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MEDICARE EXCLUSION LIST
   
I.
MEDICARE EXCLUDED PROCEDURES
 
 COSMETIC
     
  08.3 Repair of blepharoptosis & lid retraction
    08.31
    08.32
    08.33
    08.34
    08.35
    08.36
  08.70 Reconstruction of eyelid, NOS
  08.8 Other repair of eyelid
    08.89
    08.86
    08.87
  11.71 Keratomileusis
  18.5 Surgical correction of prominent ear
  18.6 Reconstruction of external auditory canal
  18.7 Other plastic repair of external ear
    18.71
    18.79
  21.8 Repair and plastic operations on the nose
    21.89
    21.83
    21.84
    21.85
    21.86
    21.87
    21.88
  27.59 Other plastic repair of mouth
  76.6 Other facial bone repair and orthognathic surgery
    76.67
    76.68
  85.3 Reduction mammoplasty and subcutaneous mammectomy
    85.36
    85.31
    85.32
    85.33
    85.34
  85.5 Augmentation mammoplasty
    85.50
    85.51
    85.52
    85.53
    85.54
  85.6 Mastopexy
  85.8 Other repair and plastic operations on breast
    85.87
    85.89
  85.93 Revision of implant of breast
  86.2 Excision or destruction of lesion or tissue of skin and subcutaneous tissue
    86.24
    86.25
  86.64 Hair transplant
  86.8 Other repair and reconstruction of skin and subcutaneous tissue
    86.81
    86.82
    86.83
    86.84
    86.86
    86.89
  86.92 Electrolysis and other epilation of skin
  20.9 Other operations on inner and middle ear
    20.95 Implantation of electromagnetic hearing device
 
 DENTAL
 
  23.0 Forceps extraction of tooth
    23.09
    23.01
  23.1 Surgical removal of tooth
    23.19
    23.11
  23.2 Restoration of tooth by filling
  23.3 Restoration of tooth by inlay
  23.4 Other dental restoration
    23.41
    23.42
    23.43
    23.49
  23.5 Implantation of tooth
  23.6 Prosthetic dental implant
  23.7 Apicoectomy and root canal therapy
    23.70
    23.71
    23.72
    23.73
  24 Other operations on teeth, gums and alveoli
    24.0
    24.1
      24.19
    24.2
    24.3
      24.31
      24.32
      24.39
    24.4
    24.5
    24.6
    24.7
    24.8
    24.9
      24.91
      24.99
  87.1 Other x-ray of face, head, and neck
    87.11
    87.12
  89.31 Dental examination
  99.97 Fitting of denture
 
 STERILIZATION (FEMALE)
 
  66.2 Bilateral endoscopic destruction or occlusion of fallopian tubes
    66.21
    66.22
    66.29
  66.3 Other bilateral destruction or occlusion of fallopian tubes
    66.31
    66.32
    66.39
  66.5 Total bilateral salpingectomy
    66.51 Removal of fallopian tube at same operative episode
    66.52 Removal of remaining fallopian tube
  66.9 Other operations on fallopian tubes
    66.92 Unilateral destruction or occlusion of fallopian tube
  69.51 Aspiration curettage of uterus for termination of pregnancy
 
 HYSTERECTOMY
 
  68 Other incision and excision of uterus
    68.3 Subtotal abdominal hysterectomy
    68.4 Total abdominal hysterectomy
    68.5 Vaginal hysterectomy
 
 STERILIZATION (MALE)
 
  63.7 Vasectomy and ligation of vas deferens
    63.70
    63.71
    63.72
    63.73
 
 SEX CHANGE
 
  64.5 Operations for sex transformation NEC
 
 ORGAN TRANSPLANTS
 
  37.5 Heart transplantation
  50.5 Liver transplant
    50.51
    50.59
 
 PROCEDURES FOR WEIGHT REDUCTION
 
  44.3 Gastroenterostomy without gastrectomy
    44.31
    44.39
  44.69 Gastric stapling (added to ME list on 6/23/92 per FI)
  45.9 Intestinal anastomosis
    45.90
    45.91
    45.92
    45.93
    45.94
    45.95
 
 OTHER
 
  93.59 Other immobilization, pressure, and attention to wound
  93.95 Hyperbaric oxygenation
  93.96 Other oxygen enrichment
  94.33 Behavior therapy
  96.3 Non-operative alimentary tract irrigation, cleaning, and local instillation
    96.31
    96.32
    96.33
    96.34
    96.35
    96.36
    96.37
    96.38
    96.39
  99.29 Injection or infusion of other therapeutic or prophylactic substance
  99.9 Other miscellaneous procedures
    99.91 Acupuncture for anesthesia
    99.92 Other acupuncture
   
II.
EXCLUDED PRINCIPAL DIAGNOSES
 
  700 Corns and callosities
  743.61 Congenital ptosis
  743.62 Congenital deformities of eyelids
  744.23 Microtia
  744.3 Unspecified anomaly of ear
  744.29 Other specified anomalies of ear
  744.9 Unspecified anomalies of nose
  748.1 Other anomalies of nose
  754.0 Certain congenital musculoskeletal deformities of skull, face, and jaw
  V70.0 Routine general medical examination at a health care facility
  V70.9 Unspecified general medical examination
  V72.1 Examination of ears and hearing
  V72.2 Dental examination