring of spinous processes (List | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22842 | Surgical - Spine Posterior segmental instrumentation (eg, pedicle fixation, dual rods | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22843 | Surgical - Spine Posterior segmental instrumentation (eg, pedicle fixation, dual rods | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22844 | Surgical - Spine Posterior segmental instrumentation (eg, pedicle fixation, dual rods | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22845 | Surgical - Spine Anterior instrumentation; 2 to 3 vertebral segments (List separately | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22846 | Surgical - Spine Anterior instrumentation; 4 to 7 vertebral segments (List separately | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22847 | Surgical - Spine Anterior instrumentation; 8 or more vertebral segments (List | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22848 | Surgical - Spine Pelvic fixation (attachment of caudal end of instrumentation to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22849 | Surgical - Spine Reinsertion of spinal fixation device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22850 | Surgical - Spine REMOVE SPINE FIX DEV,HARRINGTON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22852 | Surgical - Spine REMOVE SPINE FIX DEV,POST SGMTAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22853 | Surgical - Spine Insertion of interbody biomechanical device(s) (eg, synthetic cage | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22854 | Surgical - Spine Insertion of intervertebral biomechanical device(s) (eg, synthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22855 | Surgical - Spine REMOVE SPINE FIX DEV,ANTERIOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22856 | Surgical - Spine Total disc arthroplasty (artificial disc), anterior approach, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22857 | Surgical - Spine Total disc arthroplasty (artificial disc), anterior approach, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22858 | Surgical - Spine Total disc arthroplasty (artificial disc), anterior approach, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22859 | Surgical - Spine Insertion of intervertebral biomechanical device(s) (eg, synthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22861 | Surgical - Spine Revision including replacement of total disc arthroplasty (artificial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22862 | Surgical - Spine Revision including replacement of total disc arthroplasty (artificial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22864 | Surgical - Spine Removal of total disc arthroplasty (artificial disc), anterior | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22865 | Surgical - Spine Removal of total disc arthroplasty (artificial disc), anterior | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 22999 | Cosmetic Potential Unlisted procedure, abdomen, musculoskeletal system [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23105 | Surgical - Arthrotomy; glenohumeral joint, with synovectomy, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23107 | Surgical - Arthrotomy, glenohumeral joint, with joint exploration, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23120 | Surgical - Claviculectomy; partial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23130 | Surgical - Acromioplasty or acromionectomy, partial, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23410 | Surgical - Repair of ruptured musculotendinous cuff (eg, rotator cuff) open | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23412 | Surgical - Repair of ruptured musculotendinous cuff (eg, rotator cuff) open | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23415 | Surgical - Coracoacromial ligament release, with or without acromioplasty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23420 | Surgical - Reconstruction of complete shoulder (rotator) cuff avulsion, chronic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23430 | Surgical - Tenodesis of long tendon of biceps | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23440 | Surgical - Resection or transplantation of long tendon of biceps | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23450 | Surgical - Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23455 | Surgical - Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23460 | Surgical - Capsulorrhaphy, anterior, any type; with bone block | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23462 | Surgical - Capsulorrhaphy, anterior, any type; with coracoid process transfer | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23465 | Surgical - Capsulorrhaphy, glenohumeral joint, posterior, with or without bone | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23466 | Surgical - Capsulorrhaphy, glenohumeral joint, any type multi- directional | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23470 | Surgical - Arthroplasty, glenohumeral joint; hemiarthroplasty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23472 | Surgical - Arthroplasty, glenohumeral joint; total shoulder (glenoid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23473 | Surgical - Revision of total shoulder arthroplasty, including allograft when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23474 | Surgical - Revision of total shoulder arthroplasty, including allograft when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23700 | Surgical - Manipulation under anesthesia, shoulder joint, including application | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 23929 | Procedure - Misc. SHOULDER SURG PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24360 | Procedure - Misc. ARTHROPLASTY,ELBOW,W MEMBRANE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24361 | Procedure - Misc. ARTHROPLASTY,ELBOW,DIST HUMER PROSTH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24362 | Procedure - Misc. ARTHROPLASTY,ELBOW,IMPLNT/RECONSTRUC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24363 | Procedure - Misc. ARTHROPLASTY,ELBOW,TOTAL PROSTH REPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24370 | Procedure - Misc. REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24371 | Procedure - Misc. REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 24999 | Procedure - Misc. UPPER ARM/ELBOW SURGERY UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 25441 | Procedure - Misc. RECONSTRUCT DIST RADIUS W PROSTH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 25442 | Procedure - Misc. RECONSTRUCT DIST ULNA W PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 25443 | Procedure - Misc. RECONSTRUCT SCAPHOID CARPAL W PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 25999 | Procedure - Misc. FOREARM/WRIST SURGERY UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 26989 | Procedure - Misc. HAND/FINGER SURGERY UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27120 | Surgical - Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27122 | Surgical - Acetabuloplasty; resection, femoral head (eg, Girdlestone | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27125 | Surgical - Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27130 | Surgical - Arthroplasty, acetabular and proximal femoral prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27132 | Surgical - Conversion of previous hip surgery to total hip arthroplasty, with or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27134 | Surgical - Revision of total hip arthroplasty; both components, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27137 | Surgical - Revision of total hip arthroplasty; acetabular component only, with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27138 | Surgical - Revision of total hip arthroplasty; femoral component only, with or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27279 | Surgical - Arthrodesis, sacroiliac joint, percutaneous or minimally invasive | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27280 | Surgical - Spine Arthrodesis,open, sacroiliac joint including obtaining bone graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27299 | Surgical - PELVIS/HIP JOINT SURGERY UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27331 | Surgical - Arthrotomy, knee; including joint exploration, biopsy, or removal of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27332 | Surgical - Arthrotomy, with excision of semilunar cartilage (meniscectomy) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27333 | Surgical - Arthrotomy, with excision of semilunar cartilage (meniscectomy) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27334 | Surgical - Arthrotomy, with synovectomy, knee; anterior OR posterior | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27335 | Surgical - Arthrotomy, with synovectomy, knee; anterior AND posterior | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27403 | Surgical - Arthrotomy with meniscus repair, knee | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27405 | Surgical - Repair, primary, torn ligament and/or capsule, knee; collateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27407 | Surgical - Repair, primary, torn ligament and/or capsule, knee; cruciate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27409 | Surgical - Repair, primary, torn ligament and/or capsule, knee; collateral and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27412 | Surgical - Autologous chondrocyte implantation, knee | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27415 | Surgical - Osteochondral allograft, knee, open | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27416 | Surgical - Osteochondral autograft(s), knee, open (eg, mosaicplasty) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27425 | Surgical - Release of ligaments of knee joint, open procedure | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27427 | Surgical - Ligamentous reconstruction (augmentation), knee; extra-articular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27428 | Surgical - Ligamentous reconstruction (augmentation), knee; intra-articular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27429 | Surgical - Ligamentous reconstruction (augmentation), knee; intra-articular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27437 | Surgical - Arthroplasty, patella; without prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27438 | Surgical - Arthroplasty, patella; with prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27440 | Surgical - Arthroplasty, knee; tibial plateau | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27441 | Surgical - Arthroplasty, knee, tibial plateau; with debridement and partial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27442 | Surgical - Arthroplasty, femoral condyles or tibial plateau(s), knee | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27443 | Surgical - Arthroplasty, femoral condyles or tibial plateau(s), knee; with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27445 | Surgical - Arthroplasty, knee, hinge prosthesis (eg, Walldius type) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27446 | Surgical - Arthroplasty, knee, condyle and plateau; medial OR lateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27447 | Surgical - Arthroplasty, knee, condyle and plateau; medial AND lateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27486 | Surgical - Revision of total knee arthroplasty, with or without allograft; 1 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27487 | Surgical - Revision of total knee arthroplasty, with or without allograft; femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27488 | Surgical - Removal of prosthesis, including total knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27570 | Surgical - Manipulation of knee joint under general anesthesia (includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27580 | Surgical - FUSION OF KNEE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27599 | Investigational Unlisted procedure, femur or knee [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27702 | Surgical - Arthroplasty, Ankle; W/Implant (Total Ankle) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27703 | Surgical - Arthroplasty, Ankle; Revision, Total Ankle | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27704 | Surgical - Removal, Ankle Implant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27870 | Surgical - Arthrodesis, Ankle, Open | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 27899 | Surgical - LEG/ANKLE SURGERY PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 28899 | Investigational Unlisted procedure, foot or toes [when specified as cryoablation of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29799 | Surgical - CAST/STRAP PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29800 | Surgical - TMJ ARTHROSCOPY/DIAGNOSTIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29804 | Surgical - TMJ ARTHROSCOPY/SURGERY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29805 | Surgical - Arthroscopy, shoulder, diagnostic, with or without synovial biopsy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29806 | Surgical - Arthroscopy, shoulder, surgical; capsulorrhaphy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29807 | Surgical - Arthroscopy, shoulder, surgical; repair of SLAP lesion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29819 | Surgical - Arthroscopy, shoulder, surgical; with removal of loose body or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29820 | Surgical - Arthroscopy, shoulder, surgical; synovectomy, partial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29821 | Surgical - Arthroscopy, shoulder, surgical; synovectomy, complete | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29822 | Surgical - Arthroscopy, shoulder, surgical; debridement, limited | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29823 | Surgical - Arthroscopy, shoulder, surgical; debridement, extensive | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29824 | Surgical - Arthroscopy, shoulder, surgical; distal claviculectomy including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29825 | Surgical - Arthroscopy, shoulder, surgical; with lysis and resection of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29826 | Surgical - Arthroscopy, shoulder, surgical; decompression of subacromial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29827 | Surgical - Arthroscopy, shoulder, surgical; with rotator cuff repair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29828 | Surgical - Arthroscopy, shoulder, surgical; biceps tenodesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29843 | Surgical - WRIST ARTHROSCOP,CLEAN/DRAIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29845 | Surgical - WRIST ARTHROSCOP,FULL SYNOVECT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29860 | Surgical - Arthroscopy, hip, diagnostic with or without synovial biopsy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29861 | Surgical - Arthroscopy, hip, surgical; with removal of loose body or foreign | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29862 | Surgical - Arthroscopy, hip, surgical; with debridement/shaving of articular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29863 | Surgical - Arthroscopy, hip, surgical; with synovectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29866 | Surgical - Arthroscopy, knee, surgical; osteochondral autograft(s) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29867 | Surgical - Arthroscopy, knee, surgical; osteochondral allograft (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29868 | Surgical - Arthroscopy, knee, surgical; meniscal transplantation (includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29870 | Surgical - Arthroscopy, knee, diagnostic, with or without synovial biopsy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29871 | Surgical - Arthroscopy, knee, surgical; for infection, lavage and drainage | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29873 | Surgical - Arthroscopy, knee, surgical; with lateral release | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29874 | Surgical - Arthroscopy, knee, surgical; for removal of loose body or foreign | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29875 | Surgical - Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29876 | Surgical - Arthroscopy, knee, surgical; synovectomy, major, 2 or more | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29877 | Surgical - Arthroscopy, knee, surgical; debridement/shaving of articular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29879 | Surgical - Arthroscopy, knee, surgical; abrasion arthroplasty (includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29880 | Surgical - Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29881 | Surgical - KNEE SCOPE,MED/LAT MENISECTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29882 | Surgical - Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29883 | Surgical - Arthroscopy, knee, surgical; with meniscus repair (medial AND | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29884 | Surgical - Arthroscopy, knee, surgical; with lysis of adhesions, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29885 | Surgical - Arthroscopy, knee, surgical; drilling for osteochondritis dissecans | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29886 | Surgical - Arthroscopy, knee, surgical; drilling for intact osteochondritis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29887 | Surgical - Arthroscopy, knee, surgical; drilling for intact osteochondritis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29888 | Surgical - KNEE SCOPE,AID ANT CRUCIATE REPAIR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29889 | Surgical - Arthroscopically aided posterior cruciate ligament | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29892 | Surgical - Arthroscopically aided repair of large osteochondritis disssecans | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29893 | Surgical - ANKLE SCOPE,PLANTAR FASCIOTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29894 | Surgical - ANKLE SCOPE,REMVL LOOSE BODY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29897 | Surgical - ANKLE SCOPE,PART DEBRIDEMENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29898 | Surgical - ANKLE SCOPE,EXTENS DEBRIDEMNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29899 | Surgical - ANKLE SCOPE,W/ANKLE ARTHRODESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29904 | Surgical - ARTHROSCOPY SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29905 | Surgical - ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29914 | Surgical - Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29915 | Surgical - Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29916 | Surgical - Arthroscopy, hip, surgical; with labral repair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 29999 | Investigational Unlisted procedure, arthroscopy [when specified as thermal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 3008C | HTR2C rs3813929 [c.- 759C>T] and rs1414334 [c.551- >G]) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30117 | Investigational Excision or destruction (eg, laser), intranasal lesion, internal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30460 | Cosmetic Potential REVIS NOSE/CLEFT LIP/TIP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30462 | Cosmetic Potential REVIS NOSE/CLEFT LIP/TIP,SEPTUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30465 | Cosmetic Potential REPAIR NASAL CAVITY STENOSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30468 | Investigational Repair of nasal valve collapse with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30469 | Investigational Repair of nasal valve collapse with low energy, temperature | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30520 | Cosmetic Potential Septoplasty or submucous resection, with or without cartilage | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30620 | Cosmetic Potential Septal or other intranasal dermatoplasty (does not | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30801 | Surgical - ENT CAUTER TURBINATE MUCOSA,SUPERFICIAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30802 | Surgical - ENT CAUTER TURBINATE MUCOSA,INTRAMURAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 30999 | Investigational Unlisted procedure, nose [when specified as rhinophototherapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31267 | Surgical - ENT NASAL SCOPY,RMV TISS MAXILL SINUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31276 | Surgical - ENT NASAL SCOPY,EXPLOR FRONTAL SINUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31287 | Surgical - ENT NASAL SCOPY,SPHENOIDOTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31288 | Surgical - ENT NASAL SCOPY,REMV TISS SPHENOID | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31295 | Surgical - ENT NASAL/SINUS ENDOSCOPY,W/DILAT MAXILLARY SINUS OSTIUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31296 | Surgical - ENT NASAL/SINUS ENDOSCOPY,W/DILAT FRONTAL SINUS OSTIUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31297 | Surgical - ENT NASAL/SINUS ENDOSCOPY,W/DILAT SPHENOID SINUS OSTIUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31298 | Surgical - ENT NASAL/SINUS ENDOSCOPY W/FRONTAL & SPHENOID SINUS DILATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31299 | Surgical - ENT Unlisted procedure, accessory sinuses [when specified as insertion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31599 | Cosmetic Potential Unlisted procedure, Larynx | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31643 | Radiation Bronchoscopy, rigid or flexible, including fluoroscopic guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31660 | Investigational Bronchoscopy, rigid or flexible, including fluoroscopic guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31661 | Investigational Bronchoscopy, rigid or flexible, including fluoroscopic guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 31899 | Surgical - ENT AIRWAYS SURGICAL PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32553 | Radiation Placement of interstitial device(s) for radiation therapy guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32701 | Radiation Thoracic target(s) delineation for stereotactic body radiation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32851 | Transplant Lung transplant, single; without cardiopulmonary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32852 | Transplant Lung transplant, single; with cardiopulmonary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32853 | Transplant Lung transplant, double (bilateral sequential or en | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32854 | Transplant Lung transplant, double (bilateral sequential or en | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32994 | Procedure - Oncology Ablation therapy for reduction or eradication of 1 or more pulmonary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32998 | Procedure - Oncology Ablation therapy for reduction or eradication of 1 or more pulmonary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 32999 | Surgical - Cardiac CHEST SURGERY PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33267 | Investigational Exclusion of left atrial appendage, open, any method (eg, excision | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33268 | Investigational Exclusion of left atrial appendage, open, performed at the time of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33269 | Investigational Exclusion of left atrial appendage, thoracoscopic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33274 | Investigational Transcatheter insertion or replacement of permanent leadless | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33275 | Investigational Transcatheter removal of permanent leadless pacemaker, right | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33289 | Investigational Transcatheter implantation of wireless pulmonary artery pressure | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33340 | Investigational Percutaneous transcatheter closure of the left atrial appendage | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33361 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33362 | Surgical - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33363 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33364 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33365 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33366 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33367 | Surgical - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33368 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33369 | Procedure - Cardiac Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33405 | Surgical - Cardiac REPLACE AORT VALV,PROSTH VALV | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33406 | Surgical - Cardiac REPLACE AORT VALVE W/ALLOGRAFT VALVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33419 | Surgical - Cardiac Transcatheter mitral valve repair, percutaneous approach, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33548 | Investigational Surgical ventricular restoration procedure, includes prosthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33927 | Procedure - Cardiac Implantation of a total replacement heart system (artificial heart) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33928 | Procedure - Cardiac Removal and replacement of total replacement heart system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33929 | Procedure - Cardiac Removal of a total replacement heart system (artificial heart) for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33935 | Transplant Heart-lung transplant with recipient cardiectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33945 | Transplant Heart transplant, with or without recipient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33975 | Procedure - Cardiac Insertion of ventricular assist device; extracorporeal, single ventricle | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33976 | Procedure - Cardiac Insertion of ventricular assist device; extracorporeal, biventricular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33979 | Procedure - Cardiac Insertion of ventricular assist device; implantable intracorporeal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33981 | Procedure - Cardiac Replacement of extracorporeal ventricular assist device, single or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33982 | Procedure - Cardiac Replacement of ventricular assist device pump(s); implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33983 | Procedure - Cardiac Replacement of ventricular assist device pump(s); implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 33999 | Procedure - Cardiac Unlisted procedure, cardiac surgery [when specified as Batista | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36260 | Implantable Infusion Insertion of implantable intra-arterial infusion pump (eg, for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36261 | Implantable Infusion Revision of implanted intra-arterial infusion pump | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36299 | Procedure - Vascular VESSEL INJECTION PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36465 | Procedure - Vascular Injection of non-compounded foam sclerosant with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36466 | Procedure - Vascular Injection of non-compounded foam sclerosant with ultrasound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36468 | Cosmetic Potential Injection(s) of sclerosant for spider veins (telangiectasia); limb or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36470 | Procedure - Vascular Injection of sclerosing solution; single incompetant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36471 | Procedure - Vascular Injection of sclerosing solution; multiple incompetant veins, same | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36475 | Procedure - Vascular Endovenous ablation therapy of incompetent vein, extremity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36476 | Procedure - Vascular Endovenous ablation therapy of incompetent vein, extremity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36478 | Procedure - Vascular Endovenous ablation therapy of incompetent vein, extremity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36479 | Procedure - Vascular Endovenous ablation therapy of incompetent vein, extremity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36482 | Procedure - Vascular Endovenous ablation therapy of incompetent vein, extremity, by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36483 | Procedure - Vascular Endovenous ablation therapy of incompetent vein, extremity, by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36522 | Transplant PHOTOPHERESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36563 | Implantable Infusion Insertion of tunneled centrally inserted central | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 36583 | Implantable Infusion Replacement, complete, of a tunneled centrally | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37201 | Radiation Thoracic target(s) delineation for stereotactic body radiation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37224 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37225 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37226 | Procedure - Cardiac Revascularization, endovascular, open or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37227 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37228 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, tibial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37229 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, tibial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37230 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, tibial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37231 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, tibial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37232 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37233 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37234 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37235 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37238 | Procedure - Cardiac Transcatheter placement of an intravascular stent(s), open or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37239 | Procedure - Cardiac Transcatheter placement of an intravascular stent(s), open or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37241 | Procedure - Cardiac Vascular embolization or occlusion, inclusive of all radiological | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37242 | Bariatric Surgery Vascular embolization or occlusion, inclusive of all radiological | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37243 | Investigational Vascular embolization or occlusion, inclusive of all radiological | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37246 | Procedure - Cardiac Transluminal balloon angioplasty (exept lower extremity artery(ies) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37248 | Procedure - Cardiac Transluminal balloon angioplasty (except dialysis circuit), open or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37249 | Procedure - Cardiac Transluminal balloon angioplasty (except dialysis circuit), open or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37501 | Procedure - Cardiac UNLISTED VASCULAR ENDOSCOPY PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37700 | Procedure - Vascular LIGATN LONG SAPHENOUS VEIN AT SEPH-FEM JUNC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37718 | Procedure - Vascular LIGATE/STRIP SHORT SAPEHNOUS VEIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37722 | Procedure - Vascular LIGATE/STRIP LONG SAPH VEIN BELW SEP-FEM JUNC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37735 | Procedure - Vascular REMOVAL OF LEG VEINS/ULCER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37760 | Procedure - Vascular LIGATN PERFORATORS,SUBFASC,RADICAL,OPEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37761 | Procedure - Vascular LIGATN PERFORATORS,SUBFASC,OPEN, INCL U/S, 1 LEG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37765 | Procedure - Vascular PHLEB VEINS - EXTREM - TO 20 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37766 | Procedure - Vascular PHLEB VEINS - EXTREM 20+ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37780 | Procedure - Vascular LIGATN SHORT SAPHEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37785 | Procedure - Vascular REVISE SECONDARY VARICOSITY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 37799 | Procedure - Cardiac Unlisted procedure, vascular surgery [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38129 | Transplant LAP PROC,SPLEEN,UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38205 | Transplant Blood-derived hematopoietic progenitor cell harvesting for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38206 | Transplant Blood-derived hematopoietic progenitor cell harvesting for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38207 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38208 | Transplant Transplant preparation of hematopoietic progenitor cells; thawing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38209 | Transplant Transplant preparation of hematopoietic progenitor cells; thawing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38210 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38211 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38212 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38213 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38214 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38215 | Transplant Transplant preparation of hematopoietic progenitor cells | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38230 | Transplant Bone marrow harvesting for transplantation; allogeneic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38232 | Transplant Bone marrow harvesting for transplantation; autologous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38240 | Transplant Bone marrow or blood-derived peripheral stem cell transplantation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38241 | Transplant Hematopoietic progenitor cell (HPC); autologous transplantation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38242 | Transplant Allogeneic lymphocyte infusions | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38243 | Transplant Hematopoietic progenitor cell (HPC); HPC boost | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38589 | Transplant LAP,LYMPHATIC SYSTEM,OTHER PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 38999 | Transplant Unlisted procedure, hemic or lymphatic system [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 39599 | Surgical - Misc. DIAPHRAGM SURG PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 40799 | Surgical - Misc. LIP SURGERY PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 40899 | Surgical - Misc. MOUTH SURGERY PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 41019 | Radiation Placement of needles, catheters, or other device(s) into the head | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 41512 | Surgical - ENT Tongue base suspension, permanent suture | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 41530 | Surgical - ENT Submucosal ablation of the tongue base | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 41599 | Surgical - ENT TONGUE AND MOUTH SURG UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 4165F | Radiation 3-dimensional conformal radiotherapy (3D-CRT) or intensity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 41899 | Surgical - ENT DENTAL SURGERY PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42140 | Surgical - ENT EXCISION OF UVULA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42145 | Surgical - ENT Palatopharyngoplasty (eg, uvulopalatopharyngoplasty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42160 | Surgical - ENT DESTRUC LESN PALATE/UVULA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42225 | Surgical - ENT RECONSTRUCT CLEFT PALATE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42299 | Surgical - ENT Unlisted procedure, palate, uvula [when specified as any of the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42699 | Surgical - ENT SALIVARY SURG UNLISTED PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42892 | Surgical - GI REVISION OF PHARYNGEAL WALLS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42894 | Surgical - GI REVISION OF PHARYNGEAL WALLS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 42999 | Surgical - GI THROAT SURGERY PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43107 | Surgical - GI REMOVAL OF ESOPHAGUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43112 | Surgical - GI REMOVAL OF ESOPHAGUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43117 | Surgical - GI PARTIAL REMOVAL OF ESOPHAGUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43192 | Endoscopy Esophagoscopy, rigid, transoral; with directed submucosal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43201 | Endoscopy Esophagoscopy, rigid or flexible; with directed submucosal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43210 | Endoscopy Esophagogastroduodenoscopy, flexible, transoral; with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43214 | Surgical - GI ESOPHAGOSC DILATE BALLOON 30 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43229 | Endoscopy Esophagoscopy, flexible, transoral; with ablation of tumor(s) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43233 | Endoscopy Esophagogastroduodenoscopy, flexible transoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43253 | Endoscopy EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43279 | Surgical - GI LAP, ESOPHAGOMYOTOMY W FUNDOPLASTY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43289 | Surgical - GI LAP,ESOPHAGUS,OTHER PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43291 | Bariatric Surgery Esophagogastroduodenoscopy, flexible, transoral; with removal of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43499 | Endoscopy Unlisted procedure, esophagus [when specified as endoscopic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43620 | Bariatric Surgery Gastrectomy, total; with esophagoenterostomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43621 | Surgical - GI REMOVAL OF STOMACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43622 | Bariatric Surgery Gastrectomy, total; with formation of intestinal pouch, any type | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43631 | Bariatric Surgery Gastrectomy, partial, distal; with gastroduodenostomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43632 | Bariatric Surgery Gastrectomy, partial, distal; with gastrojejunostomy (Billroth II) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43633 | Bariatric Surgery Gastrectomy, partial, distal; with Roux-en-Y reconstruction [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43634 | Surgical - GI REMOVAL OF STOMACH, PARTIAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43644 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; with gastric | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43645 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; with gastric | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43659 | Bariatric Surgery Unlisted laparoscopy procedure, stomach [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43770 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; placement of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43771 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; revision of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43772 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; removal of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43773 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; removal and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43774 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; removal of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43775 | Bariatric Surgery Laparoscopy, surgical, gastric restrictive procedure; longitudinal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43842 | Bariatric Surgery Gastric restrictive procedure, without gastric bypass, for morbid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43843 | Bariatric Surgery Gastric restrictive procedure, without gastric bypass, for morbid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43845 | Bariatric Surgery Gastric restrictive procedure with partial gastrectomy, pylorus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43846 | Bariatric Surgery Gastric restrictive procedure, with gastric bypass for morbid obesity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43847 | Bariatric Surgery Gastric restrictive procedure, with gastric bypass for morbid obesity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43848 | Bariatric Surgery Revision, open, of gastric restrictive procedure for morbid obesity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43860 | Bariatric Surgery REVISE,GASTROJEJUN ANAST,W/O VAGOTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43865 | Bariatric Surgery REVISE GASTROJEJUN ANAST,W VAGOTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43886 | Bariatric Surgery Gastric restrictive procedure, open; revision of subcutaneous port | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43887 | Bariatric Surgery Gastric restrictive procedure, open; removal of subcutaneous port | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43888 | Bariatric Surgery Gastric restrictive procedure, open; removal and replacement of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 43999 | Bariatric Surgery Unlisted procedure, stomach [when specified as transendoscopic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44127 | Surgical - GI ENTERECTOMY W/TAPER, CONG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44135 | Transplant Intestinal allotransplantation; from cadaver donor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44136 | Transplant Intestinal allotransplantation; from living donor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44147 | Surgical - GI PARTIAL REMOVAL OF COLON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44155 | Surgical - GI REMOVAL OF COLON/ILEOSTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44208 | Surgical - GI L COLECTOMY/COLOPROCTOSTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44211 | Surgical - GI LAP COLECTOMY W/PROCTECTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44238 | Bariatric Surgery Unlisted laparoscopy procedure, intestine (except rectum) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44799 | Surgical - GI INTESTINE SURG PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44899 | Surgical - GI UNLISTED PROC,MECKEL/MESENTERY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 44979 | Surgical - GI LAP,APPENDIX UNLISTED PROCED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 45399 | Surgical - GI UNLISTED PROCEDURE COLON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 45499 | Surgical - GI UNLISTED LAP PROCEDURE, RECTUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 45999 | Surgical - GI RECTUM SURGERY PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 46601 | Investigational Anoscopy; diagnostic, with high-resolution magnification (HRA) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 46607 | Investigational Anoscopy; with high-resolution magnification (HRA) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 46730 | Surgical - GI CONSTRUCTION OF ABSENT ANUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 46740 | Surgical - GI CONSTRUCTION OF ABSENT ANUS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 46948 | Investigational Hemorrhoidectomy, internal, by transanal hemorrhoidal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 46999 | Cosmetic Potential Unlisted procedure, anus [when specified as perianal injection of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 47133 | Transplant Donor hepatectomy, (including cold preservation) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 47135 | Transplant Liver allotransplantation; orthotopic, partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 47379 | Surgical - GI UNLISTED LAPAROSCOPIC PROC, LIVER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 47399 | Procedure - Oncology Unlisted procedure, liver | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 47999 | Surgical - GI BILE TRACT SURG PROC, UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48150 | Surgical - GI PARTIAL REMOVAL OF PANCREAS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48153 | Surgical - GI PANCREATECTOMY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48160 | Transplant Pancreatectomy, total or subtotal, with autologous transplantation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48548 | Surgical - GI FUSE PANCREAS AND BOWEL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48554 | Transplant Transplantation of pancreatic allograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48556 | Transplant Removal of transplanted pancreatic allograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 48999 | Transplant Unlisted procedure, pancreas [when specified as cryosurgical or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 49329 | Surgical - GI LAP,ABD/PERIT/OMENTUM,UNLIST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 49411 | Radiation Placement of interstitial device(s) for radiation therapy guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 49412 | Radiation Placement of interstitial device(s) for radiation therapy guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 49659 | Surgical - GI LAP,HERNIA REPAIR PROC,UNLIST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 49906 | Investigational Free omental flap with microvascular anastomosis [when specified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 49999 | Surgical - GI ABDOMEN SURGERY PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50323 | Transplant Backbench standard preparation of cadaver donor renal allograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50325 | Transplant Backbench standard preparation of living donor renal allograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50327 | Transplant Backbench reconstruction of cadaver or living donor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50328 | Transplant Backbench reconstruction of cadaver or living donor renal allograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50329 | Transplant Backbench reconstruction of cadaver or living donor renal allograft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50340 | Transplant Recipient nephrectomy (separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50360 | Transplant Renal allotransplantation, implantation of graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50365 | Transplant Renal allotransplantation, implantation of graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50380 | Surgical - Genitourinary REIMPLANTATION OF KIDNEY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50547 | Transplant Laparoscopy, surgical; donor nephrectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50770 | Surgical - Genitourinary SPLICING OF URETERS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50860 | Surgical - Genitourinary TRANSPLANT URETER TO SKIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 50949 | Surgical - Genitourinary UNLISTED LAPAROSCOPY PROC, URETER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 51595 | Surgical - Genitourinary REMOVE BLADDER/REVISE TRACT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 51999 | Surgical - Genitourinary LAP PROCEDURE, UNLISTED, BLADDER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 52441 | Surgical - Genitourinary CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 53410 | Cosmetic Potential Urethroplasty, 1-stage reconstruction of male anterior urethra | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 53430 | Cosmetic Potential Urethroplasty, reconstruction of female urethra | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 53852 | Surgical - Genitourinary PROSTATIC RF THERMOTX | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 53899 | Procedure - Oncology Unlisted procedure, urinary system [when specified as transurethral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54125 | Cosmetic Potential Amputation of penis; complete | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54352 | Surgical - Genitourinary RECONSTRUCT URETHRA/PENIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54400 | Cosmetic Potential Insertion of penile prosthesis; non-inflatable (semi- rigid) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54401 | Cosmetic Potential Insertion of penile prosthesis; inflatable (self- contained) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54405 | Cosmetic Potential Insertion of multi-component, inflatable penile prosthesis, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54440 | Cosmetic Potential Plastic operation of penis for injury | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54520 | Cosmetic Potential Orchiectomy, simple (including subcapsular), with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54660 | Cosmetic Potential Insertion of testicular prosthesis (separate procedure) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54690 | Cosmetic Potential Laparoscopy, surgical; orchiectomy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54699 | Cosmetic Potential LAP,TESTIS PROCEDURE,UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 54900 | Infertility FUSION OF SPERMATIC DUCTS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55150 | Cosmetic Potential REMOVAL OF SCROTUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55175 | Cosmetic Potential REVISION OF SCROTUM,SIMPLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55180 | Cosmetic Potential Scrotoplasty; complicated | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55530 | Cosmetic Potential EXCISE VARICOCELE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55535 | Cosmetic Potential EXCISE VARICOCELE,ABD APPROACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55550 | Cosmetic Potential LAP,LIGATION SPERMATIC VEINS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55559 | Cosmetic Potential LAP,SPERMATIC CORD PROC,UNLIST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55706 | Investigational Biopsies, prostate, needle, transperineal, stereotactic template | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55845 | Surgical - Genitourinary EXTENSIVE PROSTATE SURGERY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55860 | Radiation Exposure of prostate, any approach, for insertion of radioactive | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55862 | Radiation Exposure of prostate, any approach, for insertion of radioactive | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55865 | Radiation Exposure of prostate, any approach, for insertion of radioactive | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55875 | Radiation Transperineal placement of needles or catheters into prostate for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55899 | Cosmetic Potential Unlisted procedure, male genital system [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55920 | Radiation Placement of needles or catheters into pelvic organs | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55970 | Cosmetic Potential SEX TRANSFORMATION, M TO F | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 55980 | Cosmetic Potential SEX TRANSFORMATION, F TO M | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 56625 | Cosmetic Potential Vulvectomy simple; complete | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 56800 | Cosmetic Potential Plastic repair of introitus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 56805 | Cosmetic Potential Clitoroplasty for intersex state | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 56810 | Cosmetic Potential Perineoplasty, repair of perineum, nonobstetrical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57110 | Cosmetic Potential Vaginectomy, complete removal of vaginal wall | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57155 | Radiation Insertion of uterine tandem and/or vaginal ovoids for clinical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57156 | Radiation Insertion of a vaginal radiation afterloading apparatus for clinical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57291 | Cosmetic Potential Construction of artificial vagina; without graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57292 | Cosmetic Potential Construction of artificial vagina; with graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57295 | Cosmetic Potential Revision (including removal) of prosthetic vaginal graft; vaginal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57296 | Cosmetic Potential Revision (including removal) of prosthetic vaginal graft; open | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57335 | Cosmetic Potential Vaginoplasty for intersex state | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 57426 | Cosmetic Potential Revision (including removal) of prosthetic vaginal graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58150 | Cosmetic Potential Total abdominal hysterectomy (corpus and cervix), with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58321 | Infertility Artificial insemination; intra-cervical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58322 | Infertility Artificial insemination; intra-uterine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58323 | Infertility Sperm washing for artificial insemination | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58346 | Radiation Insertion of Heyman capsules for clinical brachytherapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58570 | Cosmetic Potential Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58571 | Cosmetic Potential Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58572 | Cosmetic Potential Laparoscopy, surgical, with total hysterectomy, for uterus greater | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58573 | Cosmetic Potential Laparoscopy, surgical, with total hysterectomy, for uterus greater | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58578 | Surgical - Pelvic Unlisted laparoscopy procedure, uterus [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58579 | Surgical - Pelvic HYSTEROSCOPY,UTERUS,UNL PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58679 | Surgical - Pelvic LAP,OVIDUCT/OVARY,UNLIST PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58760 | Surgical - Pelvic FIMBRIOPLASTY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58770 | Surgical - Pelvic CREATE NEW TUBAL OPENING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 58999 | Transplant Unlisted procedure, female genital system (nonobstetrical) [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 59840 | Surgical - Pelvic INDUCED ABORTN BY D&C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 59897 | Surgical - Fetal Unlisted fetal invasive procedure, including ultrasound guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 59898 | Surgical - Fetal LAP,OB CARE/DELIV,UNLIST PROC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 59899 | Surgical - Fetal MATERNITY CARE PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 60659 | Surgical- Oncology LAP,ENDOCRINE SYSTEM,UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 60699 | Surgical- Oncology Unlisted procedure, endocrine system [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61215 | Implantable Infusion Insertion of subcutaneous reservoir, pump or continuous infusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61630 | Procedure - Cardiac Balloon angioplasty, intracranial (eg, atherosclerotic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61796 | Radiation Stereotactic radiosurgery (particle beam, gamma ray, or linear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61797 | Radiation Stereotactic radiosurgery (particle beam, gamma ray, or linear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61798 | Radiation Stereotactic radiosurgery (particle beam, gamma ray, or linear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61799 | Radiation Stereotactic radiosurgery (particle beam, gamma ray, or linear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61800 | Radiation Application of stereotactic headframe for stereotactic radiosurgery | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61885 | Neurostimulator Insertion or replacement of cranial neurostimulator pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 61886 | Neurostimulator Insertion or replacement of cranial neurostimulator pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62263 | Surgical - Spine Percutaneous lysis of epidural adhesions using solution injection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62264 | Investigational Percutaneous lysis of epidural adhesions using solution injection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62281 | Surgical - Spine Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62282 | Surgical - Spine Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62320 | Pain Management Injection(s), of diagnostic or therapeutic substance(s) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62350 | Implantable Infusion Implantation, revision or repositioning of tunneled intrathecal or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62351 | Implantable Infusion Implantation, revision or repositioning of tunneled intrathecal or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62360 | Implantable Infusion Implantation or replacement of device for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62361 | Implantable Infusion Implantation or replacement of device for intrathecal or epidural | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62362 | Implantable Infusion Implantation or replacement of device for intrathecal or epidural | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 62365 | Implantable Infusion REMOVE INFUSN DEVICE/PUMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63001 | Surgical - Spine Laminectomy with exploration and/or decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63003 | Surgical - Spine Laminectomy with exploration and/or decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63005 | Surgical - Spine Laminectomy with exploration and/or decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63012 | Surgical - Spine Laminectomy with removal of abnormal facets and/or pars inter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63015 | Surgical - Spine Laminectomy with exploration and/or decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63016 | Surgical - Spine Laminectomy with exploration and/or decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63017 | Surgical - Spine Laminectomy with exploration and/or decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63020 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63030 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63035 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63040 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63042 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63043 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63044 | Surgical - Spine Laminotomy (hemilaminectomy), with decompression of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63045 | Surgical - Spine Laminectomy, facetectomy and foraminotomy (unilateral or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63046 | Surgical - Spine Laminectomy, facetectomy and foraminotomy (unilateral or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63047 | Surgical - Spine Laminectomy, facetectomy and foraminotomy (unilateral or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63048 | Surgical - Spine Laminectomy, facetectomy and foraminotomy (unilateral or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63050 | Surgical - Spine Laminoplasty, cervical, with decompression of the spinal cord, 2 or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63051 | Surgical - Spine Laminoplasty, cervical, with decompression of the spinal cord, 2 or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63052 | Surgical - Spine Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63053 | Surgical - Spine Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63055 | Surgical - Spine Transpedicular approach with decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63056 | Surgical - Spine Transpedicular approach with decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63057 | Surgical - Spine Transpedicular approach with decompression of spinal cord | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63064 | Surgical - Spine COSTOVERT DECOMPRESS THORACIC CORD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63066 | Surgical - Spine COSTOVERT DECOMP THOR CORD,EACH ADDN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63075 | Surgical - Spine Discectomy, anterior, with decompression of spinal cord and/or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63076 | Surgical - Spine Discectomy, anterior, with decompression of spinal cord and/or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63077 | Surgical - Spine DISK SURG,THORAX,SINGLE LEVEL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63078 | Surgical - Spine DISK SURG,THORAX,EA ADDNL LEVEL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63081 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63082 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63085 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63086 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63087 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63088 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63090 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63091 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63101 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63102 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63103 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63170 | Surgical - Spine INCISE SPINAL CORD TRACT(S) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63180 | Surgical - Spine Laminectomy and section of dentate ligaments, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63182 | Surgical - Spine Laminectomy and section of dentate ligaments, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63185 | Surgical - Spine Laminectomy with rhizotomy; more than 2 segments | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63190 | Surgical - Spine Laminectomy, with release of tethered spinal cord, lumbar | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63191 | Surgical - Spine Laminectomy with section of spinal accessory nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63194 | Surgical - Spine Laminectomy with cordotomy, with section of 1 spinothalamic tract, 1 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63196 | Surgical - Spine Laminectomy with cordotomy, with section of both spinothalamic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63197 | Surgical - Spine INCIS BOTH SPINOTHAL,THOR,1 STAGE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63198 | Surgical - Spine Laminectomy with cordotomy with section of both spinothalamic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63200 | Surgical - Spine Laminectomy for excision or occlusion of arteriovenous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63250 | Surgical - Spine Laminectomy for excision or occlusion of arteriovenous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63251 | Surgical - Spine EXCIS/OCCLUD CORD AVM,THORACIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63252 | Surgical - Spine Laminectomy for excision or evacuation of intraspinal lesion other | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63265 | Surgical - Spine Laminectomy for excision or evacuation of intraspinal lesion other | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63267 | Surgical - Spine Laminectomy for excision of intraspinal lesion other than neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63270 | Surgical - Spine Laminectomy for excision of intraspinal lesion other than neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63272 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63275 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63277 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63280 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63282 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63285 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63287 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63290 | Surgical - Spine Laminectomy for biopsy/excision of intraspinal neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63300 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63301 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63302 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63303 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63304 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63305 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63306 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63307 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63308 | Surgical - Spine Vertebral corpectomy (vertebral body resection), partial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63620 | Radiation Stereotactic radiosurgery (particle beam, gamma ray, or linear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63621 | Radiation Stereotactic radiosurgery (particle beam, gamma ray, or linear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63650 | Pain Management Percutaneous implantation of neurostimulator electrode array | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63655 | Pain Management Laminectomy for implantation of neurostimulator electrodes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63663 | Pain Management Revision including replacement, when performed, of spinal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63664 | Pain Management Revision including replacement, when performed, of spinal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63685 | Pain Management Insertion or replacement of spinal neurostimulator pulse generator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 63688 | Pain Management Revision or removal of implanted spinal neurostimulator pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64553 | Neurostimulator Percutaneous implantation of neurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64555 | Neurostimulator Percutaneous implantation of neurostimulator electrodes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64561 | Neurostimulator Percutaneous implantation of neurostimulator electrodes; sacral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64566 | Neurostimulator Posterior tibial neurostimulation, percutaneous needle electrode | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64568 | Neurostimulator Open implantation of cranial nerve (eg, vagus nerve) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64569 | Neurostimulator Revision or replacement of cranial nerve (eg, vagus nerve) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64575 | Neurostimulator Open implantation of neurostimulator electrodes; peripheral nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64581 | Neurostimulator Open implantation of neurostimulator electrode array; sacral nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64582 | Surgical - ENT Open implantation of hypoglossal nerve neurostimulator array | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64583 | Surgical - ENT REVSN/RPLCMT HPGLSL NERVE NSTIM RA PG AND RESPIR SNR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64584 | Surgical - ENT REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG AND RESPIR SNR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64585 | Procedure - Misc. Revision or removal of peripheral neurostimulator electrode array | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64590 | Neurostimulator Insertion or replacement of peripheral or gastric neurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64595 | Neurostimulator REVISE/REMOVE PERIPH/GASTRIC NEUROSTIM/RECEIVER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64624 | Investigational Destruction by neurolytic agent, genicular nerve branches including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64650 | Investigational CHEMODENERV ECCRINE GLANDS BOTH AXILLAE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64653 | Investigational CHEMODENERV ECCRINE GLANDS, NON-AXILLARY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64716 | Cosmetic Potential Neuroplasty and/or transposition; cranial nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64722 | Surgical - Misc. Decompression; unspecified nerve(s) [for example | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64732 | Cosmetic Potential Transection or avulsion of; supraorbital nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64734 | Cosmetic Potential Transection or avulsion of; infraorbital nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64736 | Cosmetic Potential Transection or avulsion of; mental nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64738 | Cosmetic Potential Transection or avulsion of; inferior alveolar nerve by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64740 | Cosmetic Potential Transection or avulsion of; lingual nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64742 | Cosmetic Potential Transection or avulsion of; facial nerve, differential | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64864 | Cosmetic Potential Suture of facial nerve; extracranial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64865 | Cosmetic Potential Suture of facial nerve; infratemporal, with or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64866 | Cosmetic Potential Anastomosis; facial-spinal accessory | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64868 | Cosmetic Potential Anastomosis; facial-hypoglossal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 64999 | Surgical - Misc. Unlisted procedure, nervous system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 65755 | Transplant CORNEAL TRANSPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 65778 | Bioengineered Wound Placement of amniotic membrane on the ocular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 65779 | Bioengineered Wound Placement of amniotic membrane on the ocular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 65780 | Bioengineered Wound Ocular surface reconstruction; amniotic membrane | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 66999 | Investigational Unlisted procedure, anterior segment of eye [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67027 | Investigational Implantation of intravitreal drug delivery system (eg, ganciclovir | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67028 | Investigational Intravitreal injection of a pharmacologic agent (separate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67218 | Radiation Destruction of localized lesion of retina (eg, macular edema | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67220 | Investigational Destruction of localized lesion of choroid (eg, choroidal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67299 | Investigational Unlisted procedure, posterior segment [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67399 | Surgical - ENT EYE MUSCLE SURGERY PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67516 | Surgical - ENT SUPRACHOROIDAL SPACE INJ PHARMACOLOGIC AGENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67599 | Surgical - ENT ORBIT SURGERY PROC UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67900 | Cosmetic Potential Repair of brow ptosis (supraciliary, mid-forehead or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67901 | Cosmetic Potential Repair of blepharoptosis; frontalis muscle technique with suture or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67902 | Cosmetic Potential Repair of blepharoptosis; frontalis muscle technique with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67903 | Cosmetic Potential Repair of blepharoptosis; (tarso) levator resection or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67904 | Cosmetic Potential Repair of blepharoptosis; (tarso) levator resection or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67906 | Cosmetic Potential Repair of blepharoptosis; superior rectus technique with fascial sling | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67908 | Cosmetic Potential Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67909 | Cosmetic Potential REDN OVERCORRECTN OF LID PTOSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67950 | Cosmetic Potential CANTHOPLASTY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 67999 | Cosmetic Potential REVISION EYELID UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 68399 | Cosmetic Potential CONJUNCTIVAL SURGERY UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 68841 | Cosmetic Potential INSRTN RX ELUTING IMPLT PUNCTAL DILAT LAC CANAL EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 68899 | Cosmetic Potential TEAR DUCT SYSTEM SURG UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69505 | Surgical - ENT REMOVE MASTOID STRUCTURES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69601 | Surgical - ENT MASTOID SURGERY REVISION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69602 | Surgical - ENT MASTOID SURGERY REVISION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69641 | Surgical - ENT REVISE MIDDLE EAR & MASTOID | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69646 | Surgical - ENT REVISE MIDDLE EAR & MASTOID | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69661 | Surgical - ENT REVISE MIDDLE EAR BONE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69667 | Surgical - ENT REPAIR MIDDLE EAR STRUCTURES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69711 | Surgical - ENT REMOVE/REPAIR HEAR AID,TEMP BONE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69716 | Surgical - ENT IMPLTN OI IMPLT SKULL MAG TC ATTACHMENT ESP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69719 | Surgical - ENT RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP<100 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69726 | Surgical - ENT REMOVAL OI IMPLT SKULL PERQ ATTACHMENT ESP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69727 | Surgical - ENT REMOVAL OI IMPLT SKULL MAG TC ATTACHMENT ESP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69728 | Surgical - ENT RMVL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP>=100 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69729 | Surgical - ENT IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69730 | Surgical - ENT RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69799 | Investigational Unlisted procedure, middle ear [when specified as implantation of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69930 | Durable Medical Cochlear device implantation, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69949 | Durable Medical Unlisted procedure, inner ear [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69955 | Cosmetic Potential Total facial nerve decompression and/or repair (may | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69970 | Surgical - ENT REMOVE INNER EAR LESION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 69979 | Surgical - ENT TEMPORAL BONE,MIDDLE,SURG UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70496 | Advanced Imaging CT angiography head, with contrast, including non- contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70498 | Advanced Imaging CT angiography neck, with contrast, including non | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70540 | Advanced Imaging MRI, FACE, NECK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70542 | Advanced Imaging MRI, FACE, NECK W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70543 | Advanced Imaging MRI, FACE, NECK, COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70544 | Advanced Imaging MR angiography head; w/o contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70545 | Advanced Imaging MR angiography head; with contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70546 | Advanced Imaging MR angiography head; w/o contrast followed by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70547 | Advanced Imaging MR angiography neck; w/o contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70548 | Advanced Imaging MR angiography neck; with contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70549 | Advanced Imaging MR angiography neck; w/o contrast followed by contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70551 | Advanced Imaging MRI BRAIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70552 | Advanced Imaging MRI BRAIN CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70553 | Advanced Imaging MRI BRAIN COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70554 | Advanced Imaging Functional MRI brain not requiring physician administration | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 70555 | Advanced Imaging Functional MRI brain requiring physician administration | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 71275 | Advanced Imaging CT angiography chest, with contrast, including non- contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 71550 | Advanced Imaging MRI, CHEST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 71551 | Advanced Imaging MRI, CHEST, W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 71552 | Advanced Imaging MRI, CHEST, COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 71555 | Advanced Imaging MR angiography chest; with or w/o contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72141 | Advanced Imaging MRI, CERV SPINE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72142 | Advanced Imaging MRI, CERV SPINE CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72146 | Advanced Imaging MRI, DORSAL SPINE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72147 | Advanced Imaging MRI, DORSAL SPINE CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72148 | Advanced Imaging MRI, LUMBAR SPINE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72149 | Advanced Imaging MRI, LUMBAR SPINE CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72156 | Advanced Imaging MRI, CERV SPINE COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72157 | Advanced Imaging MRI, DORSAL SPINE COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72158 | Advanced Imaging MRI, LUMBAR SPINE COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72159 | Advanced Imaging MR angiography spinal canal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72191 | Advanced Imaging CT angiography pelvis, with contrast, including non- contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72195 | Advanced Imaging MRI, PELVIS, W/O CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72196 | Advanced Imaging MRI, PELVIS W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72197 | Advanced Imaging MRI, PELVIS, COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72198 | Advanced Imaging MR angiography pelvis; w/o contrast followed by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 72285 | Investigational Discography, cervical or thoracic, radiological | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73206 | Advanced Imaging CT angiography upper extremity, with contrast, including non | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73218 | Advanced Imaging MRI, UPPER EXTREM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73219 | Advanced Imaging MRI, UPPER EXTREM W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73220 | Advanced Imaging MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73221 | Advanced Imaging MRI, JOINT UPPER EXTREM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73222 | Advanced Imaging MRI, JOINT UPPER EXTREM W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73223 | Advanced Imaging MRI, JOINT UPPER EXTREM COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73225 | Advanced Imaging MR angiography upper extremity; with and w/o | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73706 | Advanced Imaging CT angiography lower extremity, with contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73718 | Advanced Imaging MRI, LOWER EXTREM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73719 | Advanced Imaging MRI, LOWER EXTREM W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73720 | Advanced Imaging MRI, LOWER EXTR, W/O CONTRAST F/U BY CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73721 | Advanced Imaging MRI LOWER EXTREM JT, W/O CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73722 | Advanced Imaging MRI, JOINT OF LEG W/CONTRAST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73723 | Advanced Imaging MRI, JOINT OF LEG. COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 73725 | Advanced Imaging MR angiography lower extremity; with or w/o contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74181 | Advanced Imaging MRI abdomen; w/o contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74182 | Advanced Imaging MRI abdomen; with contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74183 | Advanced Imaging MRI, ABDOMEN, COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74185 | Advanced Imaging MR angiography abdomen; with or w/o contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74261 | Advanced Imaging Computed tomographic (CT) colonography, diagnostic, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74262 | Advanced Imaging Computed tomographic (CT) colonography, diagnostic, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74263 | Advanced Imaging Computed tomographic (CT) colonography, screening, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74712 | Advanced Imaging MRI Fetal, including placental and maternal pelvic imaging when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 74713 | Advanced Imaging MRI fetal, including placental and maternal pelvic imaging when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75557 | Advanced Imaging MRI Cardiac for morphology and function without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75559 | Advanced Imaging MRI Cardiac for morphology and function without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75561 | Advanced Imaging MRI Cardiac for morphology and function without contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75563 | Advanced Imaging MRI Cardiac for morphology and function without contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75565 | Advanced Imaging Cardiac magnetic resonance imaging for velocity flow mapping | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75572 | Advanced Imaging Computed tomography, heart, with contrast material, for evaluation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75573 | Advanced Imaging Computed tomography, heart, with contrast material | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75574 | Advanced Imaging Computed tomographic angiography, heart, coronary arteries and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75635 | Advanced Imaging CT angiography abdominal aorta and bilateral iliofemoral lower | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 75894 | Advanced Imaging TRANSCATHETER RX EMBOLIZATN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76120 | Investigational Cineradiography/videoradiography, except where specifically | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76125 | Investigational Cineradiography/videoradiography to complement routine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76145 | Radiation Medical physics dose evaluation for radiation exposure that | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76376 | Investigational 3D rendering with interpretation and reporting of computed | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76377 | Investigational 3D rendering with interpretation and reporting of computed | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76390 | Advanced Imaging MR Spectroscopy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76391 | Advanced Imaging Magnetic resonance (eg, vibration) elastography | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76496 | Investigational Unlisted fluoroscopic procedure (eg, diagnostic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76497 | Investigational UNLISTED CT PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76498 | Investigational Unlisted magnetic resonance procedure (eg, diagnostic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76499 | Investigational Unlisted diagnostic radiographic procedure [when specified as 4-D | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76873 | Radiation Echography, Transrectal; Prostate Volume Study, Brachytherapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76965 | Radiation Ultrasonic guidance for interstitial radioelement application | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 76999 | Investigational UNLISTED ULTRASOUND PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77013 | Advanced Imaging CT GUIDANCE TISSUE ABLATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77014 | Radiation Computed tomography guidance for placement of radiation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77046 | Advanced Imaging Magnetic resonance imaging, breast, without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77047 | Advanced Imaging Magnetic resonance imaging, breast, without contrast material | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77048 | Advanced Imaging Magnetic resonance imaging, breast, without and with contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77049 | Advanced Imaging Magnetic resonance imaging, breast, without and with contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77078 | Advanced Imaging CT bone mineral density study; axial skeleton | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77084 | Advanced Imaging MRI bone marrow blood supply | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77089 | Advanced Imaging TBS DXA/OTHER IMG CALCULATION W/INTERP AND RPT FX RISK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77295 | Radiation 3-dimensional radiotherapy plan, including dose- volume | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77299 | Durable Medical Unlisted procedure, therapeutic radiology clinical treatment | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77300 | Radiation Basic radiation dosimetry calculation, central axis depth dose | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77301 | Radiation Intensity Modulated Radiotherapy Plan W/Dose Volume Histograms | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77316 | Radiation Brachytherapy isodose plan; simple (calculation[s] made from 1 to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77317 | Radiation Brachytherapy isodose plan; intermediate (calculation[s] made | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77318 | Radiation Brachytherapy isodose plan; complex (calculation[s] made from | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77336 | Radiation Continuing medical physics consultation, including assessment of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77338 | Radiation Multi-leaf collimator (MLC) device(s) for intensity modulated | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77370 | Radiation Special medical radiation physics consultation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77371 | Radiation Radiation treatment delivery, stereotactic radiosurgery (SRS) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77372 | Radiation Radiation treatment delivery, stereotactic radiosurgery (SRS) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77373 | Radiation Stereotactic body radiation therapy, treatment delivery, per fraction | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77385 | Radiation Intensity modulated radiation treatment delivery (IMRT), includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77386 | Radiation Intensity modulated radiation treatment delivery (IMRT), includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77387 | Radiation Guidance for localization of target volume for delivery of radiation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77399 | Radiation RADIATION DOSIMETRY UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77401 | Radiation Radiation treatment delivery, superficial and/or ortho voltage, per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77402 | Radiation Radiation treatment delivery, > 1 MeV; simple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77407 | Radiation Radiation treatment delivery, > 1 MeV; intermediate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77412 | Radiation Radiation treatment delivery, > 1 MeV; complex | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77413 | Procedure - Oncology RADIATION TREATMENT DELIVERY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77414 | Procedure - Oncology RADIATION TREATMENT DELIVERY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77423 | Investigational High energy neutron radiation treatment delivery; 1 or more | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77424 | Radiation Intraoperative Radiation Treatment Delivery, X-Ray, Single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77425 | Radiation Intraoperative Radiation Treatment Delivery, Electrons, Single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77427 | Radiation Radiation treatment management, 5 treatments | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77431 | Radiation Radiation therapy management with complete course of therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77432 | Radiation Stereotactic radiation treatment management of cranial lesion(s) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77435 | Radiation Stereotactic body radiation therapy, treatment management, per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77469 | Radiation Intraoperative radiation treatment management | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77470 | Radiation Special treatment procedure (eg, total body irradiation, hemibody | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77499 | Radiation RADIATION,MANGEMENT,THERAP-OTH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77520 | Radiation Proton treatment delivery; simple without compensation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77522 | Radiation Proton treatment delivery; simple with cpmpensation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77523 | Radiation Proton treatment delivery; Intermediate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77525 | Radiation Proton treatment delivery; complex | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77610 | Radiation HYPERTHERMIA INTERN =<5 APPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77615 | Radiation HYPERTHERMIA INTERN >5 APPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77620 | Radiation HYPERTHERMIA RX INTRACAV PROBE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77761 | Radiation Intracavitary radiation source application; Simple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77762 | Radiation Intracavitary radiation source application; intermediate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77763 | Radiation Intracavitary radiation source application; complex | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77770 | Radiation Remote afterloading high dose rate radionuclide interstitial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77771 | Radiation Remote afterloading high dose rate radionuclide interstitial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77772 | Radiation Remote afterloading high dose rate radionuclide interstitial or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77778 | Radiation Interstitial radioelement application; complex | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77790 | Radiation Supervision, handling, loading, radiation source | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 77799 | Radiation RADIUM/RADIOISOTOPE THERAPY UNLIST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78099 | Radiation ENDOCRINE NUCLEAR PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78199 | Radiation BLOOD/LYMPH NUCLEAR EXAM UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78299 | Radiation GI NUCLEAR PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78399 | Radiation MUSCULOSKELETAL NUCLEAR EXAM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78429 | Advanced Imaging Myocardial imaging, positron emission tomography (PET) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78430 | Advanced Imaging Myocardial imaging, positron emission tomography (PET), perfusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78431 | Advanced Imaging Myocardial imaging, positron emission tomography (PET), perfusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78432 | Advanced Imaging Myocardial imaging, positron emission tomography (PET) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78433 | Advanced Imaging Myocardial imaging, positron emission tomography (PET) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78451 | Advanced Imaging Myocardial perfusion imaging, tomographic (SPECT) (including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78452 | Advanced Imaging Myocardial perfusion imaging, tomographic (SPECT) (including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78453 | Advanced Imaging Myocardial perfusion imaging, planar (including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78454 | Advanced Imaging Myocardial perfusion imaging, planar (including qualitative or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78459 | Advanced Imaging PET myocardial, metabolic evaluation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78466 | Advanced Imaging Planar, infarct avid; qualitative or quantitative | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78468 | Advanced Imaging Planar, infarct avid; with ejection fraction by first pass technique | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78469 | Advanced Imaging SPECT, infarct avid; with or without quantification | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78472 | Advanced Imaging Gated equilibrium; planar, single study, wall motion plus ejection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78473 | Advanced Imaging Gated equilibrium; planar, multiple studies, wall motion study plus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78481 | Advanced Imaging First pass tech; single study, wall motion study plus ejection fraction | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78483 | Advanced Imaging First pass tech; multiple studies, wall motion study plus ejection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78491 | Advanced Imaging PET myocardial, perfusion, single study | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78492 | Advanced Imaging PET myocardial, perfusion, multiple studies | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78494 | Advanced Imaging Gated equilibrium, SPECT, at rest, wall motion study plus ejection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78499 | Advanced Imaging CARDIOVASC NUCL EXAM UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78599 | Advanced Imaging RESP NUCLEAR EXAM UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78608 | Advanced Imaging PET brain, metabolic evaluation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78609 | Advanced Imaging PET brain, perfusion evaluation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78699 | Advanced Imaging NERV SYS NUCL EXAM UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78799 | Advanced Imaging GU NUCLEAR EXAM UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78803 | Advanced Imaging Radiopharmaceutical localization of tumor, inflammatory process | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78811 | Advanced Imaging PET imaging, limited | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78812 | Advanced Imaging PET imaging, skull to mid-thigh | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78813 | Advanced Imaging PET imaging, whole body | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78814 | Advanced Imaging PET imaging with concurrent CT, limited | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78815 | Advanced Imaging PET imaging with concurrent CT, skull to mid-thigh | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78816 | Advanced Imaging PET imaging with concurrent CT, whole body | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 78999 | Investigational Unlisted miscellaneous procedure, diagnostic nuclear medicine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 79101 | Pharmacy Radiopharmaceutical Therapy, By Intravenous Administration | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 79403 | Pharmacy Radiopharmaceutical Therapy, Radiolabeled Monoclonal Antibody | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 79445 | Procedure - Oncology Radiopharmaceutical therapy, by intra-arterial particulate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 79999 | Procedure - Oncology NUCLEAR THERAPY, UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 80299 | Genetic Testing QUANTITATIVE ASSAY, DRUG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81099 | Genetic Testing URINALYSIS TEST PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81105 | Genetic Testing HPA-1 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81106 | Genetic Testing HPA-2 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81107 | Genetic Testing HPA-3 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81108 | Genetic Testing HPA-4 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81109 | Genetic Testing HPA-5 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81110 | Genetic Testing HPA-6 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81111 | Genetic Testing HPA-9 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81112 | Genetic Testing HPA-15 GENOTYPING GENE ANALYSIS COMMON VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81120 | Genetic Testing IDH1 (isocitrate dehydrogenase 1 [NADP+], soluble) (eg, glioma) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81121 | Genetic Testing IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81161 | Genetic Testing DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81162 | Genetic Testing (BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81163 | Genetic Testing BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81164 | Genetic Testing BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81165 | Genetic Testing BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81166 | Genetic Testing BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81167 | Genetic Testing BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81168 | Genetic Testing CCND1/IGH TRANSLOCATION ALYS MAJOR BP QUAL AND QUAN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81170 | Genetic Testing (ABL1 (ABL proto-oncogene 1, non-receptor tyrosine kinase) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81171 | Genetic Testing AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81172 | Genetic Testing AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81173 | Genetic Testing AR (androgen receptor) (eg, spinal and bulbar muscular atrophy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81174 | Genetic Testing AR (androgen receptor) (eg, spinal and bulbar muscular atrophy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81175 | Genetic Testing ASXL1 (additional sex combs like 1, transcriptional regulator) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81176 | Genetic Testing ASXL1 (additional sex combs like 1, transcriptional regulator) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81177 | Genetic Testing ATN1 (atrophin1) (eg, dentatorubral-pallidoluysian atrophy) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81178 | Genetic Testing ATXN1 (ataxin 1) (eg, spinocerebellar ataxia) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81179 | Genetic Testing ATXN2 (ataxin 2) (eg, spinocerebellar ataxia) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81180 | Genetic Testing ATXN3 (ataxin 3) (eg, spinocerebellar ataxia, Machado-Joseph | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81181 | Genetic Testing ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81182 | Genetic Testing ATXN8OS (ataxin 8 opposite strand [non-protein coding]) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81183 | Genetic Testing ATXN10 (ataxin 10) (eg, spinocerebellar ataxia) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81184 | Genetic Testing CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81185 | Genetic Testing CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81186 | Genetic Testing CACNA1A (calcium voltage-gated channel subunit alpha1 A) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81187 | Genetic Testing CNBP (CCHC-type zinc finger nucleic acid binding protein) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81188 | Genetic Testing CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81189 | Genetic Testing CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81190 | Genetic Testing CSTB (cystatin B) (eg, Unverricht-Lundborg disease) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81191 | Genetic Testing NTRK1 (neurotrophic receptor tyrosine kinase 1) (eg, solid tumors) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81192 | Genetic Testing NTRK2 (neurotrophic receptor tyrosine kinase 2) (eg, solid tumors) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81193 | Genetic Testing NTRK3 (neurotrophic receptor tyrosine kinase 3) (eg, solid tumors) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81194 | Genetic Testing NTRK (neurotrophic-tropomyosin receptor tyrosine kinase 1, 2, and 3) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81200 | Genetic Testing ASPA (aspartoacylase) (eg, Canavan disease) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81201 | Genetic Testing APC (adenomatous polyposis coli) (eg, familial adenomatosis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81202 | Genetic Testing APC (adenomatous polyposis coli) (eg, familial adenomatosis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81203 | Genetic Testing APC (adenomatous polyposis coli) (eg, familial adenomatosis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81204 | Genetic Testing AR (androgen receptor) (eg, spinal and bulbar muscular atrophy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81205 | Genetic Testing BCKDHB (branched-chain keto acid dehydrogenase E1, beta | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81206 | Genetic Testing BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81207 | Genetic Testing BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81208 | Genetic Testing BCR/ABL1 (t(9;22)) (eg, chronic myelogenous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81209 | Genetic Testing BLM (Bloom syndrome, RecQ helicase-like) (eg, Bloom syndrome) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81210 | Genetic Testing BRAF (v-raf murine sarcoma viral oncogene homolog B1) (eg, colon | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81212 | Genetic Testing BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81215 | Genetic Testing BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81216 | Genetic Testing BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81217 | Genetic Testing BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81218 | Genetic Testing CEBPA (CCAAT/enhancer binding protein [C/EBP], alpha) (eg, acute | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81219 | Genetic Testing CALR (calreticulin) (eg, myeloproliferative disorders), gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81220 | Genetic Testing CFTR GENE ANALYSIS COMMON VARIANTS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81221 | Genetic Testing CFTR (cystic fibrosis transmembrane conductance regulator) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81222 | Genetic Testing CFTR (cystic fibrosis transmembrane conductance regulator) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81223 | Genetic Testing CFTR (cystic fibrosis transmembrane conductance regulator) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81224 | Genetic Testing CFTR (cystic fibrosis transmembrane conductance regulator) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81225 | Genetic Testing CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81226 | Genetic Testing CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81227 | Genetic Testing CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81228 | Genetic Testing Cytogenomic (genome-wide) analysis for constitutional | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81229 | Genetic Testing Cytogenomic (genome-wide) analysis for constitutional | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81232 | Genetic Testing DPYD (dihydropyrimidine dehydrogenase) (eg, 5- fluorouracil/5-FU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81233 | Genetic Testing BTK (Bruton's tyrosine kinase) (eg, chronic lymphocytic leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81234 | Genetic Testing DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81235 | Genetic Testing EGFR (epidermal growth factor receptor) (eg, non- small cell lung | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81236 | Genetic Testing EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81237 | Genetic Testing EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81239 | Genetic Testing DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81240 | Genetic Testing F2 (prothrombin, coagulation factor II) (eg, hereditary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81241 | Genetic Testing F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81242 | Genetic Testing FANCC (Fanconi anemia, complementation group C) (eg, Fanconi | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81243 | Genetic Testing Fmr1 (Fragile X Mental Retardation 1) (Eg, Fragile X Mental | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81244 | Genetic Testing FMR1 (fragile X mental retardation 1) (eg, fragile X mental | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81245 | Genetic Testing Flt3 (Fms-Related Tyrosine Kinase 3) (Eg, Acute Myeloid Leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81246 | Genetic Testing FLT3 (fms-related tyrosine kinase 3) (eg, acute myeloid leukemia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81250 | Genetic Testing G6PC (glucose-6-phosphatase, catalytic subunit) (eg, Glycogen | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81251 | Genetic Testing GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81252 | Genetic Testing GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81253 | Genetic Testing GJB2 (gap junction protein, beta 2, 26kDa, connexin 26) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81254 | Genetic Testing GJB6 (gap junction protein, beta 6, 30kDa, connexin 30) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81255 | Genetic Testing HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81256 | Genetic Testing HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81257 | Genetic Testing HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81258 | Genetic Testing HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81259 | Genetic Testing HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81260 | Genetic Testing IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81261 | Genetic Testing IGH@ REARRANGE ABNORMAL CLONAL POP AMPLIFIED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81262 | Genetic Testing IGH@ REARRANGE ABNORMAL CLONAL POP DIRECT PROBE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81263 | Genetic Testing IGH@ VARIABLE REGION SOMATIC MUTATION ANALYSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81264 | Genetic Testing IGK@ GENE REARRANGE DETECT ABNORMAL CLONAL POP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81265 | Genetic Testing Comparative analysis using Short Tandem Repeat (STR) markers | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81266 | Genetic Testing Comparative analysis using Short Tandem Repeat (STR) markers | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81267 | Genetic Testing CHIMERISM W/COMP TO BASELINE W/O CELL SELECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81268 | Genetic Testing CHIMERISM W/COMP TO BASELINE W/CELL SELECTION EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81269 | Genetic Testing HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81270 | Genetic Testing JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81271 | Genetic Testing HTT (huntingtin) (eg, Huntington disease) gene analysis; evaluation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81272 | Genetic Testing KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81273 | Genetic Testing KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81274 | Genetic Testing HTT (huntingtin) (eg, Huntington disease) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81275 | Genetic Testing KRAS (v-Ki-ras2 Kirsten rat sarcoma viral oncogene) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81276 | Genetic Testing (KRAS (Kirsten rat sarcoma viral oncogene homolog) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81278 | Genetic Testing IGH@/BCL2 TRANSLOCATION ALYS MBR AND MCR BP QUAL/QUAN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81279 | Genetic Testing JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) targeted | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81283 | Genetic Testing IFNL3 GENE ANALYSIS RS12979860 VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81284 | Genetic Testing FXN (frataxin) (eg, Friedreich ataxia) gene analysis; evaluation to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81285 | Genetic Testing FXN (frataxin) (eg, Friedreich ataxia) gene analysis; characterization | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81286 | Genetic Testing FXN (frataxin) (eg, Friedreich ataxia) gene analysis; full gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81287 | Genetic Testing MGMT METHYLATION ANALYSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81288 | Genetic Testing MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81289 | Genetic Testing FXN (frataxin) (eg, Friedreich ataxia) gene analysis; known familial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81290 | Genetic Testing MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81291 | Genetic Testing MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81292 | Genetic Testing MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81293 | Genetic Testing MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81294 | Genetic Testing MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81295 | Genetic Testing MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81296 | Genetic Testing MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81297 | Genetic Testing MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81298 | Genetic Testing MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non- polyposis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81299 | Genetic Testing MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non- polyposis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81300 | Genetic Testing MSH6 (mutS homolog 6 [E. coli]) (eg, hereditary non- polyposis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81301 | Genetic Testing MICROSATELLITE INSTAB ANAL MISMATCH REPAIR DEF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81302 | Genetic Testing MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81303 | Genetic Testing MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81304 | Genetic Testing MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81305 | Genetic Testing MYD88 GENE ANALYSIS P.LEU265 (L265P) VARIANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81307 | Genetic Testing PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81308 | Genetic Testing PALB2 (partner and localizer of BRCA2) (eg, breast and pancreatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81309 | Genetic Testing PIK3CA (phosphatidylinositol-4, 5-biphosphate 3- kinase, catalytic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81310 | Genetic Testing NPM1 (nucleophosmin) (eg, acute myeloid leukemia) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81311 | Genetic Testing NRAS (neuroblastoma RAS viral [v-ras] oncogene homolog) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81312 | Genetic Testing PABPN1 (poly[A] binding protein nuclear 1) (eg, oculopharyngeal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81314 | Genetic Testing PDGFRA (platelet-derived growth factor receptor, alpha | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81315 | Genetic Testing PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81316 | Genetic Testing PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81317 | Genetic Testing PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81318 | Genetic Testing PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81319 | Genetic Testing PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81320 | Genetic Testing PLCG2 (phospholipase C gamma 2) (eg, chronic lymphocytic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81321 | Genetic Testing PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81322 | Genetic Testing PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81323 | Genetic Testing PTEN (phosphatase and tensin homolog) (eg, Cowden syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81324 | Genetic Testing PMP22 (peripheral myelin protein 22) (eg, Charcot- Marie-Tooth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81325 | Genetic Testing PMP22 (peripheral myelin protein 22) (eg, Charcot- Marie-Tooth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81326 | Genetic Testing PMP22 (peripheral myelin protein 22) (eg, Charcot- Marie-Tooth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81330 | Genetic Testing SMPD1(sphingomyelin phosphodiesterase 1, acid lysosomal) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81331 | Genetic Testing SNRPN/UBE3A (small nuclear ribonucleoprotein polypeptide N and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81332 | Genetic Testing SERPINA1 (serpin peptidase inhibitor, clade A, alpha- 1 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81333 | Genetic Testing TGFBI (transforming growth factor beta-induced) (eg, corneal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81334 | Genetic Testing RUNX1 (runt related transcription factor 1) (eg, acute myeloid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81336 | Genetic Testing SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81337 | Genetic Testing SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81338 | Genetic Testing MPL (MPL proto-oncogene, thrombopoietin receptor) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81339 | Genetic Testing MPL (MPL proto-oncogene, thrombopoietin receptor) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81340 | Genetic Testing TRB@ REARRANGEMENT ANAL AMPLIFICATION METHOD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81341 | Genetic Testing TRB@ REARRANGEMENT ANAL DIRECT PROBE METHODOLOGY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81342 | Genetic Testing TRG@ GENE REARRANGEMENT ANALYSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81343 | Genetic Testing Hereditary breast cancer-related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81344 | Genetic Testing TBP (TATA box binding protein) (eg, spinocerebellar ataxia) gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81345 | Genetic Testing TERT GENE ANALYSIS TARGETED SEQUENCE ANALYSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81346 | Genetic Testing TYMS (thymidylate synthetase) (eg, 5-fluorouracil/ 5- FU drug | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81347 | Genetic Testing SF3B1 (splicing factor [3b] subunit B1) (eg, myelodysplastic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81348 | Genetic Testing SRSF2 (serine and arginine-rich splicing factor 2) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81349 | Genetic Testing Cytogenomic (genome-wide) analysis for constitutional | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81350 | Genetic Testing UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81351 | Genetic Testing TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81352 | Genetic Testing TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81353 | Genetic Testing TP53 (tumor protein 53) (eg, Li-Fraumeni syndrome) gene analysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81357 | Genetic Testing U2AF1 (U2 small nuclear RNA auxiliary factor 1) (eg, myelodysplastic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81360 | Genetic Testing ZRSR2 (zinc finger CCCH-type, RNA binding motif and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81361 | Genetic Testing HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81362 | Genetic Testing HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81363 | Genetic Testing HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81364 | Genetic Testing HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81370 | Genetic Testing HLA CLASS I&II LOW HLA-A -B -C -DRB1/3/4/5&-DQB1 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81371 | Genetic Testing HLA I&II LOW RESOLUTION HLA-A -B&-DRB1/3/4/5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81373 | Genetic Testing HLA CLASS I TYPING LOW RESOLUTION ONE LOCUS EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81375 | Genetic Testing HLA II LOW RESOLUTION HLA-DRB1/3/4/5 AND -DQB1 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81376 | Genetic Testing HLA CLASS II TYPING LOW RESOLUTION ONE LOCUS EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81377 | Genetic Testing HLA II LOW RESOLUTION ONE ANTIGEN EQUIVALENT EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81378 | Genetic Testing HLA I&II HIGH RESOLUTION HLA-A -B -C AND -DRB1 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81379 | Genetic Testing HLA CLASS I TYPING HIGH RESOLUTION COMPLETE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81380 | Genetic Testing HLA CLASS I TYPING HIGH RESOLUTION ONE LOCUS EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81381 | Genetic Testing HLA Class I typing, high resolution (ie, alleles or allele groups); one | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81382 | Genetic Testing HLA CLASS II TYPING HIGH RESOLUTION ONE LOCUS EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81383 | Genetic Testing HLA II HIGH RESOLUTION 1 ALLELE/ALLELE GROUP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81400 | Genetic Testing Molecular pathology procedure, Level 1(eg, identification of single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81401 | Genetic Testing Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81402 | Genetic Testing Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81403 | Genetic Testing Molecular pathology procedure, Level 4 (eg, analysis of single exon | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81404 | Genetic Testing Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81405 | Genetic Testing Molecular pathology procedure, Level 6 (eg, analysis of 6-10 exons | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81406 | Genetic Testing Molecular pathology procedure, Level 7 (eg, analysis of 11-25 exons | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81407 | Genetic Testing Molecular pathology procedure, Level 8 (eg, analysis of 26-50 exons | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81408 | Genetic Testing Molecular pathology procedure, Level 9 (eg, analysis of >50 exons in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81410 | Genetic Testing Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81411 | Genetic Testing Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81412 | Genetic Testing Ashkenazi Jewish associated disorders (eg, Bloom syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81413 | Genetic Testing Cardiac ion channelopathies (eg, Brugada syndrome, long QT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81414 | Genetic Testing Cardiac ion channelopathies (eg, Brugada syndrome, long QT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81415 | Genetic Testing Exome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81416 | Genetic Testing Exome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81417 | Genetic Testing Exome (eg, unexplained constitutinoal or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81418 | Genetic Testing Drug metabolism (eg, pharmacogenomics) genomic sequence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81419 | Genetic Testing Epilepsy genomic sequence analysis panel, must include analyses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81420 | Genetic Testing FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81425 | Genetic Testing Genome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81426 | Genetic Testing Genome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81427 | Genetic Testing Genome (eg, unexplained constitutional or heritable disorder or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81430 | Genetic Testing Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81431 | Genetic Testing Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81432 | Genetic Testing Hereditary breast cancer-related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81433 | Genetic Testing Hereditary breast cancer-related disorders (eg, hereditary breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81434 | Genetic Testing Hereditary retinal disorders (eg, retinitis pigmentosa, Leber | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81435 | Genetic Testing Hereditary colon cancer syndromes (eg, Lynch syndrome, familial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81436 | Genetic Testing Hereditary colon cancer syndromes (eg, Lynch syndrome, familial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81437 | Genetic Testing Hereditary neuroendocrine tumor disorders (eg, medullary thyroid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81438 | Genetic Testing Hereditary neuroendocrine tumor disorders (eg, medullary thyroid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81439 | Genetic Testing Inherited cardiomyopathy (eg, hypertrophic cardiomyopathy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81440 | Genetic Testing Nuclear encoded mitochondrial genes (eg, neurologic or myopathic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81441 | Genetic Testing Inherited bone marrow failure syndromes (IBMFS) (eg, Fanconi | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81442 | Genetic Testing Nuclear encoded mitochondrial genes (eg, neurologic or myopathic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81443 | Genetic Testing Genetic testing for severe inherited conditions (eg, cystic fibrosis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81445 | Genetic Testing Targeted genomic sequence analysis panel, solid organ neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81448 | Genetic Testing Hereditary peripheral neuropathies (eg, Charcot- Marie-Tooth | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81449 | Genetic Testing Targeted genomic sequence analysis panel, solid organ neoplasm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81450 | Genetic Testing Targeted genomic sequence analysis panel, hematolymphoid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81451 | Genetic Testing Targeted genomic sequence analysis panel, hematolymphoid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81455 | Genetic Testing Targeted genomic sequence analysis panel, solid organ or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81456 | Genetic Testing Targeted genomic sequence analysis panel, solid organ or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81457 | Solid organ neoplasm, genomic sequence analysis panel | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81458 | Solid organ neoplasm, genomic sequence analysis panel | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81459 | Solid organ neoplasm, genomic sequence analysis panel | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81460 | Genetic Testing Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81462 | Solid organ neoplasm, genomic sequence analysis panel | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81463 | Solid organ neoplasm, genomic sequence analysis panel, cell-free | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81464 | Solid organ neoplasm, genomic sequence analysis panel, cell-free | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81465 | Genetic Testing Whole mitochondrial genome large deletion analysis panel (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81470 | Genetic Testing X-linked intellectual disability (XLID) (eg, syndromic and non | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81471 | Genetic Testing X-linked intellectual disability (XLID) (eg, synromic and non | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81479 | Genetic Testing Unlisted molecular pathology procedure | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81493 | Genetic Testing Coronary artery disease, mRNA, gene expression profiling by real | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81504 | Genetic Testing Oncology (tissue of origin), microarray gene expression profiling of > | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81518 | Genetic Testing Oncology (breast), mRNA, gene expression profiling by real-time RT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81519 | Genetic Testing Oncology (breast), mRNA, gene expression profiling by real-time RT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81520 | Genetic Testing Oncology (breast), mRNA gene expression profiling by hybrid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81521 | Genetic Testing Oncology (breast), mRNA, microarray gene expression profiling of 70 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81522 | Genetic Testing Oncology (breast), mRNA, gene expression profiling by RT-PCR of 12 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81523 | Genetic Testing Oncology (breast), mRNA, next-generation sequencing gene | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81525 | Genetic Testing Oncology (colon), mRNA, gene expression profiling by real-time RT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81541 | Genetic Testing Oncology (prostate), mRNA gene expression profiling by real-time | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81542 | Genetic Testing Oncology (prostate), mRNA, microarray gene expression profiling of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81546 | Genetic Testing Oncology (thyroid), mRNA, gene expression analysis of 10,196 genes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81552 | Genetic Testing Oncology (uveal melanoma), mRNA, gene expression profiling by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 81554 | Genetic Testing Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 82653 | Genetic Testing ELASTASE PANCREATIC FECAL QUANTITATIVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 82787 | Investigational Gammaglobulin (immunoglobulin); immunoglobulin subclasses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 83519 | Investigational Immunoassay for analyte other than infectious agent antibody or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 83520 | Genetic Testing Immunoassay for analyte other than infectious agent antibody or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 83529 | Genetic Testing ASSAY OF INTERLEUKIN-6 (IL-6) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 85999 | Genetic Testing HEMATOLOGY PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 86001 | Investigational Allergen specific IgG quantitative or semiquantitative | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 86152 | Investigational Cell enumeration using immunologic selection and identification in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 86153 | Investigational Cell enumeration using immunologic selection and identification in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 86255 | Investigational Fluorescent noninfectious agent antibody; screen | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 86256 | Investigational Fluorescent noninfectious agent antibody; titer, each antibody | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88182 | Genetic Testing CELL MARKER STUDY,DNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88199 | Genetic Testing CYTOPATH PROCEDURE UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88245 | Genetic Testing CHROMOSOME ANAL:BREAKGE,20-25 CELLS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88248 | Genetic Testing CHROMOSOME ANAL:BREAKGE,50-100 CELLS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88249 | Genetic Testing CHROMOSOME ANAL:BREAKGE,100 CELLS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88261 | Genetic Testing CHROMOSOME ANAL:5 CELLS,1 KARYOTYPE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88262 | Genetic Testing CHROMOSOME ANAL:15-20,2 KARYOTYPES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88263 | Genetic Testing CHROMOSOME ANAL:45 CELLS,MOSAICISM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88264 | Genetic Testing CHROMOSOME ANALYSIS:20-25 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88267 | Genetic Testing CHROMOSOME ANALY:PLACENTA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88269 | Genetic Testing CHROMOSOME ANALY:AMNIOTIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88271 | Genetic Testing CYTOGENETICS, DNA PROBE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88272 | Genetic Testing CYTOGENETICS, 3-5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88273 | Genetic Testing CYTOGENETICS, 10-30 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88274 | Genetic Testing CYTOGENETICS, 25-99 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88275 | Genetic Testing CYTOGENETICS, 100-300 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88280 | Genetic Testing CHROMOSOME KARYOTYPE STUDY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88283 | Genetic Testing CHROMOSOME BANDING STUDY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88285 | Genetic Testing CHROMOSOME COUNT:ADDN CELLS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88289 | Genetic Testing CHROMOSOME STUDY:ADDN HI RES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88291 | Genetic Testing CYTO/MOLECULAR REPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88299 | Genetic Testing CYTOGENETIC STUDY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 88749 | Investigational Unlisted in vivo (eg, transcutaneous) laboratory service [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 89240 | Investigational Unlisted miscellaneous pathology test [when specified as in vitro | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 89260 | Infertility Sperm isolation; simple prep (eg, sperm wash and swim-up) for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 89261 | Infertility Sperm isolation; complex prep (eg, Percoll gradient, albumin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 89268 | Infertility Insemination of oocytes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 89329 | Investigational Sperm evaluation; hamster penetration test | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 89330 | Investigational Sperm evaluation; cervical mucus penetration test, with or without | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90281 | Pharmacy Immune globulin, Immune globulin (Ig), Intramuscular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90283 | Pharmacy Immune globulin, IVIG Generic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90284 | Pharmacy Immune globulin subcutaneous [Human], SCIg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90378 | Pharmacy RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90380 | Pharmacy RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90381 | Pharmacy RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90626 | DOSAGE, FOR INTRAMUSCULAR USE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90627 | DOSAGE, FOR INTRAMUSCULAR USE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90758 | Pharmacy ZAIRE EBOLAVIRUS VACCINE, LIVE, FOR INTRAMUSCUALR USE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90867 | Behavioral Health TRANSCRANIAL MAGNETIC STIMULATION TREATMENT,PLANNING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90868 | Behavioral Health TRANSCRANIAL MAGNETIC STIMULATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90869 | Behavioral Health REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MNGT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90899 | Behavioral Health PSYCHIATRIC SERVICE/THERAPY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90935 | Home Health HEMODIALYSIS, ONE EVALUATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90937 | Home Health HEMODIALYSIS, REPEATED EVAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90945 | Home Health DIALYSIS, NOT HEMO, 1 EVAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90947 | Home Health DIALYSIS, REPEATED EVAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90951 | Home Health ESRD SERVICES, PER MONTH, <2 YR OLD, 4+ VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90952 | Home Health ESRD SERVICES, PER MONTH, <2 YR OLD, 2-3 VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90953 | Home Health ESRD SERVICES, PER MONTH, <2 YR OLD, 1 VISIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90954 | Home Health ESRD SERVICES, PER MONTH, 2-11 YR OLD, 4+ VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90955 | Home Health ESRD SERVICES, PER MONTH, 2-11 YR OLD, 2-3 VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90956 | Home Health ESRD SERVICES, PER MONTH, 2-11 YR OLD, 1 VISIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90957 | Home Health ESRD SERVICES, PER MONTH, 12-19 YR OLD, 4+ VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90959 | Home Health ESRD SERVICES, PER MONTH, 12-19 YR OLD, 1 VISIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90960 | Home Health ESRD SERVICES, PER MONTH, 20+ YR OLD, 4+ VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90961 | Home Health ESRD SERVICES, PER MONTH, 20+ YR OLD, 2-3 VISITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90962 | Home Health ESRD SERVICES, PER MONTH, 20+ YR OLD, 1 VISIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90963 | Home Health ESRD SERVICES, HOME DIALYSIS, PER MONTH, < 2 YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90964 | Home Health ESRD SERVICES, HOME DIALYSIS, PER MONTH, 2-11 YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90965 | Home Health ESRD SERVICES, HOME DIALYSIS, PER MONTH, 12-19 YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90966 | Home Health ESRD SERVICES, HOME DIALYSIS, PER MONTH, 20+ YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90967 | Home Health ESRD SERVICES, PER DAY, < 2 YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90968 | Home Health ESRD SERVICES, PER DAY, 2-11 YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90969 | Home Health ESRD SERVICES, PER DAY, 12-19 YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90970 | Home Health ESRD SERVICES, PER DAY,20+ YR OLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90989 | Home Health DIALYSIS TRAINING/COMPLETE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90993 | Home Health DIALYSIS TRAINING/INCOMPLETE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 90999 | Home Health DIALYSIS PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 91112 | Investigational Gastrointestinal transit and pressure measurement, stomach | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 91299 | Procedure - Misc. GASTROENTEROLOGY PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 92499 | Procedure - Misc. EYE SERVICE OR PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 92508 | Procedure - Misc. SPEECH/HEARING THERAPY, GROUP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 92700 | Investigational Unlisted otorhinolaryngological service or procedure [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 92978 | Advanced Imaging Endoluminal imaging of coronary vessel or graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93247 | Cardiac - Monitor External electrocardiographic recording for more than 7 days up to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93303 | Advanced Imaging Transthoracic echocardiography or congenital cardiac anomalies | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93304 | Advanced Imaging Transthoracic echocardiography or congenital cardiac anomalies | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93356 | Investigational Myocardial strain imaging using speckle tracking-derived | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93580 | Investigational Percutaneous transcatheter closure of congenital interatrial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93799 | Procedure - Cardiac Unlisted cardiovascular service or procedure [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 93998 | Investigational Unlisted noninvasive vascular diagnostic study [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 94625 | Procedure - Misc. PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 94626 | Procedure - Misc. PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 94799 | Respiratory PULMONARY SERVICE/PROCEDURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 95199 | Investigational Unlisted allergy/clinical immunologic service or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 95905 | Investigational Motor and/or sensory nerve conduction, using preconfigured | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 95976 | Neurostimulator Electronic analysis of implanted neurostimulator pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 95977 | Neurostimulator Electronic analysis of implanted neurostimulator pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 95999 | Investigational Unlisted neurological or neuromuscular diagnostic procedure [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96365 | Pharmacy Intravenous infusion, for therapy, prophylaxis, or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96366 | Pharmacy Intravenous infusion, for therapy, prophylaxis, or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96367 | Pharmacy Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96368 | Pharmacy Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96371 | Chemotherapy Subcutaneous infusion for therapy or prophylaxis (specify | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96372 | Pharmacy Therapeutic, prophylactic or diagnostic injection (specify substance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96401 | Chemotherapy Chemotherapy administration, subcutaneous or intramuscular; non | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96402 | Chemotherapy Chemotherapy administration, subcutaneous or intramuscular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96416 | Chemotherapy Chemotherapy administration, intravenous infusion technique | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96425 | Chemotherapy Chemotherapy administration, intra-arterial; infusion technique | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96549 | Investigational Unlisted chemotherapy procedure [when specified as insulin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96904 | Investigational Whole body integumentary photography, for monitoring of high risk | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96931 | Investigational Reflectance confocal microscopy (RCM) for cellular and sub | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96932 | Investigational Reflectance confocal microscopy (RCM) for cellular and sub | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96933 | Investigational Reflectance confocal microscopy (RCM) for cellular and sub | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96934 | Investigational Reflectance confocal microscopy (RCM) for cellular and sub | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96935 | Investigational Reflectance confocal microscopy (RCM) for cellular and sub | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96936 | Investigational Reflectance confocal microscopy (RCM) for cellular and sub | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 96999 | Cosmetic Potential Unlisted special dermatological service or procedure [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97039 | Investigational Unlisted modality [when specified as vertebral axial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97129 | Outpatient Therapies THER INTERVNTN COG FUNCTN DIR CONTACT 1ST 15 MINUTES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97139 | Investigational Unlisted therapeutic procedure [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97153 | Behavioral Health Adaptive behavior treatment by protocol, administered by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97154 | Behavioral Health Group adaptive behavior treatment by protocol, administered by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97155 | Behavioral Health Adaptive behavior treatment with protocol modification | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97156 | Behavioral Health Family adaptive behavior treatment guidance, administered by | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97157 | Behavioral Health Multiple-family group adaptive behavior treatment guidance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97158 | Behavioral Health Group adaptive behavior treatment with protocol modification | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97605 | Durable Medical Negative pressure wound therapy (eg, vacuum assisted drainage | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97606 | Durable Medical Negative pressure wound therapy (eg, vacuum assisted drainage | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97610 | Investigational Low frequency, non-contact, non-thermal ultrasound, including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 97799 | Investigational Unlisted physical medicine/rehabilitation service or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99183 | Hyperbaric treatment Physician attendance and supervision of hyperbaric | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99199 | Investigational Unlisted special service, procedure or report [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99377 | Hospice HOSPICE CARE SUPERVISION,15-29 MIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99378 | Hospice HOSPICE CARE SUPERVISION,30+ MIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99429 | Eval and Management UNLISTED PREVENTIVE SERVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99499 | Eval and Management UNLISTED E/M SERVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99500 | Home Health Home visit for prenatal monitoring and assessment to include fetal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99501 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99502 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99503 | Home Health Home visit for respiratory therapy care (eg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99504 | Home Health Home visit for mechanical ventilation care | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99505 | Home Health Home visit for stoma care and maintenance including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99506 | Home Health Home visit for intramuscular injections | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99507 | Home Health Home visit for care and maintenance of catheter(s) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99508 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99509 | Home Health Home visit for assistance with activities of daily living | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99510 | Home Health HOME VISIT,COUNSELING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99511 | Home Health Home visit for fecal impaction management and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99512 | Home Health Home visit for hemodialysis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99513 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99514 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99515 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99516 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99517 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99518 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99519 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99520 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99521 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99522 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99523 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99524 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99525 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99526 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99527 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99528 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99529 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99530 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99531 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99532 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99533 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99534 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99535 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99536 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99537 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99538 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99539 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99540 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99541 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99542 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99543 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99544 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99545 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99546 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99547 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99548 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99549 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99550 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99551 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99552 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99553 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99554 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99555 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99556 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99557 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99558 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99559 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99560 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99561 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99562 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99563 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99564 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99565 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99566 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99567 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99568 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99569 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99570 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99571 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99572 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99573 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99574 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99575 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99576 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99577 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99578 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99579 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99580 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99581 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99582 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99583 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99584 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99585 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99586 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99587 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99588 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99589 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99590 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99591 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99592 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99593 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99594 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99595 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99596 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99597 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99598 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99599 | used when CPT codes can be used) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99600 | Home Health Unlisted home visit service or procedure [when specified as home | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99601 | Home Health HOME INFUSION/VISIT, 2 HRS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| 99602 | Home Health HOME INFUSION, EACH ADDTL HR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0346 | Transportation AMBULANCE SERVICE, ALS, NON-EMERGENCY TR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0380 | Transportation BLS mileage (per mile) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0390 | Transportation ALS mileage (per mile) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0425 | Transportation Ground mileage, per statute mile | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0426 | Transportation Ambulance service, advanced life support | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0428 | Transportation Ambulance service, basic life support | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0430 | Transportation Ambulance service, conventional air services | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0431 | Transportation Ambulance service, conventional air services | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0432 | Transportation Paramedic intercept (PI), rural area, transport furnished by a | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0434 | Transportation Specialty care transport (SCT) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0435 | Transportation Fixed wing air mileage, per statute mile | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0436 | Transportation Rotary wing air mileage, per statute mile | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0888 | Transportation Noncovered ambulance mileage, per mile (e.g., for miles traveled | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A0999 | Transportation Unlisted ambulance service | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4100 | BioEngineered Wound Skin substitute, FDA cleared as a device, not | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4238 | MONTH SUPPLY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4290 | Durable Medical SACRAL NERVE STIM TEST LEAD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4468 | Investigational Potential Exsufflation belt, includes all supplies and accessories | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4555 | Durable Medical Electrode/transducer for use with electrical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4600 | Durable Medical Sleeve for intermittent limb compression device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4604 | Sleep Disorder Tubing with heating element | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4638 | Durable Medical Replacement battery for patient-owned ear pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A4659 | Investigational Surgical supply, miscellaneous [no specific code for antimicrobial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A6550 | Cardiac - Monitor Wound care set, for negative pressure wound therapy electrical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7025 | Durable Medical High frequency chest wall oscillation system vest, replacement for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7027 | Sleep Disorder Combination Oral/Nasal Mask used with positive airway pressure | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7028 | Sleep Disorder Oral Cushion, Replacement for Combination Oral/Nasal Mask, each | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7029 | Sleep Disorder Nasal Pillows, Replacement for Combination Oral/Nasal Mask, pair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7030 | Sleep Disorder Full Face Mask used with positive airway pressure device, each | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7031 | Sleep Disorder Face Mask Cushion, Replacement for Full Face Mask | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7032 | Sleep Disorder Replacement Cushion for Nasal Application Device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7033 | Sleep Disorder Replacement Pillows for Nasal Application Device, pair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7034 | Sleep Disorder Nasal Interface (mask or cannula type), used with positive airway | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7035 | Sleep Disorder Headgear | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7036 | Sleep Disorder Chinstrap | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7037 | Sleep Disorder Tubing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7038 | Sleep Disorder Filter, disposable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7044 | Sleep Disorder Oral Interface for Positive Airway Pressure Therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7045 | Sleep Disorder Replacement Exhalation Port for PAP Therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A7046 | Sleep Disorder Water chamber for humidifier, replacement, each | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9274 | Durable Medical EXT AMB INSULIN DELIVERY SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9276 | Pharmacy DISPOSABLE SENSOR, CGM SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9277 | Pharmacy EXTERNAL TRANSMITTER, CGM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9278 | Pharmacy EXTERNAL RECEIVER, CGM SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9513 | Pharmacy LUTETIUM LU 177, DOTATATE, THERAPEUTIC, 1 MILLICURIE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9543 | Radiation Yttrium Y-90 ibritumomab tiuxetan, per treatment dose (Zevalin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9573 | Advanced Imaging INJECTION, GADOPICLENOL, 1 ML | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9590 | Radiation Iodine I-131, iobenguane, 1 mCi (Azedra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9595 | Advanced Imaging Piflufolastat F-18, diagnostic, 1 mCi | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9596 | Advanced Imaging Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 mCi | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9597 | Advanced Imaging Positron emission tomography radiopharma | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9606 | Radiation Radium ra-223 dichloride, therapeutic (Xofigo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9607 | Radiation Lutetium lu 177 vipivotide tetraxetan (Pluvicto) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9900 | Durable Medical SUPPLY/ACCESSORY/SERVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| A9999 | Investigational Miscellaneous DME supply or accessory, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4035 | Durable Medical ENTERAL FEED SUPP PUMP PER D | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4102 | Durable Medical EF ADULT FLUIDS AND ELECTRO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4103 | Durable Medical EF PED FLUID AND ELECTROLYTE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4148 | Durable Medical Enteral feeding supply kit; elastomeric control fed, per day, includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4149 | Durable Medical EF BLENDERIZED FOODS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4150 | Durable Medical EF COMPLET W/INTACT NUTRIENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4152 | Durable Medical EF CALORIE DENSE>/=1.5KCAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4153 | Durable Medical EF HYDROLYZED/AMINO ACIDS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4154 | Durable Medical EF SPEC METABOLIC NONINHERIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4155 | Durable Medical EF INCOMPLETE/MODULAR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4157 | Durable Medical EF SPECIAL METABOLIC INHERIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4158 | Durable Medical EF PED COMPLETE INTACT NUT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4159 | Durable Medical EF PED COMPLETE SOY BASED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4160 | Durable Medical EF PED CALORIC DENSE>/=0.7KC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4161 | Durable Medical EF PED HYDROLYZED/AMINO ACID | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4162 | Durable Medical EF PED SPECMETABOLIC INHERIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4164 | Home Infusion Parenteral nutrition solution; carbohydrates (dextrose), 50% or less | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4168 | Home Infusion Parenteral nutrition solution; amino acid, 3.5%, (500 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4172 | Home Infusion Parenteral nutrition solution; amino acid, 5.5% | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4176 | Home Infusion Parenteral nutrition solution; amino acid, 7% | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4178 | Home Infusion Parenteral nutrition solution; amino acid, greater than | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4180 | Home Infusion Parenteral nutrition solution; carbohydrates (dextrose), greater than | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4185 | Home Infusion Parenteral nutrition solution, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4187 | Home Infusion Omegaven, 10 grams lipids | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4189 | Pharmacy PARENTERAL SOL AMINO ACID & | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4193 | Home Infusion Parenteral nutrition solution; compounded amino acid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4197 | Home Infusion Parenteral nutrition solution; compounded amino acid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4199 | Home Infusion Parenteral nutrition solution; compounded amino acid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4216 | Home Infusion Parenteral nutrition; additives (vitamins, trace | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4220 | Home Infusion Parenteral nutrition supply kit; premix, per day | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4222 | Home Infusion Parenteral nutrition supply kit; home mix, per day | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B4224 | Home Infusion Parenteral nutrition administration kit, per day | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B5000 | Home Infusion Parenteral nutrition solution compounded amino acid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B5100 | Home Infusion Parenteral nutrition solution compounded amino acid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B5200 | Home Infusion Parenteral nutrition solution compounded amino acid and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B9002 | Durable Medical ENTERAL INFUSION PUMP W/ ALA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B9004 | Home Infusion Parenteral nutrition infusion pump, portable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B9006 | Home Infusion Parenteral nutrition infusion pump, stationary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B9998 | Durable Medical ENTERAL SUPP NOT OTHERWISE C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| B9999 | Home Infusion NOC for parenteral supplies | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1761 | Procedure - Cardiac Catheter, transluminal intravascular lithotripsy, coronary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1767 | Neurostimulator Generator, neurostimulator (implantable), nonrechargeable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1772 | Implantable Infusion Infusion pump, programmable (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1778 | Neurostimulator Lead, neurostimulator (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1787 | Neurostimulator Patient programmer, neurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1789 | Surgical - Breast Prosthesis, breast (implantable) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1813 | Durable Medical Prosthesis, penile, inflatable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1820 | Neurostimulator Generator, neurostimulator (implantable), with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1822 | Neurostimulator Generator, neurostimulator (implantable), high frequency, with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1824 | Investigational Generator, cardiac contractility modulation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1833 | Investigational Monitor, cardiac, including intracardiac lead and all | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1839 | Investigational Iris prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1878 | Cosmetic Potential Material for vocal cord medialization, synthetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1883 | Neurostimulator Adapter/extension, pacing lead or neurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1885 | Procedure - Cardiac Catheter, transluminal angioplasty, laser | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1887 | Advanced Imaging Catheter, guiding (may include infusion/perfusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C1891 | Implantable Infusion Infusion pump, nonprogrammable, permanent | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C2616 | Surgical - Misc. Brachytherapy source, nonstranded, yttrium-90, per source [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C2622 | Durable Medical Prosthesis, penile, non-inflatable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C2626 | Implantable Infusion Infusion pump, nonprogrammable, temporary | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C2630 | Advanced Imaging CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5271 | Bioengineered Wound Application of low cost skin substitute graft to trunk | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5272 | Bioengineered Wound Application of low cost skin substitute graft to trunk | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5273 | Bioengineered Wound Application of low cost skin substitute graft to trunk, arms, legs, total | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5274 | Bioengineered Wound Application of low cost skin substitute graft to trunk, arms, legs, total | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5275 | Bioengineered Wound Application of low cost skin substitute graft to face, scalp, eyelids | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5276 | Bioengineered Wound Application of low cost skin substitute graft to face, scalp, eyelids | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5277 | Bioengineered Wound Application of low cost skin substitute graft to face | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C5278 | Bioengineered Wound Application of low cost skin substitute graft to face, scalp, eyelids | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C7531 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C7534 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C7535 | Procedure - Cardiac Revascularization, endovascular, open or percutaneous, femoral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8903 | Advanced Imaging Magnetic resonance imaging with contrast, breast; unilateral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8905 | Advanced Imaging Magnetic resonance imaging without contrast followed by with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8906 | Advanced Imaging Magnetic resonance imaging with contrast, breast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8907 | Advanced Imaging MAGNETIC RESONANCE IMAGING WITHOUT CONTR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8908 | Advanced Imaging Magnetic resonance imaging without contrast | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8910 | Advanced Imaging MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8914 | Advanced Imaging MAGNETIC RESONANCE ANGIOGRAPHY WITHOUT C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C8957 | Pharmacy PROLONGED IV INF, REQ PUMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9016 | Pharmacy Injection, triptorelin extended release | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9024 | Pharmacy Injection, liposomal, 1 mg daunorubicin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9027 | Pharmacy Injection, pembrolizumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9031 | Pharmacy LUTETIUM LU DOTATATE, THERAPEUTIC 1 mCi | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9047 | Pharmacy Caplacizumab-ydhp (Cablivi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9062 | Pharmacy Injection, daratumumab 10 mg and hyaluro | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9084 | Pharmacy Loncastuximab tesirine-lpyl (Zynlonta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9085 | Pharmacy Avalglucosidase alfa-ngpt (Nexviazyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9086 | Pharmacy Anifrolumab-fnia (Saphnelo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9101 | Pharmacy INJECTION, OLICERIDINE, 0.1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9146 | Pharmacy Mirvetuximab (Elahere) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9147 | Pharmacy Tremelimumab-actl (Imjudo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9148 | Pharmacy Teclistamab-cqyv (Tecvayli) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9149 | Pharmacy Teplizumab-mzwv (Tzield) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9248 | Pharmacy INJ, CLEVIDIPINE BUTYRATE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9257 | Pharmacy Bevacizumab, 0.25 mg intravitreal (Avastin) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9285 | Pharmacy LIDOCAINE 70 MG/TETRACAINE 70 MG, PER PATCH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9293 | Pharmacy INJ, GLUCARPIDASE, 10 UNITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9352 | BioEngineered Wound Microporous collagen implantable tube (NeuraGen | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9353 | BioEngineered Wound Microporous collagen implantable slit tube (NeuraWrap Nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9354 | BioEngineered Wound Acellular pericardial tissue matrix of non-human | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9355 | BioEngineered Wound Collagen nerve cuff (NeuroMatrix), per 0.5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9356 | BioEngineered Wound Tendon, porous matrix of cross-linked collagen and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9358 | BioEngineered Wound Dermal substitute, native, non-denatured collagen, fetal bovine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9360 | BioEngineered Wound Dermal substitute, native, non-denatured collagen, neonatal bovine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9361 | BioEngineered Wound Collagen matrix nerve wrap (NeuroMend Collagen Nerve Wrap), per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9363 | BioEngineered Wound Skin substitute, Integra Meshed Bilayer Wound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9364 | BioEngineered Wound Porcine implant, Permacol, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9399 | Pharmacy Avalglucosidase alfa-ngpt (Nexviazyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9453 | Pharmacy Injection, nivolumab, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9483 | Pharmacy Injection, atezolizumab, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9487 | Pharmacy USTEKINUMAB IV INJ, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9488 | Pharmacy INJ, CONIVAPTAN HYDROCHLORIDE, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9489 | Pharmacy Injection, nusinersen, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9727 | Surgical - Maxilofacial Insertion of implants into the soft palate; minimum | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9734 | Advanced Imaging Focused ultrasound ablation/therapeutic intervention, other than | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9770 | Transplant Vitrectomy, mechanical, pars plana approach, with subretinal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| C9771 | Surgical - ENT Nasal/sinus endoscopy, cryoablation nasal tissue(s) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D5932 | Durable Medical OBTURATOR PROSTHESIS DEFINITIVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7940 | Surgical - Maxilofacial Osteoplasty, for orthognathic deformities | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7941 | Surgical - Maxilofacial Osteotomy - mandibular rami | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7943 | Surgical - Maxilofacial Osteotomy - mandibular rami with bone graft; includes obtaining | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7944 | Investigational Osteotomy-segmented or subapical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7945 | Surgical - Maxilofacial Osteotomy, body of mandible | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7946 | Surgical - Maxilofacial LeFort I (maxilla, total) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7947 | Surgical - Maxilofacial LeFort I (maxilla, segmented) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7948 | Surgical - Maxilofacial LeFort II or LeFort III (osteoplasty of facial bones for midface | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7949 | Surgical - Maxilofacial LeFort II or LeFort III, with bone graft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7950 | Surgical - Maxilofacial Osseous, osteoperiosteal, or cartilage graft of the mandible or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7995 | Surgical - Maxilofacial Synthetic graft, mandible or facial bones, by report | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| D7996 | Surgical - Maxilofacial Implant, mandible for augmentation purposes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0181 | Durable Medical PRESS PAD ALTERNATING W/ PUM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0182 | Durable Medical REPLACE PUMP, ALT PRESS PAD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0183 | Durable Medical POWERED PRESSURE REDUCING UNDERLAY/PAD, ALTERNATING, WITH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0184 | Durable Medical DRY PRESSURE MATTRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0186 | Durable Medical AIR PRESSURE MATTRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0187 | Durable Medical WATER PRESSURE MATTRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0188 | Durable Medical SYNTHETIC SHEEPSKIN PAD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0189 | Durable Medical LAMBSWOOL SHEEPSKIN PAD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0190 | Durable Medical POSITIONING CUSHION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0193 | Durable Medical POWERED AIR FLOTATION BED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0194 | Durable Medical AIR FLUIDIZED BED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0196 | Durable Medical GEL PRESSURE MATTRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0197 | Durable Medical AIR PRESSURE PAD, MATTRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0198 | Durable Medical WATER PRESSURE PAD FOR MATTR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0202 | Durable Medical PHOTOTHERAPY LIGHT W/ PHOTOM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0217 | Durable Medical Water circulating heat pad with pump [when specified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0218 | Durable Medical Fluid circulating cold pad with pump, any type | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0236 | Durable Medical Pump for water circulating pad | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0250 | Durable Medical HOSP BED FIXED HT W/ MATTRES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0251 | Durable Medical HOSP BED FIXD HT W/O MATTRES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0255 | Durable Medical HOSPITAL BED VAR HT W/ MATTR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0256 | Durable Medical HOSPITAL BED VAR HT W/O MATT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0260 | Durable Medical HOSP BED SEMI-ELECTR W/ MATT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0261 | Durable Medical HOSP BED SEMI-ELECTR W/O MAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0265 | Durable Medical HOSP BED TOTAL ELECTR W/ MAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0266 | Durable Medical HOSP BED TOTAL ELEC W/O MATT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0270 | Durable Medical HOSPITAL BED INSTITUTIONAL T | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0277 | Durable Medical POWERED PRES-REDU AIR MATTRS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0296 | Durable Medical HOSP BED TOTAL ELECT W/ MATT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0297 | Durable Medical HOSP BED TOTAL ELECT W/O MAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0300 | Durable Medical ENCLOSED PED CRIB HOSP GRADE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0301 | Durable Medical HD HOSP BED, 350-600 LBS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0302 | Durable Medical EX HD HOSP BED > 600 LBS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0303 | Durable Medical HOSP BED HVY DTY XTRA WIDE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0304 | Durable Medical HOSP BED XTRA HVY DTY X WIDE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0316 | Durable Medical BED SAFETY ENCLOSURE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0371 | Durable Medical NONPOWER MATTRESS OVERLAY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0372 | Durable Medical POWERED AIR OVERLAY FOR MATTRESS, STANDA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0373 | Durable Medical NONPOWERED PRESSURE MATTRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0455 | Durable Medical OXYGEN TENT EXCL CROUP/PED T | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0457 | Durable Medical CHEST SHELL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0459 | Durable Medical CHEST WRAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0462 | Durable Medical ROCKING BED W/ OR W/O SIDE R | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0465 | Durable Medical HOME VENTILATOR, ANY TYPE, USED WITH INVASIVE INTERFACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0466 | Durable Medical HOME VENTILATOR, ANY TYPE, USED WITH NON-INVASIVE INTERFACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0467 | Durable Medical HOME VENTILATOR MULTI-FUNCTION RESPIRATORY DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0470 | Durable Medical Respiratory assist device, bi-level pressure capability, without back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0471 | Durable Medical Respiratory assist device, bi-level pressure capability, with back-up | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0472 | Durable Medical RAD W BACKUP INVASIVE INTRFC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0480 | Durable Medical PERCUSSOR ELECT/PNEUM HOME M | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0481 | Durable Medical Intrapulmonary percussive ventilation system and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0482 | Durable Medical COUGH STIMULATING DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0483 | Durable Medical High frequency chest wall oscillation air-pulse generator system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0484 | Durable Medical NON-ELEC OSCILLATORY PEP DVC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0485 | Sleep Disorder Oral device/appliance used to reduce upper airway collapsibility | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0486 | Sleep Disorder Oral device/appliance used to reduce upper airway collapsibility | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0500 | Durable Medical IPPB ALL TYPES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0530 | Electronic positional obstructive sleep apnea treatment, with sensor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0561 | Sleep Disorder Humidifier, non-heated, used with positive airway pressure device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0562 | Sleep Disorder Humidifier, heated, used with positive airway pressure device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0565 | Durable Medical COMPRESSOR AIR POWER SOURCE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0572 | Durable Medical AEROSOL COMPRESSOR ADJUST PR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0574 | Durable Medical ULTRASONIC GENERATOR W SVNEB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0575 | Durable Medical NEBULIZER ULTRASONIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0580 | Durable Medical NEBULIZER FOR USE W/ REGULAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0585 | Durable Medical NEBULIZER W/ COMPRESSOR & HE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0600 | Durable Medical SUCTION PUMP PORTAB HOM MODL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0601 | Durable Medical Continuous airway pressure (CPAP) device [may be used for either | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0604 | Durable Medical HOSP GRADE ELEC BREAST PUMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0610 | Durable Medical PACEMAKER MONITR AUDIBLE/VIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0615 | Durable Medical PACEMAKER MONITR DIGITAL/VIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0617 | Durable Medical External defibrillator with integrated | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0618 | Durable Medical APNEA MONITOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0619 | Durable Medical APNEA MONITOR W RECORDER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0621 | Durable Medical PATIENT LIFT SLING OR SEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0629 | Durable Medical SEAT LIFT FOR PT FURN-NON-EL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0630 | Durable Medical PATIENT LIFT HYDRAULIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0635 | Durable Medical PATIENT LIFT ELECTRIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0636 | Durable Medical PT SUPPORT & POSITIONING SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0637 | Durable Medical Combination sit to stand frame/table system, any size including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0638 | Durable Medical Standing frame/table system, one position (e.g., upright, supine, or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0639 | Durable Medical MOVEABLE PATIENT LIFT SYSTEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0640 | Durable Medical FIXED PATIENT LIFT SYSTEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0641 | Durable Medical Standing frame/table system, multi-position (e.g., 3- way stander) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0642 | Durable Medical Standing frame/table system, multi-position (e.g. three-way | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0650 | Durable Medical Pneumatic compressor, non-segmental home model | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0651 | Durable Medical Pneumatic compressor, segmental home model | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0652 | Durable Medical Pneumatic compressor, segmental home model | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0655 | Durable Medical Non-segmental pneumatic appliance for use with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0656 | Durable Medical SEGMENTAL PNEUMATIC TRUNK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0657 | Durable Medical SEGMENTAL PNEUMATIC CHEST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0660 | Durable Medical Non-segmental pneumatic appliance for use with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0665 | Durable Medical Non-segmental pneumatic appliance for use with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0666 | Durable Medical Non-segmental pneumatic appliance for use with pneumatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0667 | Durable Medical Segmental pneumatic appliance for use with pneumatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0668 | Durable Medical Segmental pneumatic appliance for use with pneumatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0669 | Durable Medical Segmental pneumatic appliance for use with pneumatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0670 | Durable Medical Segmental pneumatic appliance for use with pneumatic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0671 | Durable Medical Segmental gradient pressure pneumatic appliance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0672 | Durable Medical Segmental gradient pressure pneumatic appliance, full arm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0673 | Durable Medical Segmental gradient pressure pneumatic appliance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0675 | Durable Medical PNEUMATIC COMPRESSION DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0676 | Durable Medical Intermittent limb compression device (includes all | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0691 | Durable Medical UVL PNL 2 SQ FT OR LESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0692 | Durable Medical UVL SYS PANEL 4 FT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0693 | Durable Medical UVL SYS PANEL 6 FT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0694 | Durable Medical ULTRAVIOLET MULTIDIRECTIONAL LIGHT THERA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0732 | Neurostimulator Cranial electrotherapy stimulation (CES) system, any type | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0734 | External upper limb tremor stimulator of the peripheral | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0745 | Durable Medical Neuromuscular stimulator, electronic shock unit | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0747 | Durable Medical ELEC OSTEOGEN STIM NOT SPINE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0748 | Surgical - Spine Osteogenesis stimulator, electrical, non-invasive, spinal applications | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0749 | Bone Growth Osteogenesis stimulator, electrical, surgically implanted | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0760 | Durable Medical Osteogenesis stimulator, low intensity ultrasound | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0764 | Durable Medical Functional neuromuscular stimulation, transcutaneous stimulation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0765 | Durable Medical NERVE STIMULATOR FOR TX N&V | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0766 | Durable Medical Electrical stimulation device used for cancer | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0770 | Durable Medical Functional electrical stimulator, transcutaneous stimulation of nerve | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0776 | Durable Medical IV POLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0779 | Durable Medical AMB INFUSION PUMP MECHANICAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0780 | Durable Medical MECH AMB INFUSION PUMP <8HRS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0781 | Durable Medical EXTERNAL AMBULATORY INFUS PU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0782 | Implantable Infusion Infusion pump, implantable, nonprogrammable (includes all | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0783 | Implantable Infusion Infusion pump system, implantable, programmable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0784 | Durable Medical EXTERNAL AMBULATORY INFUSION PUMP, INSUL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0785 | Durable Medical IMPLANTABLE INTRASPINAL (EPIDURAL/INTRAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0787 | Durable Medical EXT AMB INF PUMP, INSULIN, W/CONT GLUCOSE SENSING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0791 | Durable Medical PARENTERAL INFUSION PUMP STA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0830 | Durable Medical AMBULATORY TRACTION DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0911 | Durable Medical HD TRAPEZE BAR ATTACH TO BED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0930 | Durable Medical FRACTURE FRAME FREE STANDING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0946 | Durable Medical FRACTURE FRAME DUAL W CROSS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0947 | Durable Medical FRACTURE FRAME ATTACHMNTS PE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0948 | Durable Medical FRACTURE FRAME ATTACHMNTS CE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0951 | Durable Medical LOOP HEEL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0952 | Durable Medical TOE LOOP/HOLDER, EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0953 | Durable Medical WHEELCHAIR ACCESSORY; LATERAL THIGH/KNEE SUPPORT, INCL FIXED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0954 | Durable Medical WHEELCHAIR ACCESSORY; FOOT BOX, ATTACHMENT AND MOUNTING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0955 | Durable Medical CUSHIONED HEADREST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0956 | Durable Medical W/C LATERAL TRUNK/HIP SUPPOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0957 | Durable Medical W/C MEDIAL THIGH SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0958 | Durable Medical WHLCHR ATT- CONV 1 ARM DRIVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0959 | Durable Medical AMPUTEE ADAPTER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0960 | Durable Medical W/C SHOULDER HARNESS/STRAPS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0961 | Durable Medical WHEELCHAIR BRAKE EXTENSION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0966 | Durable Medical WHEELCHAIR HEAD REST EXTENSI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0967 | Durable Medical MANUAL WC HAND RIM W PROJECT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0968 | Durable Medical WHEELCHAIR COMMODE SEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0969 | Durable Medical WHEELCHAIR NARROWING DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0970 | Durable Medical WHEELCHAIR NO. 2 FOOTPLATES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0971 | Durable Medical WHEELCHAIR ANTI-TIPPING DEVI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0973 | Durable Medical W/CH ACCESS DET ADJ ARMREST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0974 | Durable Medical W/CH ACCESS ANTI-ROLLBACK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0978 | Durable Medical W/C ACC,SAF BELT PELV STRAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0980 | Durable Medical WHEELCHAIR SAFETY VEST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0981 | Durable Medical SEAT UPHOLSTERY, REPLACEMENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0982 | Durable Medical BACK UPHOLSTERY, REPLACEMENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0983 | Durable Medical MANUAL WHEELCHAIR ACCESSORY, POWER ADD-O | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0984 | Durable Medical ADD PWR TILLER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0985 | Durable Medical W/C SEAT LIFT MECHANISM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0986 | Durable Medical Manual wheelchair accessory, push-rim activated | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0988 | Durable Medical MANUAL WHEELCHAIR ACCESSORY, LEVER-ACTIVATED, WHEEL DRIVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0990 | Durable Medical WHEELCHAIR ELEVATING LEG RES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0992 | Durable Medical WHEELCHAIR SOLID SEAT INSERT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0994 | Durable Medical WHEELCHAIR ARM REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E0995 | Durable Medical WHEELCHAIR CALF REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1002 | Durable Medical Wheelchair accessory, power seating system, tilt | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1003 | Durable Medical Wheelchair accessory, power seating system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1004 | Durable Medical Wheelchair accessory, power seating system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1005 | Durable Medical Wheelchair accessory, power seatng System, recline | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1006 | Durable Medical Wheelchair accessory, power seating system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1007 | Durable Medical Wheelchair accessory, power seating system, combination tilt and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1008 | Durable Medical Wheelchair accessory, power seating system, combination tilt and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1009 | Durable Medical Wheelchair accessory, addition to power seating system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1010 | Durable Medical Wheelchair accessory, addition to power seating system, power leg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1011 | Durable Medical PED WC MODIFY WIDTH ADJUSTM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1012 | Durable Medical Wheelchair accessory, addition to power seating system, center | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1014 | Durable Medical RECLINING BACK ADD PED W/C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1015 | Durable Medical SHOCK ABSORBER FOR MAN W/C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1016 | Durable Medical SHOCK ABSORBER FOR POWER W/C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1017 | Durable Medical HD SHCK ABSRBR FOR HD MAN WC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1018 | Durable Medical HD SHCK ABSRBER FOR HD POWWC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1020 | Durable Medical RESIDUAL LIMB SUPPORT SYSTEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1028 | Durable Medical W/C MANUAL SWINGAWAY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1029 | Durable Medical W/C VENT TRAY FIXED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1030 | Durable Medical W/C VENT TRAY GIMBALED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1035 | Durable Medical PATIENT TRANSFER SYSTEM <300 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1036 | Durable Medical PATIENT TRANSFER SYSTEM >300 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1037 | Durable Medical TRANSPORT CHAIR, PED SIZE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1038 | Durable Medical TRANSPORT CHAIR PT WT<=300LB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1039 | Durable Medical TRANSPORT CHAIR PT WT >300LB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1050 | Durable Medical WHELCHR FXD FULL LENGTH ARMS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1060 | Durable Medical WHEELCHAIR DETACHABLE ARMS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1070 | Durable Medical WHEELCHAIR DETACHABLE FOOT R | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1083 | Durable Medical HEMI-WHEELCHAIR FIXED ARMS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1084 | Durable Medical HEMI-WHEELCHAIR DETACHABLE A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1085 | Durable Medical HEMI-WHEELCHAIR FIXED ARMS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1086 | Durable Medical HEMI-WHEELCHAIR DETACHABLE A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1087 | Durable Medical WHEELCHAIR LIGHTWT FIXED ARM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1088 | Durable Medical WHEELCHAIR LIGHTWEIGHT DET A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1089 | Durable Medical WHEELCHAIR LIGHTWT FIXED ARM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1090 | Durable Medical WHEELCHAIR LIGHTWEIGHT DET A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1092 | Durable Medical WHEELCHAIR WIDE W/ LEG RESTS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1093 | Durable Medical WHEELCHAIR WIDE W/ FOOT REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1100 | Durable Medical WHCHR S-RECL FXD ARM LEG RES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1110 | Durable Medical WHEELCHAIR SEMI-RECL DETACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1130 | Durable Medical WHLCHR STAND FXD ARM FT REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1140 | Durable Medical WHEELCHAIR STANDARD DETACH A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1150 | Durable Medical WHEELCHAIR STANDARD W/ LEG R | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1160 | Durable Medical WHEELCHAIR FIXED ARMS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1161 | Durable Medical MANUAL ADULT WC W TILTINSPAC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1170 | Durable Medical WHLCHR AMPU FXD ARM LEG REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1171 | Durable Medical WHEELCHAIR AMPUTEE W/O LEG R | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1172 | Durable Medical WHEELCHAIR AMPUTEE DETACH AR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1180 | Durable Medical WHEELCHAIR AMPUTEE W/ FOOT R | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1190 | Durable Medical WHEELCHAIR AMPUTEE W/ LEG RE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1195 | Durable Medical WHEELCHAIR AMPUTEE HEAVY DUT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1200 | Durable Medical WHEELCHAIR AMPUTEE FIXED ARM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1220 | Durable Medical WHLCHR SPECIAL SIZE/CONSTRC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1221 | Durable Medical WHEELCHAIR SPEC SIZE W FOOT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1222 | Durable Medical WHEELCHAIR SPEC SIZE W/ LEG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1223 | Durable Medical WHEELCHAIR SPEC SIZE W FOOT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1224 | Durable Medical WHEELCHAIR SPEC SIZE W/ LEG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1225 | Durable Medical MANUAL SEMI-RECLINING BACK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1226 | Durable Medical MANUAL FULLY RECLINING BACK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1227 | Durable Medical WHEELCHAIR SPEC SZ SPEC HT A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1228 | Durable Medical WHEELCHAIR SPEC SZ SPEC HT B | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1229 | Durable Medical PEDIATRIC WHEELCHAIR NOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1230 | Durable Medical Power operated vehicle (3- or 4-wheel nonhighway, specify brand | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1231 | Durable Medical RIGID PED W/C TILT-IN-SPACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1232 | Durable Medical FOLDING PED WC TILT-IN-SPACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1233 | Durable Medical RIG PED WC TLTNSPC W/O SEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1234 | Durable Medical FLD PED WC TLTNSPC W/O SEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1235 | Durable Medical RIGID PED WC ADJUSTABLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1236 | Durable Medical FOLDING PED WC ADJUSTABLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1237 | Durable Medical RGD PED WC ADJSTABL W/O SEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1238 | Durable Medical FLD PED WC ADJSTABL W/O SEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1239 | Durable Medical Power wheelchair, pediatric size, not otherwise | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1240 | Durable Medical WHCHR LITWT DET ARM LEG REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1250 | Durable Medical WHEELCHAIR LIGHTWT FIXED ARM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1260 | Durable Medical WHEELCHAIR LIGHTWT FOOT REST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1270 | Durable Medical WHEELCHAIR LIGHTWEIGHT LEG R | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1280 | Durable Medical WHCHR H-DUTY DET ARM LEG RES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1285 | Durable Medical WHEELCHAIR HEAVY DUTY FIXED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1290 | Durable Medical WHEELCHAIR HVY DUTY DETACH A | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1295 | Durable Medical WHEELCHAIR HEAVY DUTY FIXED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1296 | Durable Medical WHEELCHAIR SPECIAL SEAT HEIG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1297 | Durable Medical WHEELCHAIR SPECIAL SEAT DEPT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1298 | Durable Medical WHEELCHAIR SPEC SEAT DEPTH/W | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1352 | Durable Medical OXYGEN ACC FLOW REG CPBL POS INSPIRATORY PRESS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1390 | Durable Medical OXYGEN CONCENTRATOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1391 | Durable Medical OXYGEN CONCENTRATOR, DUAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1392 | Durable Medical PORTABLE OXYGEN CONCENTRATOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1399 | Durable Medical Durable medical equipment, miscellaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1405 | Durable Medical O2/WATER VAPOR ENRICH W/HEAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1406 | Durable Medical O2/WATER VAPOR ENRICH W/O HE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1510 | Durable Medical KIDNEY DIALYSATE DELIVRY SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1520 | Durable Medical HEPARIN INFUSION PUMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1530 | Durable Medical REPLACEMENT AIR BUBBLE DETEC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1540 | Durable Medical REPLACEMENT PRESSURE ALARM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1550 | Durable Medical BATH CONDUCTIVITY METER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1560 | Durable Medical REPLACE BLOOD LEAK DETECTOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1570 | Durable Medical ADJUSTABLE CHAIR FOR ESRD PT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1575 | Durable Medical TRANSDUCER PROTECT/FLD BAR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1580 | Durable Medical UNIPUNCTURE CONTROL SYSTEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1590 | Durable Medical HEMODIALYSIS MACHINE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1592 | Durable Medical AUTO INTERM PERITONEAL DIALY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1594 | Durable Medical CYCLER DIALYSIS MACHINE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1600 | Durable Medical DELI/INSTALL CHRG HEMO EQUIP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1610 | Durable Medical REVERSE OSMOSIS H2O PURI SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1620 | Durable Medical REPLACEMENT BLOOD PUMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1630 | Durable Medical RECIPROCATING PERITONEAL DIA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1634 | Durable Medical PERITONEAL DIALYSIS CLAMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1635 | Durable Medical COMPACT TRAVEL HEMODIALYZER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1636 | Durable Medical SORBENT CARTRIDGES PER 10 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1637 | Durable Medical HEMOSTATS FOR DIALYSIS, EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1699 | Durable Medical DIALYSIS EQUIPMENT NOC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1800 | Durable Medical ADJUST ELBOW EXT/FLEX DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1802 | Durable Medical ADJST FOREARM PRO/SUP DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1805 | Durable Medical ADJUST WRIST EXT/FLEX DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1810 | Durable Medical ADJUST KNEE EXT/FLEX DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1812 | Durable Medical KNEE EXT/FLEX W ACT RES CTRL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1815 | Durable Medical ADJUST ANKLE EXT/FLEX DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1820 | Durable Medical SOFT INTERFACE MATERIAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1821 | Durable Medical Replacement soft interface material/cuffs for bi- directional static | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1825 | Durable Medical ADJUST FINGER EXT/FLEX DEVC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1830 | Durable Medical ADJUST TOE EXT/FLEX DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1840 | Durable Medical ADJ SHOULDER EXT/FLEX DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E1905 | Durable Medical Virtual reality cognitive behavioral therapy device (CBT), including | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2000 | Durable Medical GASTRIC SUCTION PUMP HME MDL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2102 | Pharmacy ADJUNCTIVE CONT GLUCOSE MONITOR OR RECEIVER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2103 | RECEIVER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2201 | Durable Medical MAN W/CH ACC SEAT W>=20<24 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2202 | Durable Medical SEAT WIDTH 24-27 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2203 | Durable Medical FRAME DEPTH LESS THAN 22 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2204 | Durable Medical FRAME DEPTH 22 TO 25 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2205 | Durable Medical MANUAL WC ACCESSORY, HANDRIM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2206 | Durable Medical COMPLETE WHEEL LOCK ASSEMBLY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2207 | Durable Medical CRUTCH AND CANE HOLDER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2208 | Durable Medical CYLINDER TANK CARRIER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2209 | Durable Medical ARM TROUGH EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2210 | Durable Medical WHEELCHAIR BEARINGS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2211 | Durable Medical PNEUMATIC PROPULSION TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2212 | Durable Medical PNEUMATIC PROP TIRE TUBE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2213 | Durable Medical PNEUMATIC PROP TIRE INSERT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2214 | Durable Medical PNEUMATIC CASTER TIRE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2215 | Durable Medical PNEUMATIC CASTER TIRE TUBE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2216 | Durable Medical FOAM FILLED PROPULSION TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2217 | Durable Medical FOAM FILLED CASTER TIRE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2218 | Durable Medical FOAM PROPULSION TIRE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2219 | Durable Medical FOAM CASTER TIRE ANY SIZE EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2222 | Durable Medical SOLID CASTER INTEGRATED WHL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2227 | Durable Medical MANUAL WHEELCHAIR ACCESSORY, GEAR REDUCT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2228 | Durable Medical MWC ACC, WHEELCHAIR BRAKE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2230 | Durable Medical Manual wheelchair accessory, manual standing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2231 | Durable Medical SOLID SEAT SUPPORT BASE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2291 | Durable Medical PLANAR BACK FOR PED SIZE WC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2292 | Durable Medical PLANAR SEAT FOR PED SIZE WC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2294 | Durable Medical CONTOUR SEAT FOR PED SIZE WC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2295 | Durable Medical PED DYNAMIC SEATING FRAME | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2300 | Durable Medical Power wheelchair accessory, power seat elevation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2301 | Durable Medical Power wheelchair accessory, power standing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2310 | Durable Medical Power wheelchair accessory, electronic connection between | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2311 | Durable Medical Power wheelchair accessory, electronic connection between | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2312 | Durable Medical Power wheelchair accessory, hand or chin control interface, mini | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2313 | Durable Medical PWC HARNESS, EXPAND CONTROL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2321 | Durable Medical Power wheelchair accessory, hand control interface, remote joystick | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2322 | Durable Medical Power wheelchair accessory, hand control interface, multiple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2323 | Durable Medical Power wheelchair accessory, specialty joystick handle for hand | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2324 | Durable Medical Power wheelchair accessory, chin cup for chin control interface | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2325 | Durable Medical Power wheelchair accessory, sip and puff interface, nonproportional | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2326 | Durable Medical Power wheelchair accessory, breath tube kit for sip and puff | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2327 | Durable Medical Power wheelchair accessory, head control interface, mechanical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2328 | Durable Medical POWER WHEELCHAIR ACCESSORY, HEAD CONTROL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2329 | Durable Medical Power wheelchair accessory, head control interface, contact switch | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2330 | Durable Medical Power wheelchair accessory, head control interface, proximity | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2331 | Durable Medical Power wheelchair accessory, attendant control, proportional | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2340 | Durable Medical Power wheelchair accessory, nonstandard seat frame width, 20-23 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2341 | Durable Medical Power wheelchair accessory, nonstandard seat frame width, 24-27 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2342 | Durable Medical Power wheelchair accessory, nonstandard seat frame depth, 20 or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2343 | Durable Medical Power wheelchair accessory, nonstandard seat frame depth, 22-25 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2351 | Durable Medical Power wheelchair accessory, electronic interface to operate speech | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2366 | Durable Medical BATTERY CHARGER, SINGLE MODE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2370 | Durable Medical PWR WC MOTOR/GEAR BOX COMBO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2373 | Durable Medical HAND/CHIN CTRL SPEC JOYSTICK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2374 | Durable Medical HAND/CHIN CTRL STD JOYSTICK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2375 | Durable Medical NON-EXPANDABLE CONTROLLER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2376 | Durable Medical EXPANDABLE CONTROLLER, REPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2377 | Durable Medical EXPANDABLE CONTROLLER, INITL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2381 | Durable Medical PNEUM DRIVE WHEEL TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2382 | Durable Medical TUBE, PNEUM WHEEL DRIVE TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2383 | Durable Medical INSERT, PNEUM WHEEL DRIVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2384 | Durable Medical PNEUMATIC CASTER TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2385 | Durable Medical TUBE, PNEUMATIC CASTER TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2386 | Durable Medical FOAM FILLED DRIVE WHEEL TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2387 | Durable Medical FOAM FILLED CASTER TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2389 | Durable Medical FOAM CASTER TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2390 | Durable Medical SOLID DRIVE WHEEL TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2391 | Durable Medical SOLID CASTER TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2394 | Durable Medical DRIVE WHEEL EXCLUDES TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2402 | Cardiac - Monitor Negative pressure wound therapy electrical pump, stationary or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2500 | Durable Medical Speech generating device, digitized speech, using pre- recorded | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2502 | Durable Medical Speech generating device, digitized speech, using | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2504 | Durable Medical Speech generating device, digitized speech, using prerecorded | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2506 | Durable Medical Speech generating device, digitized speech, using | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2508 | Durable Medical Speech generating device, synthesized speech, requiring message | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2510 | Durable Medical Speech generating device, synthesized speech, permitting multiple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2511 | Durable Medical Speech generating software program, for personal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2512 | Durable Medical Accessory for speech generating device, mounting | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2599 | Durable Medical Accessory for speech generating device, not | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2601 | Durable Medical GEN W/C CUSHION WDTH < 22 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2602 | Durable Medical GEN W/C CUSHION WDTH >=22 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2603 | Durable Medical SKIN PROTECT WC CUS WD <22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2604 | Durable Medical SKIN PROTECT WC CUS WD>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2605 | Durable Medical POSITION WC CUSH WDTH <22 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2606 | Durable Medical POSITION WC CUSH WDTH>=22 IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2607 | Durable Medical SKIN PRO/POS WC CUS WD <22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2608 | Durable Medical SKIN PRO/POS WC CUS WD>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2609 | Durable Medical CUSTOM FABRICATE W/C CUSHION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2610 | Durable Medical POWERED W/C CUSHION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2611 | Durable Medical GEN USE BACK CUSH WDTH <22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2612 | Durable Medical GEN USE BACK CUSH WDTH>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2613 | Durable Medical POSITION BACK CUSH WD <22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2614 | Durable Medical POSITION BACK CUSH WD>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2615 | Durable Medical POS BACK POST/LAT WDTH <22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2616 | Durable Medical POS BACK POST/LAT WDTH>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2617 | Durable Medical CUSTOM FAB W/C BACK CUSHION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2619 | Durable Medical REPLACE COVER W/C SEAT CUSH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2620 | Durable Medical WC PLANAR BACK CUSH WD <22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2621 | Durable Medical WC PLANAR BACK CUSH WD>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2622 | Durable Medical ADJ SKIN PRO W/C CUS WD<22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2623 | Durable Medical ADJ SKIN PRO WC CUS WD>=22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2624 | Durable Medical ADJ SKIN PRO/POS CUS<22IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2625 | Durable Medical ADJ SKIN PRO/POS WC CUS>=22 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2626 | Durable Medical WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2627 | Durable Medical WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2628 | Durable Medical WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2629 | Durable Medical WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2630 | Durable Medical WHEELCHAIR ACCESSORY, SHOULDER ELBOW, MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2631 | Durable Medical WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2632 | Durable Medical WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT, OFFSET | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E2633 | Durable Medical WHEELCHAIR ACCESSORY, ADDITION TO MOBILE ARM SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E8000 | Durable Medical POSTERIOR GAIT TRAINER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E8001 | Durable Medical UPRIGHT GAIT TRAINER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| E8002 | Durable Medical ANTERIOR GAIT TRAINER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0035 | Advanced Imaging PET MYOCARDIAL PERFUSION IMAGING, (FOLLO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0068 | Home Health Professional services for the administration of anti- infective, pain | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0069 | Home Health Professional services for the administration of subcutaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0070 | Home Health Professional services for the administration of intravenous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0088 | Home Health Professional services, initial visit, for the administration of anti | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0089 | Home Health Professional services, initial visit, for the administration of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0090 | Home Health Professional services, initial visit, for the administration of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0151 | Home Health Services performed by a qualified physical therapist in the home | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0152 | Home Health Services performed by a qualified occupational | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0153 | Home Health Services performed by a qualified speech-language | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0155 | Home Health Services of clinical social worker in home health or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0156 | Home Health Services of home health/hospice aide in home health | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0157 | Home Health Services performed by a qualified physical therapist assistant in the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0158 | Home Health Services performed by a qualified occupational therapist assistant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0159 | Home Health Services performed by a qualified physical therapist, in the home | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0160 | Home Health Services performed by a qualified occupational therapist, in the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0161 | Home Health Services performed by a qualified speech-language pathologist, in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0162 | Home Health Skilled services by a registered nurse (RN) for management and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0176 | Behavioral Health Activity therapy, such as music, dance, art or play therapies not for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0182 | Hospice HOSPICE CARE SUPERVISION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0235 | Advanced Imaging PET NOT OTHERWISE SPECIFIED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0277 | Hyperbaric Treatment Hyperbaric oxygen under pressure, full body | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0299 | Home Health Direct skilled nursing services of a registered nurse (RN) in the home | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0300 | Home Health Direct skilled nursing services of a licensed practical nurse (LPN) in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0321 | Home Health Home health services furnished using synchronous telemedicine | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0322 | Home Health The collection of physiologic data digitally stored and/or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0329 | Procedure - Misc. Electromagnetic therapy to one or more areas for chronic ulcers | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0339 | Radiation Robot lin-radsurg com, first | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0340 | Radiation Robt lin-radsurg fractx 2-5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0341 | Transplant Percutaneous islet cell transplant, includes portal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0342 | Transplant Laparoscopy for islet cell transplant, includes portal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0343 | Transplant Laparotomy for islet cell transplant, includes portal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0410 | Behavioral Health GRP PSYCH PARTIAL HOSP 45-50 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0411 | Behavioral Health INTER ACTIVE GRP PSYCH PARTI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0429 | Cosmetic Potential Dermal filler injection(s) for the treatment of facial lipodystrophy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0452 | Genetic Testing MOLECULAR PATHOLOGY PROCEDURE; PHYSICIAN INTERP AND REPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0453 | Procedure - Misc. CONTINUOUS INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING, FROM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0455 | Procedure - Misc. PREPARATION WITH INSTILLATION OF FECAL MICROBIOTA BY ANY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0458 | Radiation Low dose rate (ldr) prostate brachytherapy services, composite rate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0490 | Home Health FACE-TO-FACE HOME HEALTH NURSING VISIT BY RHC OR FQHC IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0493 | Home Health Skilled services of a registered nurse (RN) for the observation and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0494 | Home Health Skilled services of a licensed practical nurse (LPN) for the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0495 | Home Health Skilled services of a registered nurse (RN), in the training and/or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G0496 | Home Health Skilled services of a licensed practical nurse (LPN), in the training | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G2168 | Home Health Services performed by a physical therapist assistant in the home | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G2169 | Home Health Services performed by an occupational therapist assistant in the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6001 | Radiation Ultrasonic guidance for placement of radiation therapy fields | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6002 | Radiation Stereoscopic x-ray guidance for localization of target volume for the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6003 | Radiation Radiation treatment delivery, single treatment area,single port or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6004 | Radiation Radiation treatment delivery, single treatment area,single port or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6005 | Radiation Radiation treatment delivery, single treatment area,single port or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6006 | Radiation Radiation treatment delivery, single treatment area,single port or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6007 | Radiation Radiation treatment delivery, 2 separate treatment areas, 3 or more | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6008 | Radiation Radiation treatment delivery, 2 separate treatment areas, 3 or more | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6009 | Radiation Radiation treatment delivery, 2 separate treatment areas, 3 or more | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6010 | Radiation Radiation treatment delivery, 2 separate treatment areas, 3 or more | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6011 | Radiation Radiation treatment delivery,3 or more separate treatment areas | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6012 | Radiation Radiation treatment delivery,3 or more separate treatment areas | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6013 | Radiation Radiation treatment delivery,3 or more separate treatment areas | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6014 | Radiation Radiation treatment delivery ,3 or more separate treatment areas | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6015 | Radiation Intensity modulated Treatment delivery, single or multiple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6016 | Radiation Compensator-based beam modulation treatment delivery of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G6017 | Radiation Intra-fraction localization and tracking of target or patient motion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| G9143 | Genetic Testing Warfarin responsiveness testing by genetic technique using any | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0005 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0008 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0009 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0010 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0011 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0012 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0013 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0014 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0015 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0016 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0017 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0018 | Behavioral Health ALCOHOL AND/OR DRUG SERVICES | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0031 | Behavioral Health Mental health assessment by non-physician [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H0032 | Behavioral Health Mental health service plan development by non- physician [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H1004 | Home Health FOLLOW UP HOME VISIT/PRENTAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H2012 | Behavioral Health Behavioral health day treatment, per hour [when specified as direct | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H2019 | Behavioral Health Therapeutic behavioral services, per 15 minutes [when specified as | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| H2020 | Behavioral Health Therapeutic behavioral services, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0122 | Pharmacy INJ, ERAVACYCLINE, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0129 | Pharmacy ABATACEPT INJ,10MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0135 | Pharmacy Adalimumab (Humira) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0172 | Pharmacy Aducanumab-avwa (Aduhelm) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0174 | Pharmacy Leqembi (Injection, lecanemab-irmb, 1mg) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0178 | Pharmacy Aflibercept (Eylea) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0179 | Pharmacy INJ, BROLUCIZUMAB-DBLL, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0180 | Pharmacy AGALSIDASE BETA INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0184 | Pharmacy INJECTION, AMISULPRIDE, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0202 | Pharmacy Alemtuzumab (Lemtrada) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0205 | Pharmacy ALGLUCERASE PER 10 UNITS INJ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0207 | Pharmacy Amifostine (Ethyol) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0208 | Pharmacy Sodium thiosulfate injection (Pedmark) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0218 | Pharmacy Olipudase alfa (Xenpozyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0219 | Pharmacy Avalglucosidase alfa-ngpt (Nexviazyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0220 | Pharmacy ALGUCOSIDASE ALFA 10MG INJ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0221 | Pharmacy Alglucosidase alfa (Lumizyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0222 | Pharmacy Patisiran (Onpattro) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0223 | Pharmacy Givosiran (Givlaari) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0224 | Pharmacy Lumasiran (Oxlumo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0225 | Pharmacy Vutrisiran (Amvuttra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0248 | Pharmacy INJ, REMDESIVIR, 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0256 | Pharmacy Alpha 1 proteinase inhibitor (Aralast) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0257 | Pharmacy Alpha 1 proteinase inhibitor (Glassia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0289 | Pharmacy INJECTION, AMPHOTERICIN B LIPOSOME, 10 M | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0330 | Pharmacy INJECTION, SUCCINYLCHOLINE CHLORIDE, UP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0391 | Pharmacy INJECTION, ARTESUNATE, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0401 | Pharmacy INJECTION ARIPIPRAZOLE EXTENDED RELEASE 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0456 | Pharmacy Injection, azithromycin, 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0470 | Pharmacy Injection, dimercaprol, per 100 mg [BAL in oil] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0480 | Pharmacy BASILIXIMAB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0485 | Pharmacy Belatacept (Nulojix) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0490 | Pharmacy Belimumab (Benlysta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0491 | Pharmacy Saphnelo (anifrolumab-fnia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0515 | Pharmacy INJECTION, BENZTROPINE MESYLATE, PER 1 M | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0517 | Pharmacy Benralizumab (Fasenra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0558 | Pharmacy Injection, penicillin G benzathine and penicillin G procaine, 100,000 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0561 | Pharmacy Injection, penicillin G benzathine, 100,000 units [IM] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0565 | Pharmacy INJ, BEZLOTOXUMAB, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0567 | Pharmacy INJECTION, CERLIPONASE ALFA 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0570 | Pharmacy BUPRENORPHINE IMPLANT, 74.2 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0583 | Pharmacy INJECTION, BIVALIRUDIN, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0584 | Pharmacy INJECTION, BUROSUMAB-TWZA 1M | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0585 | Pharmacy OnabotulinumtoxinA (Botox) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0586 | Pharmacy AbobotulinumtoxinA (Dysport) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0587 | Pharmacy RimabotulinumtoxinB (Myobloc) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0588 | Pharmacy IncobotulinumtoxinA (Xeomin) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0593 | Pharmacy INJ, LANADELUMAB-FLYO, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0596 | Pharmacy INJ, C1 ESTERASE INHIBITOR (RECOMBINANT), RUCONEST, 10 UNITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0597 | Pharmacy C-1 ESTERASE, BERINERT 10 UNITS INJ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0598 | Pharmacy C1 ESTERASE INHIBITOR INJ 10 UNITS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0599 | Pharmacy C1 esterase inhibitor (human) (Haegarda) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0600 | Pharmacy Injection, edetate calcium disodium up to 1,000 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0606 | Pharmacy INJ, ETELCALCETIDE, 0.1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0638 | Pharmacy CANAKINUMAB 1 MG INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0641 | Pharmacy Levoleucovorin (Fusilev) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0642 | Pharmacy INJ, LEVOLEUCOVORIN (KHAPZORY), 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0690 | Pharmacy Injection, cefazolin sodium, 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0691 | Pharmacy INJECTION, LEFAMULIN, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0693 | Pharmacy Injection, cefiderocol, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0695 | Pharmacy INJ, CEFTOLOZANE 50 MG AND TAZOBACTAM 25 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0696 | Pharmacy Injection, ceftriaxone sodium, per 250 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0698 | Pharmacy Injection, cefotaxime sodium, per gm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0699 | Pharmacy INJ, CEFIDEROCOL, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0712 | Pharmacy INJ, CEFTAROLINE FOSAMIL, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0714 | Pharmacy INJ, CEFTAZIDIME AND AVIBACTAM, 0.5 G/0.125 G | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0716 | Pharmacy Injection, centruroides immune f(ab)2, u | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0717 | Pharmacy Certolizumab pegol (Cimzia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0741 | Pharmacy Cabotegravir extended-release; rilpivirine extended- release | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0742 | Mountain Health Co-Op, Services Requiring Prior Authorization 165 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0743 | Pharmacy Injection, cilastatin sodium; imipenem, per 250 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0760 | Pharmacy INJECTION, COLCHICINE, PER 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0775 | Pharmacy Clostridial collagenase histolyticum (Xiaflex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0791 | Pharmacy Crizanlizumab (Adakveo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0800 | Pharmacy Repository corticotropin injection (Acthar Gel, Purified Cortrophin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0850 | Pharmacy CYTOMEGALOVIRUS IMM IV VIAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0875 | Pharmacy Injection, dalbavancin, 5mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0881 | Pharmacy Darbepoetin Alfa (Aranesp) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0882 | Pharmacy Darbepoetin Alfa (Aranesp) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0884 | Pharmacy Injection, argatroban, 1 mg (for esrd on | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0885 | Pharmacy Injection, epoetin alfa (for non-ESRD use), 1000 units (Epogen | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0887 | Pharmacy Epoetin beta (Mircera) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0888 | Pharmacy Epoetin beta (Mircera) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0893 | Pharmacy |INJECTION, DECITABINE (SUN PHARMA), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0894 | Pharmacy DECITABINE INJ, 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0895 | Pharmacy Injection, deferoxamine mesylate, 500 mg [Desferal] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0896 | Pharmacy Luspatercept (Reblozyl) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J0897 | Pharmacy Denosumab (Prolia, Xgeva) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1120 | Pharmacy INJECTION, ACETAZOLAMIDE SODIUM, UP TO 5 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1267 | Pharmacy Injection, doripenem, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1290 | Pharmacy Ecallantide (Kalbitor) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1301 | Pharmacy Edaravone (Radicava) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1302 | Pharmacy Sutimlimab-jome (Enjaymo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1303 | Pharmacy Ravulizumab-cwvz (Ultomiris) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1305 | Pharmacy Evinacumab (Evkeeza) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1306 | Pharmacy Inclisiran (Leqvio) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1322 | Pharmacy Elosulfase Alfa (Vimizim) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1324 | Pharmacy ENFUVIRTIDE INJ, 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1325 | Pharmacy Epoprostenol (Flolan) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1335 | Pharmacy Injection, ertapenem sodium, 500 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1410 | Pharmacy INJECTION, ESTROGEN CONJUGATED, PER 25 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1411 | Pharmacy Etranacogene dezaparvovec-drlb (Hemgenix) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1412 | nominal 2 × 10^13 vector genomes (Roctavian) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1413 | therapeutic dose (ELEVIDYS) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1426 | Pharmacy Casimersen (Amondys 45) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1427 | Pharmacy Viltolarsen (Viltepso) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1428 | Pharmacy Eteplirsen (Exondys 51) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1429 | Pharmacy Golodirsen (Vyondys 53) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1437 | Pharmacy Injection, ferric derisomaltose, 10 mg (Monoferric) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1438 | Pharmacy Etanercept (Enbrel) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1439 | Pharmacy Injection, ferric carboxymaltose, 1 mg (Injectafer) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1442 | Pharmacy Filgrastim (Neupogen) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1443 | Pharmacy INJ, FERRIC PYROPHOSPHATE CITRATE SOLUTION, 0.1 MG OF IRON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1447 | Pharmacy Tbo-Filgrastim (Granix) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1448 | Pharmacy Trilaciclib (Cosela) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1449 | Pharmacy Eflapegrastim-xnst (Rolvedon) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1450 | Pharmacy Injection, fluconazole, 200 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1454 | Pharmacy INJ, FOSNETUPITANT 235 MG AND PALONOSETRON 0.25 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1458 | Pharmacy GALSULFASE INJ, 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1459 | Pharmacy Immune globulin, IV, non-lyophilized (Privigen) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1460 | Pharmacy Gamma globulin, IM (Gamastan S/D) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1490 | Pharmacy INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1551 | Pharmacy Immuno globulin (Cutaquig) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1554 | Pharmacy Immune Globulin (Human) IV (Asceniv) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1555 | Pharmacy Immune Globulin (Cuvitru) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1556 | Pharmacy Immune Globulin (Bivigam) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1557 | Pharmacy Immune Globulin (Gammaplex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1558 | Pharmacy Immune Globulin (Human)-klhw (Xembify) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1559 | Pharmacy Immune Globulin (Human) Subcutaneous (Hizentra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1560 | Pharmacy Immune Globulin (Human) (Gamastan) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1561 | Gammaked) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1562 | Pharmacy IMMUNE GLOBULIN INJ 1000MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1566 | Pharmacy Immune Globulin (Human) IV (Carimune, Gammagard SD) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1568 | Pharmacy Immune Globulin (Human) IV (Octagam) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1569 | Liquid) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1572 | Pharmacy Immune Globulin (Human) IV (Flebogamma) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1575 | Pharmacy Immune Globulin (Human) IV (HyQvia) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1576 | LYOPHILIZED (E.G., LIQUID), 500 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1595 | Pharmacy Glatiramer acetate (Copaxone) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1599 | Pharmacy Immune Globulin (Human) IV (Panzyga) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1602 | Pharmacy Golimumab (Simponi Aria) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1627 | Pharmacy INJ, GRANISETRON, EXTENDED-RELEASE, 0.1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1628 | Pharmacy Guselkumab (Tremfya) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1632 | Pharmacy Brexanolone (Zulresso) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1640 | Pharmacy INJ, HEMIN, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1675 | Pharmacy Histrelin acetate (Supprelin LA, Vantas) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1729 | Pharmacy INJECTION, HYDROXYPROGESTERONE CAPROATE, NOS, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1743 | Pharmacy Idursulfase (Elaprase) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1744 | Pharmacy Icatibant (Firazyr, Sajazir) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1745 | Pharmacy Infliximab (Remicade) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1746 | Pharmacy Ibalizumab-uiyk (Trogarzo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1747 | Pharmacy Spesolimab-sbzo (Spevigo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1750 | Pharmacy Injection, iron dextran, 50 mg (Infed) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1751 | Pharmacy INJECTION, IRON DEXTRAN 165, 50 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1756 | Pharmacy Injection, iron sucrose, 1 mg (Venofer) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1786 | Pharmacy Imiglucerase (Cerezyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1815 | potentiation therapy] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1817 | Pharmacy Insulin for administration through DME (i.e., insulin pump) per 50 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1823 | Pharmacy Inebilizumab-cdon (Uplizna) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1826 | Pharmacy Interferon beta-1a (Avonex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1830 | Pharmacy Interferon beta-1b (Betaseron) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1833 | Pharmacy INJ, ISAVUCONAZONIUM, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1930 | Pharmacy Lanreotide (Somatuline Depot) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1931 | Pharmacy Laronidase (Aldurazyme) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1932 | Pharmacy Lanreotide (cipla) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1943 | Pharmacy INJ, ARIPIPRAZOLE LAUROXIL, (ARISTADA INITIO), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1944 | Pharmacy INJ, ARIPIPRAZOLE LAUROXIL, (ARISTADA), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1950 | Pack) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1951 | Pharmacy Leuprolide acetate (Fensolvi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1953 | Pharmacy INJECTION, LEVETIRACETAM, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1954 | Pharmacy Leuprolide acetate (Lutrate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J1956 | Pharmacy Injection, levofloxacin, 250 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2062 | Pharmacy LOXAPINE, INHALATION, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2170 | Pharmacy Mecasermin (Increlex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2182 | Pharmacy Mepolizumab (Nucala) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2185 | Pharmacy Injection, meropenem, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2278 | Pharmacy Ziconotide Intrathecal Infusion (Prialt) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2280 | Pharmacy Injection, moxifloxacin, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2323 | Pharmacy Natalizumab (Tysabri) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2326 | Pharmacy Nusinersen (Spinraza) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2327 | Pharmacy Rrisankizumab-rzaa (Skyrizi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2329 | Pharmacy INJECTION, UBLITUXIMAB-XIIY, 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2350 | Pharmacy Ocrelizumab (Ocrevus) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2353 | Pharmacy Octreotide, depot form (Sandostatin) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2354 | Pharmacy Octreotide (Bynfezia, Sandostatin LAR) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2356 | Pharmacy Tezepelumab-ekko (Tezspire) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2357 | Pharmacy Omalizumab (Xolair) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2358 | Pharmacy INJECTION, OLANZAPINE, LONG-ACTING, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2425 | Pharmacy PALIFERMIN INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2502 | Pharmacy INJ, PASIREOTIDE LONG ACTING, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2503 | Pharmacy Pegaptanib (Macugen) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2504 | Pharmacy INJECTION, PEGADEMASE BOVINE, 25 IU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2505 | Pharmacy INJECTION, PEGFILGRASTIM, 6 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2506 | Pharmacy Pegfilgrastim (Neulasta) - excludes biosimilar | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2507 | Pharmacy Pegloticase (Krystexxa) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2510 | Mountain Health Co-Op, Services Requiring Prior Authorization 169 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2540 | Pharmacy Injection, penicillin G potassium, up to 600,000 units | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2562 | Pharmacy Plerixafor Injection (Mozobil) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2724 | Pharmacy PROTEIN C CONCENTRATE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2777 | Pharmacy Faricimab-svoa (Vabysmo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2778 | Pharmacy Ranibizumab (Lucentis) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2779 | (Susvimo), 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2783 | Pharmacy INJECTION, RASBURICASE, 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2786 | Pharmacy Reslizumab (Cinqair) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2787 | Pharmacy RIBOFLAVIN 5-PHOSPHATE, OPHTHALMIC SOLUTION, UP TO 3 ML | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2793 | Pharmacy Rilonacept (Arcalyst) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2796 | Pharmacy Romiplostim (Nplate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2797 | Pharmacy INJ, ROLAPITANT, 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2798 | Pharmacy INJ, RISPERIDONE, (PERSERIS), 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2800 | Pharmacy INJECTION, METHOCARBAMOL, UP TO 10 ML | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2820 | Pharmacy Sargramostim (Leukine, Prokine) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2840 | Pharmacy Sebelipase alfa (Kanuma) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2860 | Pharmacy Siltuximab (Sylvant) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2916 | mg (Ferrlecit) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2940 | Pharmacy Somatrem (somatrem) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2941 | Omnitrope, Serostim, Zomacton, Zorbtive) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J2998 | Pharmacy Plasminogen, human-tvmh (Ryplazim) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3031 | Pharmacy INJ, FREMANEZUMAB-VFRM, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3032 | Pharmacy Eptinezumab (Vyepti) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3060 | Pharmacy Taliglucerase alfa (Elelyso) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3095 | Pharmacy INJECTION, TELEVANCIN, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3110 | Pharmacy Teriparatide (Bonsity, Forteo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3111 | Pharmacy Romosozumab-aqqg (Evenity) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3240 | Pharmacy INJECTION, THYROTROPIN ALPHA, 0.9 MG, PR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3241 | Pharmacy Teprotumumab-trbw (Tepezza) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3245 | Pharmacy Tildrakizumab-asmn (Ilumya) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3262 | Pharmacy Tocilizumab (Actemra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3263 | Pharmacy Inj, toripalimab-tpzi, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3285 | Pharmacy Treprostinil (Remodulin) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3299 | Pharmacy Triamcinolone acetonide inj susp (Xipere) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3304 | Pharmacy Traiamcinolone Acetonide (Zilretta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3315 | Pharmacy Triptorelin pamoate (Trelstar, Trelstar Depot, Trelstar LA) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3316 | Pharmacy Triptorelin extended release (Triptodur) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3357 | Pharmacy Ustekinumab (Stelara) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3358 | Pharmacy Ustekinumab (Stelara) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3372 | Pharmacy INJECTION, VANCOMYCIN HCL (XELLIA), 500 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3380 | Pharmacy Vedolizumab (Entyvio) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3385 | Pharmacy Velaglucerase alfa (VPRIV) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3396 | Pharmacy VERTEPORFIN INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3397 | Pharmacy Vestronidase alfa (Mepsevii) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3398 | for Luxturna [ ]) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3399 | [Zolgensma] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3486 | Pharmacy INJECTION, ZIPRASIDONE MESYLATE, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3489 | Pharmacy Injection, zoledronic acid, 1 mg (Reclast) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3490 | Pharmacy Abaloparatide (Tymlos) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3520 | Pharmacy Edetate disodium, per 150 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3590 | Pharmacy Adalimumab-adaz (Hyrimoz) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3591 | Pharmacy DRUG OR BIOLOGICAL, ESRD ON DIALYSIS, NOC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J3950 | Casgevy™ (exagamglogene autotemcel) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7170 | Pharmacy Emicizumab-kxwh (Hemlibra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7175 | Pharmacy Factor X (Coagadex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7177 | Pharmacy Human fibrinogen (Fibryga) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7178 | Pharmacy Fibrinogen concentrate )RiaSTAP) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7179 | Pharmacy Von Willebrand Factor (Vonvendi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7180 | Pharmacy Factor XIII concentrate (human) (Corifact) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7181 | Pharmacy Coagulation factor XIII A-subunit (recombinant) (Tretten) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7182 | Pharmacy Factor VIII (antihemophilic factor, recombinant) (Novoeight) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7183 | Pharmacy Antihemophilic factor VIII (Wilate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7185 | Solofuse) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7186 | Pharmacy Antihemophilic factor VIII (Alphanate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7187 | Pharmacy Antihemophilic factor VIII (Humate-P) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7188 | Pharmacy Antihemophilic Factor VIII (Obizur) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7189 | Pharmacy Factor VIIa Recombinant (Novoseven RT) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7190 | Pharmacy (Factor VIII) human plasma-derived (Hemofil M) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7191 | Pharmacy Antihemophilic Factor VIII (Obizur) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7192 | FS, Recombinate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7193 | Pharmacy Coagulation factor IX (human) (Mononine) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7194 | Pharmacy Factor IX Complex Human (Profilnine SD) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7195 | Pharmacy Factor IX (Ixinity) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7197 | Pharmacy ANTITHROMBIN III HUMAN PER IU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7198 | Pharmacy Anti-inhibitor coagulant complex (FEIBA) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7199 | Pharmacy HEMOPHILIA CLOTTING FACTOR NOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7200 | Pharmacy Factor IX Recombinant (Rixubis) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7201 | Pharmacy Factor IX, Fc fusion protein (recombinant) (Alprolix) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7202 | Pharmacy Factor IX, albumin fusion protein, (recombinant) (Idelvion) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7203 | Pharmacy Factor IX, (antihemophilic factor, recombinant), glycopegylated | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7204 | exei (Esperoct) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7205 | Pharmacy Factor VIII Fc fusion protein, (recombinant) (Eloctate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7207 | (Adynovate) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7208 | ([Jivi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7209 | Pharmacy Factor VIII, (antihemophilic factor, recombinant) (Nuwiq) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7210 | Pharmacy Factor VIII, (Antihemophilic Factor, recombinant) (Afstyla) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7211 | Pharmacy Factor VIII, (antihemophilic factor, recombinant( (Kovaltry) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7212 | Pharmacy Factor VIIa Recombinant (SevenFact) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7213 | Pharmacy INJECTION, COAGULATION FACTOR IX (RECOMBINANT), IXINITY, 1 IU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7309 | Pharmacy METHYL AMINOLEVULINATE, TOP 1G 16.8% | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7310 | Pharmacy GANCICLOVIR 4.5MG LONG ACT IMPT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7311 | Pharmacy Fluocinolone acetonide, intravitreal implant (Retisert) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7312 | Pharmacy Dexamethasone intravitreal implant (Ozurdex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7313 | Pharmacy Fluocinolone acetonide, intravitreal implant (Iluvien) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7314 | Pharmacy Fluocinolone acetonide (Yutiq) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7315 | Pharmacy SODIUM HYALURONATE, 20 MG, FOR INTRA ART | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7316 | Pharmacy Ocriplasmin (Jetrea) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7318 | Pharmacy INJECTION, DUROLANE 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7320 | INJECTION, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7321 | Pharmacy HYALURONAN/HYALGAN INTRA-ARTIC INJ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7322 | 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7323 | Pharmacy HYALURONAN/EUFLEXXA INTRA-ARTIC INJ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7324 | Pharmacy ORTHOVISC INJ PER DOSE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7325 | Pharmacy SYNVISC OR SYNVISC-ONE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7326 | Pharmacy HYALURONAN/DERIVATIVE, GEL-ONE,INTRA-ARTICULAR INJ PER DOSE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7327 | PER DOSE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7328 | 0.1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7329 | Pharmacy INJECTION, TRIVISC 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7330 | Pharmacy Autologous cultured chondrocytes, implant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7340 | Pharmacy Carbidopa/levodopa enteral suspension (Duopa) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7351 | Pharmacy Bimatoprost implant (Durysta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7352 | Pharmacy Afamelanotide (Scenesse) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7401 | Pharmacy Mometasone furoate sinus implant, 10 mic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7402 | micrograms | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7504 | Pharmacy LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7599 | Pharmacy IMMUNOSUPPRESSIVE DRUG, NEC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7639 | Pharmacy DORNASE ALPHA, INHALATION SOLUTION, FDA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7640 | Pharmacy FORMOTEROL, INHALATION SOLUTION, COMPOUN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7677 | NON-COMPOUNDED, ADMINISTERED THROUGH DME, 1 MICROGRAM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7682 | Pharmacy TOBRAMYCIN UNIT INH 300MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7685 | Pharmacy TOBRAMYCIN INH SOL UNT DO 300M | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7686 | Pharmacy Treprostinil (Tyvaso) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7699 | Pharmacy INHALATION SOLUT FOR DME NOC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7799 | Pharmacy NON INHALATION DRUGS NOC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J7999 | Pharmacy Naltrexone pellet (Naltrexone) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J8498 | Pharmacy ANTIEMETIC RECTAL/SUPP NOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J8499 | Pharmacy ORAL PRESCRIP DRUG NON CHEMO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J8610 | Pharmacy METHOTREXATE; ORAL, 2.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J8655 | Pharmacy NETUPITANT 300 MG AND PALONOSETRON 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J8999 | Pharmacy ORAL PRESCRIPTION DRUG CHEMO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9000 | Pharmacy Injection, doxorubicin HCl, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9015 | Pharmacy Aldesleukin (Proleukin) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9017 | Pharmacy ARSENIC TRIOXIDE, 1MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9019 | Pharmacy Asparaginase (Erwinaze) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9020 | Pharmacy Injection, asparaginase, not otherwise specified, 10,000 units | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9021 | NON-COMPOUNDED, ADMINISTERED THROUGH DME, 1 MICROGRAM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9022 | Pharmacy Atezolizumab (Tecentriq) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9023 | Pharmacy Avelumab (Bavencio) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9025 | Pharmacy Injection, azacitidine, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9027 | Pharmacy CLOFARABINE INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9029 | DOSE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9032 | Pharmacy Belinostat (Beleodaq) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9033 | Pharmacy Bendamustine (Treanda) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9034 | Pharmacy Bendamustine (Bendeka) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9035 | Pharmacy Bevacizumab (Avastin) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9036 | Pharmacy Bendamustine (Belrapzo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9037 | Pharmacy Injection, belantamab mafodontin-blmf, 0.5 mg (Blenrep) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9039 | Pharmacy Blinatumomab (Blincyto) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9040 | Pharmacy Injection, bleomycin sulfate, 15 units | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9041 | Pharmacy Injection, bortezomib, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9042 | Pharmacy Brentuximab vedotin (Adcetris) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9043 | Pharmacy Cabazitaxel (Jevtana) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9045 | Pharmacy Injection, carboplatin, 50 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9047 | Pharmacy Carfilzomib (Kyprolis) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9050 | Pharmacy Injection, carmustine, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9052 | Pharmacy INJECTION, CARMUSTINE (ACCORD), 100 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9055 | Pharmacy Cetuximab (Erbitux) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9056 | Pharmacy INJECTION, BENDAMUSTINE HCL (VIVIMUSTA), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9057 | Pharmacy Copanlisib HCl (Aliqopa) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9058 | Pharmacy INJECTION, BENDAMUSTINE HCL (APOTEX), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9059 | Pharmacy INJECTION, BENDAMUSTINE HCL (BAXTER), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9060 | Pharmacy Injection, cisplatin, powder or solution, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9061 | Pharmacy Amivantamab-ymoiw (Rybrevant) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9063 | Pharmacy INJECTION, MIRVETUXIMAB SORAVTANSINE-GYNX, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9064 | Pharmacy INJECTION, CABAZITAXEL (SANDOZ), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9065 | Pharmacy INJECTION, CLADRIBINE, PER 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9070 | Pharmacy Cyclophosphamide, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9098 | Pharmacy CYTARABINE LIPOSOME, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9100 | Pharmacy Injection, cytarabine, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9118 | Pharmacy Calaspargase pegol-mknl (Asparlas) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9119 | Pharmacy Cemiplimab-rwlc (Libtayo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9120 | Pharmacy DACTINOMYCIN, 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9130 | Pharmacy Dacarbazine, 100 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9144 | Mountain Health Co-Op, Services Requiring Prior Authorization 179 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9145 | Pharmacy Daratumumab (Darzalex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9150 | Pharmacy Injection, daunorubicin, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9151 | Pharmacy DAUNORUBICIN CITRATE LIPO 10MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9153 | Pharmacy Injection, liposomal, 1 mg daunorubicin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9171 | Pharmacy INJECTION, DOCETAXEL, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9173 | Pharmacy Durvalumab (Imfinzi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9176 | Pharmacy Elotuzumab (Empliciti) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9177 | Pharmacy Enfortumab vedotin-ejfv (Padcev) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9178 | Pharmacy Injection, epirubicin HCl, 2 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9179 | Pharmacy Eribulin mesylate (Halaven) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9181 | Pharmacy Injection, etoposide, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9200 | Pharmacy FLOXURIDINE 500MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9201 | Pharmacy Injection, gemcitabine HCl, not otherwise specified, 200 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9202 | Pharmacy Goserelin acetate (Zoladex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9203 | Pharmacy Gemtuzumab ozogamicin (Mylotarg) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9204 | Pharmacy Injection, mogamulizumab-kpkc, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9205 | Pharmacy Injection, irinotecan liposome, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9207 | Pharmacy Ixabepilone (Ixempra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9209 | Pharmacy Injection, mesna, 200 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9210 | Pharmacy Emapalumab-lzsg (Gamifant) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9211 | Pharmacy IDARUBICIN HCL 5MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9212 | Pharmacy Injection, interferon alfacon-1, recombinant, 1 mcg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9213 | Pharmacy Injection, interferon, alfa-2a, recombinant, 3 million units | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9214 | Pharmacy Injection, interferon, alfa-2b, recombinant, 1 million units | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9215 | Mountain Health Co-Op, Services Requiring Prior Authorization 179 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9216 | Pharmacy Interferon Gamma-1b (Actimmune) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9217 | Pharmacy Leuprolide acetate (Eligard, Lupron Depot, Lupron Depo-Ped) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9218 | Pharmacy Leuprolide acetate (Lupron) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9219 | Pharmacy Leuprolide acetate implant, 65 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9223 | Pharmacy Sacituzumab govitecan-hziy, 10 mg (Zepzelca) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9225 | Pharmacy VANTAS IMPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9226 | Pharmacy SUPPRELIN LA IMPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9227 | Pharmacy INJECTION, ISATUXIMAB-IRFC, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9228 | Pharmacy INJ, IPILIMUMAB, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9229 | Pharmacy Inotuzumab Ozogamicin (Besponsa) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9230 | Pharmacy MECHLORETHAMINE HCL 10MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9245 | Pharmacy MELPHALAN HCL 50MG INJ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9246 | Pharmacy INJECTION, MELPHALAN (EVOMELA), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9247 | Pharmacy Melphalan flufenamide; melflufen (Pepaxto) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9248 | Pharmacy INJECTION, MELPHALAN (HEPZATO), 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9258 | THERAPEUTICALLY EQUIVALENT TO , 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9259 | REGENT) NOT THERAPEUTICALLY EQUIVALENT TO , 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9261 | Pharmacy NELARABINE INJ 50MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9262 | Pharmacy Omacetaxine mepesuccinate (Synribo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9263 | Pharmacy Injection, oxaliplatin, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9264 | THERAPEUTICALLY EQUIVALENT TO , 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9266 | Pharmacy Asparaginase (Oncaspar) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9268 | Pharmacy PENTOSTATIN PER 10MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9269 | Pharmacy Tagraxofusp-erzs (Elzonris) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9270 | Pharmacy Injection, plicamycin, 2.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9271 | Pharmacy Pembrolizumab (Keytruda) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9272 | Pharmacy Dostarlimab (Jemperli) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9273 | Pharmacy Tisotumab vedotin-tftv (Tivdak) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9274 | Pharmacy Tebentafusp-tebn (Kimmtrak) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9280 | Pharmacy Injection, mitomycin, 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9281 | Pharmacy Mitomycin pyelocalyceal instillation, 1 mg (Jelmyto) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9285 | Pharmacy Olaratumab (Lartruvo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9286 | Pharmacy INJECTION, GLOFITAMAB-GXBM, 2.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9293 | Pharmacy Injection, mitoxantrone HCl, per 5 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9294 | Pharmacy Pemetrexed disodium (Alimta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9295 | Pharmacy INJ, NECITUMUMAB, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9296 | Pharmacy Pemetrexed disodium (Alimta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9297 | Pharmacy Pemetrexed disodium (Alimta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9299 | Pharmacy Nivolumab (Opdivo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9301 | Pharmacy Obinutuzumab (Gazyva) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9302 | Pharmacy Ofatumumab (Arzerra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9303 | Pharmacy Panitumumab (Vectibix) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9304 | Pharmacy Pemetrexed (Pemfexy) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9305 | Pharmacy Pemetrexed disodium (Alimta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9306 | Pharmacy Pertuzumab (Perjeta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9307 | Pharmacy PRALATREXATE 1 MG INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9308 | Pharmacy Ramucirumab (Cyramza) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9309 | Pharmacy Polatuzumab vedotin-piiq (Polivy) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9310 | Pharmacy RITUXIMAB, 100 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9311 | Pharmacy Injection, rituximab 10 mg and hyaluroni | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9312 | Pharmacy Rituximab (Rituxan) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9313 | Pharmacy Moxetumomab-tdfk (Lumoxiti) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9314 | Pharmacy Pemetrexed Teva) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9316 | Pharmacy Sacituzumab govitecan-hziy, 10 mg (Phesgo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9317 | Pharmacy Sacituzumab govitecan-hziy, 10 mg (Trodelvy) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9318 | Pharmacy Romidepsin (Istodax) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9319 | Pharmacy Romidepsin (Istodax) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9320 | Pharmacy STREPTOZOCIN 1G | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9321 | Pharmacy INJECTION, EPCORITAMAB-BYSP, 0.16 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9322 | EQUIVALENT TO , 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9323 | TO , 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9324 | Pharmacy INJECTION, PEMETREXED (PEMRYDI RTU), 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9325 | Pharmacy Talimogene laherparepvec (Imlygic) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9330 | Pharmacy TEMSIROLIMUS INJECTION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9331 | Pharmacy Sirolimus albumin bound (Fyarro) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9332 | Pharmacy Efgartigimod alfa-fcab (Vyvgart) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9340 | Pharmacy THIOTEPA 15MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9345 | Pharmacy INJECTION, RETIFANLIMAB-DLWR, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9347 | Pharmacy INJECTION, TREMELIMUMAB-ACTL, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9348 | Pharmacy Naxitamab-gqgk (Danyelza) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9349 | Pharmacy Injection, tafasitamab-cxix, 2 mg (Monjuvi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9350 | Pharmacy INJECTION, MOSUNETUZUMAB-AXGB, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9352 | Pharmacy Injection, trabectedin, 0.1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9353 | Pharmacy Margetuximab-cmkb (Margenza) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9354 | Pharmacy Ado-trastuzumab emtansine (Kadcyla) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9355 | Pharmacy TRASTUZUMAB, EXCLUDES BIOSIMILAR, 10 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9356 | Pharmacy Injection, trastuzumab, 10 mg and Hyalur | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9357 | Pharmacy VALRUBICIN INTRAVESICAL 200MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9358 | Pharmacy Fam-trastuzumab deruxtecan-nxki (Enhertu) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9359 | Pharmacy Loncastuximab tesirine-lpyl (Zynlonta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9360 | Pharmacy Injection, vinblastine sulfate, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9370 | Pharmacy VINCRISTINE SULFATE, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9371 | Pharmacy Injection, vincristine sulfate liposome, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9380 | Pharmacy INJECTION, TECLISTAMAB-CQYV, 0.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9390 | Pharmacy Injection, vinorelbine tartrate, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9393 | Pharmacy Fulvestrant (Teva - not therapeutically equivalent to , 25 mg) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9394 | Pharmacy Fulvestrant (Fresenius kabi - not therapeutically equivalent to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9395 | Pharmacy Fulvestrant (Teva - not therapeutically equivalent to , 25 mg) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9400 | Pharmacy Ziv-aflibercept (Zaltrap) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9600 | Pharmacy PORFIMER SODIUM 75 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| J9999 | Pharmacy Loncastuximab tesirine-lpyl (Zynlonta) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0008 | Durable Medical CUSTOM MANUAL WHEELCHAIR/BASE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0009 | Durable Medical OTHER MANUAL WHEELCHAIR/BASE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0010 | Durable Medical Standard-weight frame motorized/power | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0011 | Durable Medical Standard-weight frame motorized/power wheelchair with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0012 | Durable Medical Lightweight portable motorized/power wheelchair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0013 | Durable Medical Custom motorized/power wheelchair base | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0014 | Durable Medical Other motorized/power wheelchair base | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0015 | Durable Medical DETACH NON-ADJUS HGHT ARMRST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0017 | Durable Medical DETACH ADJUST ARMREST BASE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0018 | Durable Medical DETACH ADJUST ARMRST UPPER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0019 | Durable Medical ARM PAD EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0020 | Durable Medical FIXED ADJUST ARMREST PAIR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0037 | Durable Medical HIGH MOUNT FLIP-UP FOOTREST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0038 | Durable Medical LEG STRAP EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0039 | Durable Medical LEG STRAP H STYLE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0040 | Durable Medical ADJUSTABLE ANGLE FOOTPLATE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0041 | Durable Medical LARGE SIZE FOOTPLATE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0042 | Durable Medical STANDARD SIZE FOOTPLATE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0043 | Durable Medical FTRST LOWER EXTENSION TUBE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0044 | Durable Medical FTRST UPPER HANGER BRACKET | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0045 | Durable Medical FOOTREST,COMPLETE ASSEMBLY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0046 | Durable Medical ELEVAT LEGRST LOW EXTENSION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0047 | Durable Medical ELEVAT LEGRST UP HANGR BRACK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0050 | Durable Medical RATCHET ASSEMBLY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0051 | Durable Medical CAM RELEASE ASSEM FTRST/LGRST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0052 | Durable Medical SWINGAWAY DETACH FOOTREST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0053 | Durable Medical ELEVATE FOOTREST ARTICULATE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0056 | Durable Medical SEAT HT <17 OR >=21 LTWT WC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0065 | Durable Medical SPOKE PROTECTORS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0069 | Durable Medical REAR WHL COMPLETE SOLID TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0070 | Durable Medical REAR WHL COMPL PNEUM TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0071 | Durable Medical FRONT CASTR COMPL PNEUM TIRE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0072 | Durable Medical FRNT CSTR CMPL SEM-PNEUM TIR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0073 | Durable Medical CASTER PIN LOCK EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0077 | Durable Medical FRONT CASTER ASSEM COMPLETE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0098 | Durable Medical Drive belt for power wheelchair, replacement only | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0105 | Durable Medical IV HANGER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0108 | Durable Medical W/C COMPONENT-ACCESSORY NOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0195 | Durable Medical ELEVATING WHLCHAIR LEG RESTS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0455 | Durable Medical PUMP UNINTERRUPTED INFUSION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0462 | Durable Medical TEMPORARY REPLACEMENT EQPMNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0552 | Durable Medical SUPPLY/EXT INF PUMP SYR TYPE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0601 | Durable Medical REPL BATT SILVER OXIDE 1.5 V | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0602 | Durable Medical REPL BATT SILVER OXIDE 3 V | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0603 | Durable Medical REPL BATT ALKALINE 1.5 V | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0604 | Durable Medical REPL BATT LITHIUM 3.6 V | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0605 | Durable Medical REPL BATT LITHIUM 4.5 V | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0607 | Durable Medical REPL BATT FOR AED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0669 | Durable Medical SEAT/BACK CUS NO SADMERC VER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0730 | Durable Medical CTRL DOSE INH DRUG DELIV SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0733 | Durable Medical Power wheelchair accessory, 12 to 24 amp hour sealed lead acid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0739 | Durable Medical REPAIR/SVC DME NON-OXYGEN EQ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0740 | Durable Medical REPAIR/SVC OXYGEN EQUIPMENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0743 | Durable Medical SUCTION PUMP, HOME MODEL, PORTABLE, FOR USE ON WOUNDS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0744 | Durable Medical ABSORP WND DRSG FOR USE WITH SUCTION PUMP, PORT, PAD SIZE <= | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0745 | Durable Medical ABSORP WND DRSG FOR USE WITH SUCTION PUMP, PORT, PAD SIZE 16 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0746 | Durable Medical ABSORP WND DRSG FOR USE WITH SUCTION PUMP, PORT, PAD SIZE >48 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0800 | Durable Medical Power operated vehicle, group 1 standard, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0801 | Durable Medical Power operated vehicle, group 1 heavy-duty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0802 | Durable Medical Power operated vehicle, group 1 very heavy-duty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0806 | Durable Medical Power operated vehicle, group 2 standard, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0807 | Durable Medical Power operated vehicle, group 2 heavy-duty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0808 | Durable Medical Power operated vehicle, group 2 very heavy-duty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0812 | Durable Medical Power operated vehicle, not otherwise classified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0813 | Durable Medical Power wheelchair, group 1 standard, portable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0814 | Durable Medical Power wheelchair, group 1 standard, portable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0815 | Durable Medical Power wheelchair, group 1 standard, sling/solid seat | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0816 | Durable Medical Power wheelchair, group 1 standard, captain's chair, patient weight | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0820 | Durable Medical Power wheelchair, group 2 standard, portable, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0821 | Durable Medical Power wheelchair, group 2 standard, portable, captain's chair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0822 | Durable Medical Power wheelchair, group 2 standard, sling/solid seat/back, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0823 | Durable Medical Power wheelchair, group 2 standard, captain's chair, patient weight | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0824 | Durable Medical Power wheelchair, group 2 heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0825 | Durable Medical Power wheelchair, group 2 heavy-duty, captain's | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0826 | Durable Medical Power wheelchair, group 2 very heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0827 | Durable Medical Power wheelchair, group 2 very heavy-duty, captain's chair, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0828 | Durable Medical Power wheelchair, group 2 extra heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0829 | Durable Medical Power wheelchair, group 2 extra heavy-duty, captain's chair, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0830 | Durable Medical Power wheelchair, group 2 standard, seat elevator, sling/solid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0831 | Durable Medical Power wheelchair, group 2 standard, seat elevator, captain's chair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0835 | Durable Medical Power wheelchair, group 2 standard, single power option, sling/solid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0836 | Durable Medical Power wheelchair, group 2 standard, single power option, captain's | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0837 | Durable Medical Power wheelchair, group 2 heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0838 | Durable Medical Power wheelchair, group 2 heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0839 | Durable Medical Power wheelchair, group 2 very heavy-duty, single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0840 | Durable Medical Power wheelchair, group 2 extra heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0841 | Durable Medical Power wheelchair, group 2 standard, multiple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0842 | Durable Medical Power wheelchair, group 2 standard, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0843 | Durable Medical Power wheelchair, group 2 heavy-duty, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0848 | Durable Medical Power wheelchair, group 3 standard, sling/solid seat/back, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0849 | Durable Medical Power wheelchair, group 3 standard, captain's chair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0850 | Durable Medical Power wheelchair, group 3 heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0851 | Durable Medical Power wheelchair, group 3 heavy-duty, captain's chair, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0852 | Durable Medical Power wheelchair, group 3 very heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0853 | Durable Medical Power wheelchair, group 3 very heavy-duty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0854 | Durable Medical Power wheelchair, group 3 extra heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0855 | Durable Medical Power wheelchair, group 3 extra heavy duty, captain's chair, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0856 | Durable Medical Power wheelchair, group 3 standard, single power option, sling/solid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0857 | Durable Medical Power wheelchair, group 3 standard, single power option, captain's | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0858 | Durable Medical Power wheelchair, group 3 heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0859 | Durable Medical Power wheelchair, group 3 heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0860 | Durable Medical Power wheelchair, group 3 very heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0861 | Durable Medical Power wheelchair, group 3 standard, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0862 | Durable Medical Power wheelchair, group 3 heavy-duty, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0863 | Durable Medical Power wheelchair, group 3 very heavy-duty, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0864 | Durable Medical Power wheelchair, group 3 extra heavy-duty | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0868 | Durable Medical Power wheelchair, group 4 standard, sling/solid seat/back, patient | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0869 | Durable Medical Power wheelchair, group 4 standard, captain's chair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0870 | Durable Medical Power wheelchair, group 4 heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0871 | Durable Medical Power wheelchair, group 4 very heavy-duty, sling/solid seat/back | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0877 | Durable Medical Power wheelchair, group 4 standard, single power option, sling/solid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0878 | Durable Medical Power wheelchair, group 4 standard, single power | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0879 | Durable Medical Power wheelchair, group 4 heavy-duty, single power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0880 | Durable Medical Power wheelchair, group 4 very heavy-duty, single | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0884 | Durable Medical Power wheelchair, group 4 standard, multiple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0885 | Durable Medical Power wheelchair, group 4 standard, multiple | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0886 | Durable Medical Power wheelchair, group 4 heavy-duty, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0890 | Durable Medical Power wheelchair, group 5 pediatric, single power option, sling/solid | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0891 | Durable Medical Power wheelchair, group 5 pediatric, multiple power option | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0898 | Durable Medical Power wheelchair, not otherwise classified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0899 | Durable Medical Power mobility device, not coded by DME PDAC or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K0900 | Durable Medical Customized durable medical equipment, other than wheelchair | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1001 | Durable Medical Electronic positional obstructive sleep apnea treatment, with sensor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1002 | Durable Medical Cranial electrotherapy stimulation (CES) system, any type | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1014 | Durable Medical Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1018 | Durable Medical External upper limb tremor stimulator of the peripheral nerves of the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1019 | Durable Medical Supplies and accessories for external upper limb tremor stimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1020 | Surgical - Misc. Non-invasive vagus nerve stimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1021 | Durable Medical Exsufflation belt, includes all supplies and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1022 | Durable Medical Addition to lower extremity prosthesis, endoskeletal, knee | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1023 | Durable Medical Distal transcutaneous electrical nerve stimulator, stimulates | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1027 | Durable Medical ORAL DEVICE/APPLIANCE TO REDUCE UPPER AIRWAY COLLAPSIBILITY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1028 | Durable Medical Power source and control electronics unit for oral device/appliance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1029 | Durable Medical Oral device/appliance for neuromuscular electrical stimulation of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| K1030 | Investigational External recharging system for battery (internal) for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L0112 | Durable Medical Cranial orthotics - cranial cervical orthosis, congenital torticollis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L0113 | Durable Medical CRANIAL CERVICAL TORTICOLLIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L0984 | Durable Medical PROTECTIVE BODY SOCK EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L0999 | Durable Medical ADDITION TO SPINAL ORTHOSIS, NOT OTHERWI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1300 | Durable Medical BODY JACKET MOLD TO PATIENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1310 | Durable Medical POST-OPERATIVE BODY JACKET | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1499 | Durable Medical Spinal orthosis, not otherwise specified [when specified as a spinal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1681 | Durable Medical HIP ORTHOSIS, BILATERAL HIP JOINTS AND THIGH CUFFS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1832 | Durable Medical KO ADJ JNT POS RIGID SUPPORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1840 | Durable Medical KO DEROT ANT CRUCIATE CUSTOM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1843 | Durable Medical KO SINGLE UPRIGHT CUSTOM FIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1844 | Durable Medical KO W/ADJ JT ROT CNTRL MOLDED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1847 | Durable Medical KO ADJUSTABLE W AIR CHAMBERS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1848 | Durable Medical KNEE ORTHOSIS ADJUSTABLE JOINT AIR SUPP PREFAB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1850 | Durable Medical KO SWEDISH TYPE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1852 | Durable Medical KNEE ORTHOSIS, DOUBLE UPRIGHT, MEDIAL-LATERAL AND ROTATION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1860 | Durable Medical KO SUPRACONDYLAR SOCKET MOLD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L1990 | Durable Medical ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2005 | Durable Medical KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2006 | Durable Medical Knee ankle foot device, any material, single or double upright, swing | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2360 | Durable Medical EXTENDED STEEL SHANK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2570 | Durable Medical HIP CLEVIS TYPE 2 POSIT JNT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2600 | Durable Medical HIP CLEVIS/THRUST BEARING FR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2610 | Durable Medical HIP CLEVIS/THRUST BEARING LO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2620 | Durable Medical PELVIC CONTROL HIP HEAVY DUT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2622 | Durable Medical HIP JOINT ADJUSTABLE FLEXION | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2624 | Durable Medical HIP ADJ FLEX EXT ABDUCT CONT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2627 | Durable Medical PLASTIC MOLD RECIPRO HIP & C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2628 | Durable Medical METAL FRAME RECIPRO HIP & CA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2630 | Durable Medical PELVIC CONTROL BAND & BELT U | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2640 | Durable Medical PELVIC CONTROL BAND & BELT B | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2650 | Durable Medical PELV & THOR CONTROL GLUTEAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2660 | Durable Medical THORACIC CONTROL THORACIC BA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2670 | Durable Medical THORAC CONT PARASPINAL UPRIG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2680 | Durable Medical THORAC CONT LAT SUPPORT UPRI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2795 | Durable Medical KNEE CONTROL FULL KNEECAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L2999 | Durable Medical Lower extremity orthosis, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3000 | Durable Medical FT INSERT UCB BERKELEY SHELL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3010 | Durable Medical FOOT LONGITUDINAL ARCH SUPPO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3020 | Durable Medical FOOT LONGITUD/METATARSAL SUP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3031 | Durable Medical FOOT LAMIN/PREPREG COMPOSITE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3040 | Durable Medical FT ARCH SUPRT PREMOLD LONGIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3060 | Durable Medical FOOT ARCH SUPP LONGITUD/META | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3201 | Durable Medical OXFORD W SUPINAT/PRONAT INF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3202 | Durable Medical OXFORD W/ SUPINAT/PRONATOR C | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3203 | Durable Medical OXFORD W/ SUPINATOR/PRONATOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3204 | Durable Medical HIGHTOP W/ SUPP/PRONATOR INF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3206 | Durable Medical HIGHTOP W/ SUPP/PRONATOR CHI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3207 | Durable Medical HIGHTOP W/ SUPP/PRONATOR JUN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3224 | Durable Medical WOMAN SHOE OXFORD BRACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3225 | Durable Medical MAN SHOE OXFORD BRACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3253 | Durable Medical SHOE MOLDED PLASTAZOTE CUST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3265 | Durable Medical PLASTAZOTE SANDAL EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3332 | Durable Medical SHOE LIFTS TAPERED TO ONE-HA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3334 | Durable Medical SHOE LIFTS ELEVATION HEEL /I | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3480 | Durable Medical SHOE HEEL PAD & DEPRESS FOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3904 | Durable Medical Wrist-hand-finger orthosis (WHFO), external powered, electric | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3967 | Durable Medical SEWHO AIRPLANE W/O JNTS CF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3971 | Durable Medical SEWHO CAP DESIGN W/JNT(S) CF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L3999 | Durable Medical Upper limb orthosis, not otherwise specified [when specified as an | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4000 | Durable Medical REPL GIRDLE MILWAUKEE ORTH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4002 | Durable Medical REPLACE STRAP, ANY ORTHOSIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4010 | Durable Medical REPLACE TRILATERAL SOCKET BR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4020 | Durable Medical REPLACE QUADLAT SOCKET BRIM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4030 | Durable Medical REPLACE SOCKET BRIM CUST FIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4040 | Durable Medical REPLACE MOLDED THIGH LACER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4045 | Durable Medical REPLACE NON-MOLDED THIGH LAC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4050 | Durable Medical REPLACE MOLDED CALF LACER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4055 | Durable Medical REPLACE NON-MOLDED CALF LACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4060 | Durable Medical REPLACE HIGH ROLL CUFF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4070 | Durable Medical REPLACE PROX & DIST UPRIGHT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4080 | Durable Medical REPL MET BAND KAFO-AFO PROX | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4090 | Durable Medical REPL MET BAND KAFO-AFO CALF/ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4100 | Durable Medical REPL LEATH CUFF KAFO PROX TH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4110 | Durable Medical REPL LEATH CUFF KAFO-AFO CAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4130 | Durable Medical REPLACE PRETIBIAL SHELL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4205 | Durable Medical ORTHO DVC REPAIR PER 15 MIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4210 | Durable Medical ORTH DEV REPAIR/REPL MINOR P | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4394 | Durable Medical REPLACE FOOT DROP SPINT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L4631 | Durable Medical AFO, WALK BOOT TYPE, CUS FAB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5000 | Durable Medical Prosthesis - partial foot prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5010 | Durable Medical Prosthesis - partial foot prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5020 | Durable Medical Prosthesis - partial foot prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5050 | Durable Medical Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5060 | Durable Medical Prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5100 | Durable Medical Prosthesis - below knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5105 | Durable Medical Prosthesis - below knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5150 | Durable Medical Prosthesis - knee disarticulation (or through knee) prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5160 | Durable Medical Prosthesis - knee disarticulation (or through knee) prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5200 | Durable Medical Prosthesis - above knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5210 | Durable Medical Prosthesis - above knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5220 | Durable Medical Prosthesis - above knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5230 | Durable Medical Prosthesis - above knee prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5250 | Durable Medical Prosthesis - hip disarticulation prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5270 | Durable Medical Prosthesis - hip disarticulation prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5280 | Durable Medical Prosthesis - hemipelvectomy, Canadian type: molded socket, hip | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5301 | Durable Medical Prosthesis - below knee, molded socket, shin, each foot | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5312 | Durable Medical Prosthesis - knee disarticulation (or through knee), molded socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5321 | Durable Medical Prosthesis - above knee, molded socket, open end, SACH foot | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5331 | Durable Medical Prosthesis - hip disarticulation, Canadian type, molded socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5341 | Durable Medical Prosthesis - hemipelvectomy, Canadian type, molded socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5400 | Durable Medical Prosthesis - immediate post surgical or early fitting prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5410 | Durable Medical Prosthesis - immediate post surgical or early fitting prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5420 | Durable Medical Prosthesis - immediate post surgical or early fitting prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5430 | Durable Medical Prosthesis - immediate post surgical or early fitting prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5450 | Durable Medical Prosthesis - immediate post surgical or early fitting prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5460 | Durable Medical Prosthesis - immediate post surgical or early fitting prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5500 | Durable Medical Prosthesis - initial prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5505 | Durable Medical Prosthesis - initial prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5510 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5520 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5530 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5535 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5540 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5560 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5570 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5580 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5585 | Durable Medical PREP AK ISCHIAL OPEN END | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5590 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5595 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5600 | Durable Medical Prosthesis - preparatory prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5610 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5611 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5613 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5614 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5615 | Addition, endoskeletal knee-shin system, 4 bar linkage or multiaxial | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5616 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5617 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5618 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5620 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5622 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5624 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5626 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5628 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5629 | Durable Medical Prosthesis - additions to lower extremity prostheses, test sockets | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5630 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5631 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5632 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5634 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5636 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5637 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5638 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5639 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5640 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5642 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5643 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5644 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5645 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5646 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5647 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5648 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5649 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5650 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5651 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5652 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5653 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5654 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5655 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5656 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5658 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5661 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5665 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5666 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5668 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5670 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5671 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5672 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5673 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5676 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5677 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5678 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5679 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5680 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5681 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5682 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5683 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5684 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5685 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5686 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5688 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5690 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5692 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5694 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5695 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5696 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5697 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5698 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5699 | Durable Medical Prosthesis - additions to lower extremity prostheses, socket inserts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5700 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5701 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5702 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5703 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5704 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5705 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5706 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5707 | Durable Medical Prosthesis - replacements for lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5710 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5711 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5712 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5714 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5716 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5718 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5722 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5724 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5726 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5728 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5780 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5781 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5782 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5785 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5790 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5795 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5810 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5811 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5812 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5814 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5816 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5818 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5822 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5824 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5826 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5828 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5830 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5840 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5845 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5848 | Durable Medical Prosthesis - additions to lower extremity prostheses, exoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5850 | Durable Medical Prosthesis - addition, endoskeletal system, above | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5855 | Durable Medical Prosthesis - addition, endoskeletal system, hip disarticulation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5856 | Durable Medical Addition to lower extremity prosthesis, endoskeletal knee-shin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5857 | Durable Medical Addition to lower extremity prosthesis, endoskeletal knee-shin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5858 | Durable Medical Addition to lower extremity prosthesis, endoskeletal knee shin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5859 | Durable Medical Addition to lower extremity prosthesis, endoskeletal knee-shin | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5910 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5920 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5925 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5926 | Addition to lower extremity prosthesis, endoskeletal, knee | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5930 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5940 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5950 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5960 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5961 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5962 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5964 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5966 | Durable Medical Prosthesis - additions to lower extremity prostheses, endoskeletal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5968 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5969 | Durable Medical Addition, endoskeletal ankle-foot or ankle system | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5970 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5971 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5972 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5973 | Durable Medical Endoskeletal ankle-foot system, microprocessor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5974 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5975 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5976 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5978 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5979 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5980 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5981 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5982 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5984 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5985 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5986 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5987 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5988 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5990 | Durable Medical Prosthesis - additions to lower extremity prostheses | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5991 | Durable Medical ADDITION TO LOWER EXTREMITY PROSTHESES, OSSEOINTEGRATED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L5999 | Durable Medical Prosthesis - addition to lower extremity prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6000 | Durable Medical PAR HAND ROBIN-AIDS THUM REM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6010 | Durable Medical HAND ROBIN-AIDS LITTLE/RING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6020 | Durable Medical PART HAND ROBIN-AIDS NO FING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6050 | Durable Medical WRST MLD SCK FLX HNG TRI PAD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6055 | Durable Medical WRST MOLD SOCK W/EXP INTERFA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6100 | Durable Medical ELB MOLD SOCK FLEX HINGE PAD | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6110 | Durable Medical ELBOW MOLD SOCK SUSPENSION T | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6120 | Durable Medical ELBOW MOLD DOUB SPLT SOC STE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6130 | Durable Medical ELBOW STUMP ACTIVATED LOCK H | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6200 | Durable Medical ELBOW MOLD OUTSID LOCK HINGE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6205 | Durable Medical ELBOW MOLDED W/ EXPAND INTER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6250 | Durable Medical ELBOW INTER LOC ELBOW FORARM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6300 | Durable Medical SHLDER DISART INT LOCK ELBOW | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6310 | Durable Medical SHOULDER PASSIVE RESTOR COMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6320 | Durable Medical SHOULDER PASSIVE RESTOR CAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6350 | Durable Medical THORACIC INTERN LOCK ELBOW | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6360 | Durable Medical THORACIC PASSIVE RESTOR COMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6370 | Durable Medical THORACIC PASSIVE RESTOR CAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6380 | Durable Medical POSTOP DSG CAST CHG WRST/ELB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6382 | Durable Medical POSTOP DSG CAST CHG ELB DIS/ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6384 | Durable Medical POSTOP DSG CAST CHG SHLDER/T | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6386 | Durable Medical POSTOP EA CAST CHG & REALIGN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6388 | Durable Medical POSTOP APPLICAT RIGID DSG ON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6400 | Durable Medical BELOW ELBOW PROSTH TISS SHAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6450 | Durable Medical ELB DISART PROSTH TISS SHAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6500 | Durable Medical ABOVE ELBOW PROSTH TISS SHAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6550 | Durable Medical SHLDR DISAR PROSTH TISS SHAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6570 | Durable Medical SCAP THORAC PROSTH TISS SHAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6580 | Durable Medical WRIST/ELBOW BOWDEN CABLE MOL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6582 | Durable Medical WRIST/ELBOW BOWDEN CBL DIR F | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6584 | Durable Medical ELBOW FAIR LEAD CABLE MOLDED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6586 | Durable Medical ELBOW FAIR LEAD CABLE DIR FO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6588 | Durable Medical SHDR FAIR LEAD CABLE MOLDED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6590 | Durable Medical SHDR FAIR LEAD CABLE DIRECT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6600 | Durable Medical POLYCENTRIC HINGE PAIR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6605 | Durable Medical SINGLE PIVOT HINGE PAIR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6610 | Durable Medical FLEXIBLE METAL HINGE PAIR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6611 | Durable Medical Addition to upper extremity prosthesis, external | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6615 | Durable Medical DISCONNECT LOCKING WRIST UNI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6616 | Durable Medical DISCONNECT INSERT LOCKING WR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6620 | Durable Medical FLEXION/EXTENSION WRIST UNIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6621 | Durable Medical Upper extremity prosthesis addition, flexion/extension wrist with or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6623 | Durable Medical SPRING-ASS ROT WRST W/ LATCH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6624 | Durable Medical FLEX/EXT/ROTATION WRIST UNIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6625 | Durable Medical ROTATION WRST W/ CABLE LOCK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6628 | Durable Medical QUICK DISCONN HOOK ADAPTER O | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6629 | Durable Medical LAMINATION COLLAR W/ COUPLIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6630 | Durable Medical STAINLESS STEEL ANY WRIST | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6632 | Durable Medical LATEX SUSPENSION SLEEVE EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6635 | Durable Medical LIFT ASSIST FOR ELBOW | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6637 | Durable Medical NUDGE CONTROL ELBOW LOCK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6638 | Durable Medical Upper extremity addition to prosthesis, electric locking feature, only | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6640 | Durable Medical SHOULDER ABDUCTION JOINT PAI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6641 | Durable Medical EXCURSION AMPLIFIER PULLEY T | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6642 | Durable Medical EXCURSION AMPLIFIER LEVER TY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6645 | Durable Medical SHOULDER FLEXION-ABDUCTION J | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6646 | Durable Medical Upper extremity addition, shoulder joint, multipositional locking | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6647 | Durable Medical Upper extremity addition, shoulder lock mechanism, body powered | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6648 | Durable Medical Upper extremity addition, shoulder lock mechanism, external | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6650 | Durable Medical SHOULDER UNIVERSAL JOINT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6655 | Durable Medical STANDARD CONTROL CABLE EXTRA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6660 | Durable Medical HEAVY DUTY CONTROL CABLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6665 | Durable Medical TEFLON OR EQUAL CABLE LINING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6670 | Durable Medical HOOK TO HAND CABLE ADAPTER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6672 | Durable Medical HARNESS CHEST/SHLDER SADDLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6675 | Durable Medical HARNESS FIGURE OF 8 SING CON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6676 | Durable Medical HARNESS FIGURE OF 8 DUAL CON | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6677 | Durable Medical Upper extremity addition, harness, triple control, simultaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6680 | Durable Medical TEST SOCK WRIST DISART/BEL E | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6682 | Durable Medical TEST SOCK ELBW DISART/ABOVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6684 | Durable Medical TEST SOCKET SHLDR DISART/THO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6686 | Durable Medical SUCTION SOCKET | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6687 | Durable Medical FRAME TYP SOCKET BEL ELBOW/W | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6688 | Durable Medical FRAME TYP SOCK ABOVE ELB/DIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6689 | Durable Medical FRAME TYP SOCKET SHOULDER DI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6690 | Durable Medical FRAME TYP SOCK INTERSCAP-THO | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6691 | Durable Medical REMOVABLE INSERT EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6692 | Durable Medical SILICONE GEL INSERT OR EQUAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6693 | Durable Medical LOCKINGELBOW FOREARM CNTRBAL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6694 | Durable Medical ELBOW SOCKET INS USE W/LOCK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6695 | Durable Medical ELBOW SOCKET INS USE W/O LCK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6696 | Durable Medical CUS ELBO SKT IN FOR CON/ATYP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6697 | Durable Medical CUS ELBO SKT IN NOT CON/ATYP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6698 | Durable Medical BELOW/ABOVE ELBOW LOCK MECH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6703 | Durable Medical TERM DEV, PASSIVE HAND MITT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6704 | Durable Medical TERM DEV, SPORT/REC/WORK ATT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6706 | Durable Medical TERM DEV MECH HOOK VOL OPEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6707 | Durable Medical TERM DEV MECH HOOK VOL CLOSE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6708 | Durable Medical TERM DEV MECH HAND VOL OPEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6709 | Durable Medical TERM DEV MECH HAND VOL CLOSE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6711 | Durable Medical PED TERM DEV, HOOK, VOL OPEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6712 | Durable Medical PED TERM DEV, HOOK, VOL CLOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6713 | Durable Medical PED TERM DEV, HAND, VOL OPEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6714 | Durable Medical PED TERM DEV, HAND, VOL CLOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6715 | Durable Medical Terminal device, multiple articulating digit, includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6721 | Durable Medical HOOK/HAND, HVY DTY, VOL OPEN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6722 | Durable Medical HOOK/HAND, HVY DTY, VOL CLOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6805 | Durable Medical TERM DEV MODIFIER WRIST UNIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6810 | Durable Medical TERM DEV PRECISION PINCH DEV | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6881 | Durable Medical Automatic grasp feature, addition to upper limb | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6882 | Durable Medical Microprocessor control feature, addition to upper | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6883 | Durable Medical Replacement socket, below elbow/wrist disarticulation, molded to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6884 | Durable Medical Replacement socket, above elbow/elbow disarticulation, molded to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6885 | Durable Medical Replacement socket, shoulder disarticulation/interscapular | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6890 | Durable Medical PREFAB GLOVE FOR TERM DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6895 | Durable Medical CUSTOM GLOVE FOR TERM DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6900 | Durable Medical HAND RESTORAT THUMB/1 FINGER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6905 | Durable Medical HAND RESTORATION MULTIPLE FI | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6910 | Durable Medical HAND RESTORATION NO FINGERS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6915 | Durable Medical HAND RESTORATION REPLACMNT G | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6920 | Durable Medical : Wrist disarticulation, external power, self-suspended inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6925 | Durable Medical Wrist disarticulation, external power, self- suspended inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6930 | Durable Medical Below elbow, external power, self-suspended inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6935 | Durable Medical Below elbow, external power, self-suspended inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6940 | Durable Medical Elbow disarticulation, external power, molded inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6945 | Durable Medical Elbow disarticulation, external power, molded inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6950 | Durable Medical Above elbow, external power, molded inner socket, removable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6955 | Durable Medical Above elbow, external power, molded inner socket, removable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6960 | Durable Medical : Shoulder disarticulation, external power, molded inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6965 | Durable Medical Shoulder disarticulation, external power, molded inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6970 | Durable Medical Interscapular-thoracic, external power, molded inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L6975 | Durable Medical Interscapular-thoracic, external power, molded inner socket | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7007 | Durable Medical Electric hand, switch or myoelectric controlled | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7008 | Durable Medical Electric hand, switch or myoelectric, controlled | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7009 | Durable Medical Electric hook, switch or myoelectric controlled | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7040 | Durable Medical PREHENSILE ACTUATOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7045 | Durable Medical Electric hook, switch or myoelectric controlled | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7170 | Durable Medical ELECTRONIC ELBOW HOSMER SWIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7180 | Durable Medical Electronic elbow, microprocessor sequential control | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7181 | Durable Medical Electronic elbow, microprocessor simultaneous | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7185 | Durable Medical ELECTRON ELBOW ADOLESCENT SW | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7186 | Durable Medical ELECTRONIC ELBOW CHILD SWITCH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7190 | Durable Medical Electronic elbow, adolescent, Variety Village or | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7191 | Durable Medical Electronic elbow, child, Variety Village or equal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7259 | Durable Medical Electronic wrist rotator, any type | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7360 | Durable Medical SIX VOLT BAT OTTO BOCK/EQ EA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7364 | Durable Medical TWELVE VOLT BATTERY UTAH/EQU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7400 | Durable Medical ADD UE PROST BE/WD, ULTLITE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7401 | Durable Medical ADD UE PROST A/E ULTLITE MAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7402 | Durable Medical ADD UE PROST S/D ULTLITE MAT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7403 | Durable Medical ADD UE PROST B/E ACRYLIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7404 | Durable Medical ADD UE PROST A/E ACRYLIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7405 | Durable Medical ADD UE PROST S/D ACRYLIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7499 | Durable Medical UPPER EXTREMITY PROSTHESIS, NOT OTHERWIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7510 | Durable Medical Prosthesis - repair of prosthetic device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7520 | Durable Medical Prosthesis - repair of prosthetic device | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7600 | Durable Medical PROSTHETIC DONNING SLEEVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L7700 | Durable Medical GASKET OR SEAL, FOR USE WITH PROSTHETIC SOCKET INSERT, ANY TYPE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8035 | Durable Medical CUSTOM BREAST PROSTHESIS, POST MASTECTOM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8039 | Durable Medical BREAST PROSTHESIS, NOS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8040 | Durable Medical NASAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8041 | Durable Medical MIDFACIAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8042 | Durable Medical ORBITAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8043 | Durable Medical UPPER FACIAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8044 | Durable Medical HEMI-FACIAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8045 | Durable Medical AURICULAR PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8046 | Durable Medical PARTIAL FACIAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8047 | Durable Medical NASAL SEPTAL PROSTHESIS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8048 | Durable Medical UNSPECIFIED MAXILLOFACIAL PROSTHESIS, BY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8049 | Durable Medical REPAIR MAXILLOFACIAL PROSTH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8400 | Durable Medical Prosthesis - prosthetic sheath | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8410 | Durable Medical Prosthesis - prosthetic sheath | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8415 | Durable Medical SHEATH UPPER LIMB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8417 | Durable Medical Prosthesis - prosthetic sheath/sock, including a gel cushion layer | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8420 | Durable Medical Prosthesis - prosthetic sock, multiple ply | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8430 | Durable Medical Prosthesis - prosthetic sock, multiple ply | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8435 | Durable Medical PROS SOCK MULTI PLY UPPER LM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8440 | Durable Medical Prosthesis - prosthetic shrinker | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8460 | Durable Medical Prosthesis - prosthetic shrinker | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8465 | Durable Medical SHRINKER UPPER LIMB | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8470 | Durable Medical Prosthesis - prosthetic sock, single ply | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8480 | Durable Medical PROS SOCK SINGLE PLY AK | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8485 | Durable Medical PROS SOCK SINGLE PLY UPPER L | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8499 | Durable Medical UNLISTED MISC PROSTHETIC SER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8500 | Durable Medical ARTIFICIAL LARYNX | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8501 | Durable Medical TRACHEOSTOMY SPEAKING VALVE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8505 | Durable Medical ARTIFICIAL LARYNX, ACCESSORY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8507 | Durable Medical TRACH-ESOPH VOICE PROS PT IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8509 | Durable Medical TRACH-ESOPH VOICE PROS MD IN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8510 | Durable Medical VOICE AMPLIFIER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8511 | Durable Medical INDWELLING TRACH INSERT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8512 | Durable Medical GEL CAP FOR TRACH VOICE PROS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8513 | Durable Medical TRACH PROS CLEANING DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8514 | Durable Medical REPL TRACH PUNCTURE DILATOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8515 | Durable Medical GEL CAP APP DEVICE FOR TRACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8600 | Durable Medical Implantable breast prosthesis, silicone or equal | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8607 | Cosmetic Potential Injectable bulking agent for vocal cord medialization, 0.1 ml, includes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8613 | Durable Medical OSSICULA IMPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8614 | Durable Medical Cochlear device, includes all internal and external | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8615 | Durable Medical COCH IMPLANT HEADSET REPLACE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8616 | Durable Medical COCH IMPLANT MICROPHONE REPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8617 | Durable Medical COCH IMPLANT TRANS COIL REPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8618 | Durable Medical COCH IMPLANT TRAN CABLE REPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8619 | Durable Medical Cochlear implant external speech processor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8623 | Durable Medical LITH ION BATT CID,NON-EARLVL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8624 | Durable Medical LITH ION BATT CID, EAR LEVEL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8625 | Durable Medical EXTERNAL RECHARG SYS FOR COCHLEAR IMPLANT OR AUDITORY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8627 | Durable Medical Cochlear implant, external speech processor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8628 | Durable Medical Cochlear implant, external controller component | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8629 | Durable Medical CID TRANSMIT COIL AND CABLE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8630 | Durable Medical METACARPOPHALANGEAL JOINT IMPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8631 | Durable Medical MCP JOINT REPL 2 PC OR MORE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8641 | Durable Medical METATARSAL JOINT IMPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8642 | Durable Medical HALLUX IMPLANT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8658 | Durable Medical INTERPHALANGEAL JOINT SPACER | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8659 | Durable Medical INTERPHALANGEAL JOINT REPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8670 | Durable Medical VASCULAR GRAFT, SYNTHETIC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8678 | Investigational Electrical stimulator supplies (external) for use with implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8679 | Neurostimulator Neurostimulator Implantation - Implantable neurostimulator, pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8680 | Neurostimulator Neurostimulator Implantation – Implantable heurostimulator | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8681 | Neurostimulator Patient programmer (external) for use with implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8682 | Neurostimulator Neurostimulator Implantation - Implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8683 | Neurostimulator Neurostimulator Implantation - Radiofrequency Transmitter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8684 | Neurostimulator Radiofrequency transmitter (external) for use with implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8685 | Neurostimulator Neurostimulator Implantation - Implantable Neurostimulator Pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8686 | Neurostimulator Neurostimulator Implantation - Implantable | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8687 | Neurostimulator Neurostimulator Implantation - Implantable Neurostimulator Pulse | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8688 | Neurostimulator Implantable neurostimulator pulse generator, dual array; non | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8689 | Durable Medical EXTERNAL RECHARG SYS INTERN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8690 | Durable Medical AUD OSSEO DEV, INT/EXT COMP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8691 | Durable Medical OSSEOINTEGRATED SND PROC RPL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8692 | Durable Medical AUDITORY OSSEOINTEGRATED DEVICE, EXTERNA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8693 | Durable Medical AUD OSSEO DEV, ABUTMENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8694 | Durable Medical AUDITORY OSSEOINTEGRATED DEVICE, TRANSDUCER/ACTUATOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8695 | Durable Medical EXTERNAL RECHARG SYS EXTERN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8696 | Durable Medical ANTENNA (EXTERNAL) FOR IMPL DIAPHRAGMATIC/PHRENIC NERVE STIM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8698 | Durable Medical MISC COMP/SUPPLY/ACCESS USED WITH TOTAL ARTIFICIAL HEART | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L8699 | Durable Medical Prosthetic implant, not otherwise specified | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| L9900 | Durable Medical ORTHOTIC AND PROSTHETIC SUPPLY, ACCESSOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q0138 | Pharmacy Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q0139 | Pharmacy FERUMOXYTOL, ESRD USE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q0506 | Durable Medical BATTERY, LITHIUM-ION, FOR USE WITH ELECT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q0515 | Pharmacy Semorelin acetate | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2017 | Pharmacy TENIPOSIDE, 50 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2026 | Cosmetic Potential Injection, Radiesse, 0.1 ml | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2028 | Cosmetic Potential Injection, Sculptra, 0.5 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2041 | Pharmacy Axicabtagene Ciloleucel [Yescarta] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2042 | Pharmacy Tisagenlecleucel [Kymriah] | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2043 | Pharmacy Sipuleucel-T (Provenge) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2049 | Pharmacy Liposomal doxorubicin (Lipodox) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2050 | Pharmacy Liposomal doxorubicin (Doxil) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2052 | Pharmacy SERVICES SUPPLIES IN HOME MEDICARE IVIG DEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2053 | Pharmacy Sacituzumab govitecan-hziy, 10 mg (Tecartus) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2054 | Pharmacy Lisocabtagene maraleucel (Breyanzi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2055 | Pharmacy Idecabtagene vicleucel (Abecma) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q2056 | Pharmacy Ciltacabtagene autoleucel (Carvykti) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q3001 | Radiation Brachytherapy Radioelements | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q3027 | Pharmacy Interferon beta-1a (Avonex) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q3028 | Pharmacy Interferon beta-1a (Rebif) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4050 | Durable Medical CAST SUPPLIES UNLISTED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4051 | Durable Medical SPLINT SUPPLIES, MISC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4074 | Pharmacy Iloprost (Ventavis) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4081 | Pharmacy Epoetin alfa (for ESRD on dialysis) (Epogen, Procrit) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4082 | Pharmacy DRUG/BIO NOC PART B DRUG CAP | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4100 | BioEngineered Wound Skin substitute, not otherwise classified [when specified as OrCel for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4101 | BioEngineered Wound Apligraf, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4102 | BioEngineered Wound Oasis Wound Matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4105 | BioEngineered Wound Integra Dermal Regeneration Template (DRT) or Integra Omnigraft | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4106 | BioEngineered Wound Dermagraft, per square centimeter [for diabetic foot | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4107 | BioEngineered Wound GraftJacket, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4108 | BioEngineered Wound Integra Matrix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4114 | BioEngineered Wound Integra Flowable Wound Matrix, injectable, 1 cc | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4116 | BioEngineered Wound AlloDerm, per square centimeter [AlloDerm RTM, AlloDerm RTU for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4122 | BioEngineered Wound Dermacell, Dermacell AWM or Dermacell AWM porous, per square | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4128 | BioEngineered Wound FlexHD, Allopatch HD, or Matrix HD, per square centimeter [when | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4132 | BioEngineered Wound Grafix CORE and GrafixPL CORE, per square | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4133 | BioEngineered Wound Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per square | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4151 | BioEngineered Wound AmnioBand or Guardian, per sq cm [for diabetic foot | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4154 | BioEngineered Wound Biovance, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4159 | BioEngineered Wound Affinity, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4186 | BioEngineered Wound EpiFix, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4187 | BioEngineered Wound EpiCord, per square centimeter [for diabetic foot | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4193 | BioEngineered Wound Coll-e-derm, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4197 | BioEngineered Wound PuraPly XT, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4200 | BioEngineered Wound Skin TE, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4202 | BioEngineered Wound Keroxx (2.5g/cc), 1cc | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4203 | BioEngineered Wound Derma-gide, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4226 | BioEngineered Wound MyOwn Skin, includes harvesting and preparation procedures, per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4244 | BioEngineered Wound Procenta, per 200 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4251 | BioEngineered Wound Vim, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4252 | BioEngineered Wound Vendaje, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4253 | BioEngineered Wound Zenith Amniotic Membrane, per sq cm | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4254 | BioEngineered Wound Novafix DL, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4267 | Bioengineered Wound NeoStim DL, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q4268 | Bioengineered Wound SurGraft FT, per square centimeter | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5001 | Home Health Hospice or home health care provided in patient's home/residence | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5002 | Home Health Hospice or home health care provided in assisted | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5006 | Hospice HOSPICE IN HOSPICE FACILITY | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5009 | Hospice Hospice or home health care provided in place not | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5101 | Pharmacy Filgrastim-sndz (Zarxio) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5102 | Pharmacy Injection, infliximab, biosimilar, 10 mg | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5103 | Pharmacy Infliximab-dyyb (Inflectra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5104 | Pharmacy Infliximab-abda (Renflexis) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5105 | Pharmacy Epoetin alfa-epbx (Retacrit) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5106 | Pharmacy Epoetin alfa-epbx (Retacrit) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5107 | Pharmacy Mvasi (bevacizumab-awwb) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5108 | Pharmacy Pegfilgrastim-jmdb (Fulphila) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5109 | Pharmacy Infliximab-qbtx (Ixifi) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5110 | Pharmacy Filgrastim-aafi (Nivestym) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5111 | Pharmacy Pegfilgrastim-cbqv (Udenyca) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5112 | Pharmacy Ontruzant (trastuzumab-dttb) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5113 | Pharmacy Herzuma (trastuzumab-pkrb) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5114 | Pharmacy Ogivri (trastuzumab-dkst) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5115 | Pharmacy Tituximab-abbs (Truxima) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5116 | Pharmacy Trazimera (trastuzumab-qyyp) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5117 | Pharmacy Injection, trastuzumab-anns, biosimilar | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5118 | Pharmacy Zirabev (bevacizumab-bvzr) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5119 | Pharmacy Rituximab-pvvr (Ruxience) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5120 | Pharmacy Pegfilgrastim-bmez, biosimilar (Ziextenzo) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5121 | Pharmacy Infliximab-axxq (Avsola) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5122 | Pharmacy Immune globulin (Nyvepria) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5123 | Pharmacy Rituximab-arrx (RIABNI) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5124 | Pharmacy Ranibizumab-nuna (Byooviz) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5125 | Pharmacy Filgrastim-ayow (Releuko) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5126 | Pharmacy Bevacizumab-maly (Alymsys) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5127 | Pharmacy Pegfilgrastim-fpgk (Stimufend) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5128 | Pharmacy Ranibuzumab-cqrn (Cimerli) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5129 | Pharmacy Bevacizumab-adcd (Vegzelma) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5130 | Pharmacy Pegfilgrastim-pbbk (Fylnetra) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5133 | Pharmacy INJECTION, TOCILIZUMAB-BAVI (TOFIDENCE), BIOSIMILAR, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q5134 | Pharmacy INJECTION, NATALIZUMAB-SZTN (TYRUKO), BIOSIMILAR, 1 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| Q9977 | Pharmacy COMPOUNDED DRUG NOT OTHERWISE CLASSIFIED | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0013 | Pharmacy Spravato (esketamine) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0023 | Pharmacy INJECTION, CIMETIDINE HYDROC 300MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0040 | Pharmacy INJECTION, TICARCILLIN DISOD 3.1GM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0126 | Pharmacy INJECTION, FOLLITROPIN ALFA, 75 IU | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0142 | Pharmacy COLISTIMETHATE INH SOL MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0166 | Pharmacy INJECTION, OLANZAPINE, 2.5 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0169 | Pharmacy CALCITROL, 0.25 MICROGRAM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S0189 | Pharmacy TESTOSTERONE PELLET 75 MG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S1034 | Durable Medical ARTIF PANCREAS DEVC SYS THAT CMNCT W/ALL DEVC | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S1035 | Durable Medical SENSOR; INVASV DSPBL USE ARTIF PANCREAS DEVC SYS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S1040 | Durable Medical Cranial orthotics - cranial remolding orthosis, pediatric, rigid, with | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2053 | Transplant Transplantation of small intestine and liver allografts | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2054 | Transplant Transplantation of multivisceral organs | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2055 | Transplant Harvesting of donor multivisceral organs, with preparation and | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2060 | Transplant Lobar lung transplantation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2061 | Transplant Donor lobectomy (lung) for transplantation, living | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2065 | Transplant Simultaneous pancreas kidney transplantation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2066 | Surgical - Breast Breast reconstruction with gluteal artery perforator (GAP) flap | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2067 | Surgical - Breast Breast reconstruction of a single breast with "stacked" deep inferior | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2068 | Surgical - Breast Breast reconstruction with deep inferior epigastric perforator (DIEP) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2102 | Transplant Islet cell tissue transplant from pancreas, allogeneic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2103 | Transplant Adrenal tissue transplant to brain | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2118 | Surgical - TOTAL HIP RESURFACING | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2140 | Transplant Cord blood harvesting for transplantation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2142 | Transplant Cord blood-derived stem cell transplantation, allogeneic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2150 | Transplant Bone marrow or blood-derived peripheral stem cells harvesting | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2152 | Transplant SOLID ORGAN TRANSPL PKG | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2202 | Surgical - Misc. Echosclerotherapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2235 | Surgical - Misc. Implantation of auditory brain stem implant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2300 | Surgical - Misc. Arthroscopy, shoulder, surgical; with thermally | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2400 | Surgical - Fetal Repair, congenital diaphragmatic hernia in the fetus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2401 | Surgical - Fetal Repair, urinary tract obstruction in the fetus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2402 | Surgical - Fetal Repair, congenital cystic adenomatoid malformation in the fetus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2403 | Surgical - Fetal Repair, extralobar pulmonary sequestration in the | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2404 | Surgical - Fetal Repair, myelomeningocele in the fetus, procedure | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2405 | Surgical - Fetal Repair of sacrococcygeal teratoma in the fetus | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S2409 | Surgical - Fetal Repair, congenital malformation of fetus, procedure performed in | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3800 | Genetic Testing Genetic testing for amyotrophic lateral sclerosis (ALS) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3840 | Genetic Testing DNA analysis for germline mutations of the RET proto-oncogene for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3841 | Genetic Testing Genetic testing for retinoblastoma | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3842 | Genetic Testing Genetic testing for von Hippel-Lindau disease | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3844 | Genetic Testing DNA analysis of the connexin 26 gene (gjb2) for susceptibility to | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3845 | Genetic Testing Genetic testing for alpha-thalassemia | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3846 | Genetic Testing Genetic testing for hemoglobin E beta-thalassemia | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3849 | Genetic Testing Genetic testing for Niemann-Pick diseases | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3850 | Genetic Testing Genetic testing for sickle cell anemia | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3853 | Genetic Testing Genetic testing for myotonic muscular dystrophy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3854 | Genetic Testing Gene expression profiling panel for use in the management of | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3861 | Genetic Testing Genetic testing, sodium channel, voltage-gated, type V, alpha | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3865 | Genetic Testing Comprehensive gene sequence analysis for hypertrophic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3866 | Genetic Testing Genetic analysis for a specific gene mutation for hypertrophic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S3870 | Genetic Testing Comparative genomic hybridization (CGH) microarray testing for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S4015 | Infertility COMPLETE IN VITRO FERTILIZATION CYCLE, N | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S4021 | Infertility IN VITRO FERTILIZATION PROCEDURE CANCELL | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5035 | Home Health Home infusion, therapy, routine service of infusion device (e.g | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5036 | Home Health Home infusion therapy, repair of infusion device (e.g., pump repair) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5108 | Behavioral Health Home care training to home care client, per 15 | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5109 | Home Health Home care training to home care client; per session | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5110 | Behavioral Health Home care training, family; per 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5111 | Home Health Home care training, family | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5115 | Home Health Home care training, non-family | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5116 | Home Health Home care training, non-family | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5180 | Home Health Home health respiratory therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5181 | Home Health Home health respiratory therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5199 | Durable Medical PERSONAL CARE ITEM, NOS, EACH | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5497 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5498 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5501 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5502 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5517 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5518 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5520 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5521 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5522 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S5523 | Home Health Home infusion therapy, catheter care maintenance | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S8030 | Radiation Scleral application of tantalum ring(s) for localization of lesions for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S8035 | Advanced Imaging Magnetic source imaging | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S8092 | Advanced Imaging Electron beam computed tomography (also known as ultrafast CT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9056 | Investigational Coma stimulation, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9061 | Home Health Home administration of aerosolized drug therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9097 | Home Health Home visit for wound care | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9098 | Home Health HOME PHOTOTHERAPY VISIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9122 | Home Health Home health aide or certified nurse assistant | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9123 | Home Health Nursing care in the home ; by registered nurse, per hour (use for | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9124 | Home Health Nursing care in the home; by licensed practical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9126 | Home Health HOSPICE CARE, IN THE HOME, P | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9127 | Home Health Social work visit, in the home, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9128 | Home Health Speech therapy, in the home, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9129 | Home Health Occupational therapy, in the home, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9131 | Home Health Physical therapy, in the home, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9208 | Home Health HOME MGMT PRETERM LABOR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9209 | Home Health Home management of complications of pregnancy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9211 | Home Health Home management of complications of pregnancy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9212 | Home Health Home management of complications of pregnancy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9213 | Home Health Home management of complications of pregnancy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9214 | Home Health Home management of complications of pregnancy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9325 | Home Health Home infusion therapy, pain management infusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9326 | Home Health Home infusion therapy, pain management infusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9327 | Home Health Home infusion therapy, pain management infusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9328 | Home Health Home infusion therapy, pain management infusion, per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9329 | Home Health Home infusion therapy, chemotherapy infusion, per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9330 | diem (do not use this code with or ) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9331 | diem (do not use this code with or ) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9335 | Home Health HT HEMODIALYSIS DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9336 | Home Health Home infusion therapy, continuous anticoagulant infusion therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9338 | Home Health Home infusion therapy, immunotherapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9339 | Home Health HIT PERITON DIALYSIS DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9340 | Home Health HIT ENTERAL PER DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9341 | Home Health HIT ENTERAL GRAV DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9342 | Home Health HIT ENTERAL PUMP DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9343 | Home Health HIT ENTERAL BOLUS NURS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9345 | Home Health Home infusion therapy, anti-hemophilic agent | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9346 | Home Health Home infusion therapy, alpha-1-proteinase inhibitor | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9347 | Home Health HIT LONGTERM INFUSION DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9348 | Home Health Home infusion therapy, sympathomimetic/inotropic agent infusion | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9349 | Home Health HIT TOCOLYSIS DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9351 | Home Health Home infusion therapy, continuous antiemetic | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9353 | Home Health HIT CONT INSULIN DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9355 | Home Infusion Home infusion therapy, chelation therapy; administrative services | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9357 | Home Health Home infusion therapy, enzyme replacement intravenous therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9359 | Home Health HIT ANTI-TNF PER DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9361 | Home Health Home infusion therapy, diuretic intravenous therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9363 | Home Health Home infusion therapy, antispasmotic therapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9364 | Home Infusion Home infusion therapy, total parenteral nutrition (TPN) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9365 | Home Infusion Home infusion therapy, total parenteral nutrition (TPN); one liter per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9366 | Home Infusion Home infusion therapy, total parenteral nutrition (TPN); more than | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9367 | Home Infusion Home infusion therapy, total parenteral nutrition (TPN); more than | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9368 | Home Infusion Home infusion therapy, total parenteral nutrition (TPN); more than | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9370 | Home Health Home therapy, intermittent antiemetic injection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9372 | Home Health Home therapy, intermittent anticoagulant injection | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9373 | Home Health Home infusion therapy, hydration therapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9374 | Home Health Home infusion therapy, hydration therapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9375 | Home Health Home infusion therapy, hydration therapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9376 | Home Health Home infusion therapy, hydration therapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9377 | Home Health Home infusion therapy, hydration therapy; per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9379 | Home Health Home infusion therapy, infusion therapy not | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9381 | Home Health HIT HIGH RISK/ESCORT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9460 | Home Health DIABETIC MANAGEMENT PROGRAM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9474 | Home Health ENTEROSTOMAL THERAPY BY A RE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9480 | Behavioral Health INTENSIVE OUTPATIENT PSYCHIA | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9484 | Home Health CRISIS INTERVENTION PER HOUR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9490 | Home Health Home infusion therapy, corticosteroid infusion; per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9494 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9497 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9500 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9501 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9502 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9503 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9504 | Home Health Home infusion therapy, antibiotic, antiviral, or antifungal therapy | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9529 | Home Health VENIPUNCTURE HOME/SNF | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9537 | Home Health HT HEM HORM INJ DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9538 | Home Health Home transfusion of blood product(s); per diem | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9542 | Home Health Home injectable therapy, not otherwise classified; per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9558 | Home Health HT INJ GROWTH HORM DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9559 | Home Health HIT INJ INTERFERON DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9560 | Pharmacy Home injectable therapy; hormonal therapy (e.g., leuprolide | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9562 | Home Health HT INJ PALIVIZUMAB DIEM | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9563 | Home Health HOME INJ THERAPY, IMMUNOTHERAPY, INCLUDING ADMIN SVCS | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9590 | Home Health Home therapy, irrigation therapy (e.g., sterile irrigation of an organ | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9810 | Home Health Home therapy, professional pharmacy services, per hour | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9960 | Transportation Ambulance service, conventional air services | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| S9961 | Transportation Ambulance service, conventional air service | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1000 | Home Health Private duty/independent nursing service(s) | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1001 | Home Health Nursing assessment/evaluation | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1002 | Home Health RN services, up to 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1003 | Home Health LPN/LVN services, up to 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1004 | Home Health Services of a qualified nursing aide, up to 15 minutes | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1019 | Home Health PERSONAL CARE SER PER 15 MIN | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1021 | Home Health Home health aide or certified nurse assistant, per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1022 | Home Health Contracted home health agency services, all services provided | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1028 | Home Health HOME ENVIRONMENT ASSESSMENT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1030 | Home Health Nursing care, in the home, by registered nurse, per | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1031 | Home Health Nursing care, in the home, by licensed practical | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T1502 | Home Health MEDICATION ADMIN VISIT | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T2036 | Behavioral Health Therapeutic camping, overnight, waiver; each session | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T2037 | Behavioral Health Therapeutic camping, day, waiver; each session | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T2042 | Home Health HOSPICE ROUTINE HOME CARE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T2043 | Home Health HOSPICE CONTINUOUS HOME CARE; PER HOUR | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T2045 | Home Health HOSPICE GENERAL CARE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| T2046 | Home Health HOSPICE LONG TERM CARE, R&B | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| V2788 | Surgical - ENT Presbyopia correcting function of intraocular lens | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| V5095 | Durable Medical Semi-implantable middle ear hearing prosthesis | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| V5299 | Exclusion HEARING SERVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |
| V5336 | Exclusion REPAIR COMMUNICATION DEVICE | 2026-07-06 | Not listed | 97% | [PDF] Category Code Code Description - Mountain Health CO-OP |