Line	Diagnosis	Treatment
1	PREGNANCY (See Guideline Notes 1,2,64,65)	MATERNITY CARE
2	BIRTH OF INFANT (See Guideline Notes 64,65)	NEWBORN CARE
3	PREVENTIVE SERVICES, BIRTH TO 10 YEARS OF AGE (See Coding Specification Below) (See Guideline Notes 64,65) (See Prevention Tables)	MEDICAL THERAPY
4	PREVENTIVE SERVICES, OVER AGE OF 10 (See Prevention Tables) (See Guideline Notes 3,64,65)	MEDICAL THERAPY
5	ABUSE OR DEPENDENCE OF PSYCHOACTIVE SUBSTANCE (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
6	TOBACCO DEPENDENCE (See Guideline Notes 1,4,64,65)	MEDICAL THERAPY/BRIEF COUNSELING NOT TO EXCEED 10 FOLLOW-UP VISITS OVER 3 MONTHS
7	REPRODUCTIVE SERVICES (See Guideline Notes 64,65)	CONTRACEPTION MANAGEMENT; STERILIZATION
8	OBESITY (See Guideline Notes 1,5)	INTENSIVE NUTRITIONAL/PHYSICAL ACTIVITY COUNSELING AND BEHAVIORAL INTERVENTIONS
9	MAJOR DEPRESSION, RECURRENT (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
10	TYPE I DIABETES MELLITUS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
11	ASTHMA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
12	HYPERTENSION AND HYPERTENSIVE DISEASE (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
13	GALACTOSEMIA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
14	OTHER RESPIRATORY CONDITIONS OF FETUS AND NEWBORN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
15	HIV DISEASE (INCLUDING ACQUIRED IMMUNODEFICIENCY SYNDROME) AND RELATED OPPORTUNISTIC INFECTIONS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
16	CONGENITAL HYPOTHYROIDISM (See Guideline Notes 1,64,65)	MEDICAL THERAPY
17	PHENYLKETONURIA (PKU) (See Guideline Notes 1,64,65)	MEDICAL THERAPY
18	CONGENITAL INFECTIOUS DISEASES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
19	CONGENITAL SYPHILIS (See Guideline Notes 64,65)	MEDICAL THERAPY
20	VERY LOW BIRTH WEIGHT (UNDER 1500 GRAMS) (See Guideline Notes 1,64,65)	MEDICAL THERAPY
21	NEONATAL MYASTHENIA GRAVIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
22	HYDROCEPHALUS AND BENIGN INTRACRANIAL HYPERTENSION (See Guideline Note 1)	MEDICAL AND SURGICAL TREATMENT
23	SYNDROME OF "INFANT OF A DIABETIC MOTHER" AND NEONATAL HYPOGLYCEMIA (See Guideline Notes 64,65)	MEDICAL THERAPY
24	OMPHALITIS OF THE NEWBORN AND NEONATAL INFECTIVE MASTITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
25	LOW BIRTH WEIGHT (1500-2500 GRAMS) (See Guideline Notes 1,64,65)	MEDICAL THERAPY
26	CYSTIC FIBROSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
27	SCHIZOPHRENIC DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
28	CONVULSIONS AND OTHER CEREBRAL IRRITABILITY IN NEWBORN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
29	CEREBRAL DEPRESSION, COMA, AND OTHER ABNORMAL CEREBRAL SIGNS OF NEWBORN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
30	VESICOURETERAL REFLUX (See Guideline Notes 64,65)	MEDICAL THERAPY, REIMPLANTATION
31	DYSPLASIA OF CERVIX AND CERVICAL CARCINOMA IN SITU, CERVICAL CONDYLOMA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
32	BIPOLAR DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
33	TYPE II DIABETES MELLITUS (See Guideline Notes 1,7,8,64,65)	MEDICAL THERAPY, BARIATRIC SURGERY WITH BMI ? 35 (See Coding Specification Below
34	DRUG WITHDRAWAL SYNDROME IN NEWBORN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
35	REGIONAL ENTERITIS, IDIOPATHIC PROCTOCOLITIS, ULCERATION OF INTESTINE (See Guideline Notes 1,9,64,65)	MEDICAL AND SURGICAL TREATMENT
36	EPILEPSY AND FEBRILE CONVULSIONS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
37	SEVERE BIRTH TRAUMA FOR BABY (See Guideline Notes 1,64,65)	MEDICAL THERAPY
38	NEONATAL THYROTOXICOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
39	HEMATOLOGICAL DISORDERS OF FETUS AND NEWBORN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
40	SPINA BIFIDA (See Guideline Notes 1,64,65)	SURGICAL TREATMENT
41	TERMINATION OF PREGNANCY (See Guideline Notes 1,64,65) (Note: This line item is not priced as part of the list.)	INDUCED ABORTION
42	ACQUIRED HYPOTHYROIDISM, DYSHORMONOGENIC GOITER (See Guideline Notes 1,64,65)	MEDICAL THERAPY
43	ECTOPIC PREGNANCY (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
44	PRIMARY, AND SECONDARY SYPHILIS (See Guideline Notes 64,65)	MEDICAL THERAPY
45	DISORDERS RELATING TO LONG GESTATION AND HIGH BIRTHWEIGHT (See Guideline Notes 64,65)	MEDICAL THERAPY
46	PANHYPOPITUITARISM, IATROGENIC AND OTHER PITUITARY DISORDERS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
47	HYPOCALCEMIA, HYPOMAGNESEMIA AND OTHER ENDOCRINE AND METABOLIC DISTURBANCES SPECIFIC TO THE FETUS AND NEWBORN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
48	INTUSSCEPTION, VOLVULUS, INTESTINAL OBSTRUCTION, AND FOREIGN BODY IN STOMACH, INTESTINES, COLON, AND RECTUM (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
49	CLEFT PALATE WITH AIRWAY OBSTRUCTION (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT, ORTHODONTICS
50	COARCTATION OF THE AORTA (See Guideline Notes 1,6)	SURGICAL TREATMENT
51	CORONARY ARTERY ANOMALY (See Guideline Note 6)	REIMPLANTATION OF CORONARY ARTERY
52	RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY POLYARTHROPATHIES (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY, INJECTIONS
53	CHRONIC RESPIRATORY DISEASE ARISING IN THE NEONATAL PERIOD (See Guideline Notes 1,64,65)	MEDICAL THERAPY
54	CONGENITAL HYDRONEPHROSIS (See Guideline Notes 64,65)	NEPHRECTOMY/REPAIR
55	TUBERCULOSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
56	GONOCOCCAL INFECTIONS AND OTHER SEXUALLY TRANSMITTED DISEASES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
57	ACUTE PELVIC INFLAMMATORY DISEASE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
58	HYDATIDIFORM MOLE (See Guideline Notes 64,65)	D & C, HYSTERECTOMY
59	DENTAL CONDITIONS (EG. INFECTIONS) (See Guideline Notes 10,64,65)	URGENT AND EMERGENT DENTAL SERVICES
60	CHOLELITHIASIS, CHOLECYSTITIS, COMMON BILIARY DUCT STONE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
61	ULCERS, GASTRITIS, DUODENITIS, AND GI HEMORRHAGE (See Guideline Notes 1,9,64,65)	MEDICAL AND SURGICAL TREATMENT
62	FLAIL CHEST (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
63	BURN FULL THICKNESS GREATER THAN 10% OF BODY SURFACE (See Guideline Notes 1,6,64,65)	FREE SKIN GRAFT, MEDICAL THERAPY
64	BRONCHIECTASIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
65	END STAGE RENAL DISEASE (See Guideline Notes 1,7,64,65)	MEDICAL THERAPY INCLUDING DIALYSIS
66	METABOLIC DISORDERS INCLUDING HYPERLIPIDEMIA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
67	SUBSTANCE-INDUCED DELUSIONAL AND MOOD DISORDERS; INTOXICATION (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
68	SPONTANEOUS ABORTION COMPLICATED BY INFECTION AND/OR HEMORRHAGE, MISSED ABORTION (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
69	SUBSTANCE-INDUCED DELIRIUM	MEDICAL THERAPY
70	CONGENITAL ANOMALIES OF UPPER ALIMENTARY TRACT, EXCLUDING TONGUE (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
71	TERMINAL ILLNESS REGARDLESS OF DIAGNOSIS[Deleted]	COMFORT CARE (See Guideline Notes 7,11,12)[Deleted]
72	CANCRUM ORIS (See Guideline Notes 64,65)	MEDICAL THERAPY
73	DISSEMINATED INFECTIONS WITH LOCALIZED SITES (See Guideline Notes 64,65)	MEDICAL THERAPY
74	VENTRICULAR SEPTAL DEFECT (See Guideline Notes 1,6,64,65)	CLOSURE
75	ACUTE BACTERIAL MENINGITIS (See Guideline Notes 6,64,65)	MEDICAL THERAPY
76	ACUTE AND SUBACUTE ISCHEMIC HEART DISEASE, MYOCARDIAL INFARCTION (See Guideline Notes 1,6,13,64,65)	MEDICAL AND SURGICAL TREATMENT
77	CONGENITAL PULMONARY VALVE STENOSIS (See Guideline Notes 64,65)	PULMONARY VALVE REPAIR
78	NEUROLOGICAL DYSFUNCTION IN BREATHING, EATING, SWALLOWING, BOWEL, OR BLADDER CONTROL CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT (EG. G-TUBES, J-TUBES, RESPIRATORS, TRACHEOSTOMY,
79	AGRANULOCYTOSIS (See Guideline Notes 1,7,11,14,64,65)	BONE MARROW TRANSPLANTATION
80	BURN, PARTIAL THICKNESS GREATER THAN 30% OF BODY SURFACE OR WITH VITAL SITE; FULL THICKNESS WITH VITAL SITE, LESS THAN 10% OF BODY SURFACE (See Guideline Notes 1,6,64,65)	FREE SKIN GRAFT, MEDICAL THERAPY
81	POLYCYTHEMIA NEONATORUM, SYMPTOMATIC (See Guideline Notes 64,65)	MEDICAL THERAPY
82	DERMATOMYOSITIS, POLYMYOSITIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
83	ADDISON'S DISEASE (See Guideline Notes 64,65)	MEDICAL THERAPY
84	DEEP ABSCESSES, INCLUDING APPENDICITIS AND PERIORBITAL ABSCESS (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
85	PATENT DUCTUS ARTERIOSUS; AORTIC PULMONARY FISTULA (See Guideline Notes 1,6,64,65)	LIGATION
86	INJURY TO MAJOR BLOOD VESSELS OF EXTREMITIES	LIGATION
87	PHLEBITIS AND THROMBOPHLEBITIS, DEEP (See Guideline Notes 1,64,65)	MEDICAL THERAPY
88	INJURY TO INTERNAL ORGANS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
89	FRACTURE OF HIP, CLOSED (See Guideline Notes 6,15,64,65)	MEDICAL AND SURGICAL TREATMENT
90	MYOCARDITIS (NONVIRAL), PERICARDITIS (NONVIRAL) AND ENDOCARDITIS (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
91	DEEP OPEN WOUND OF NECK, INCLUDING LARYNX; FRACTURE OF LARYNX OR TRACHEA, OPEN (See Guideline Notes 64,65)	REPAIR
92	DIABETES MELLITUS WITH END STAGE RENAL DISEASE (See Coding Specification Below) (See Guideline Notes 1,16)	SIMULTANEOUS PANCREAS/KIDNEY (SPK) TRANSPLANT, PANCREAS AFTER KIDNEY (PAK) TRANS
93	DISORDERS OF PANCREATIC ENDOCRINE SECRETION (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
94	ENDOCARDIAL CUSHION DEFECTS (See Guideline Notes 1,6,64,65)	REPAIR
95	CONGENITAL PULMONARY VALVE ATRESIA (See Guideline Notes 6,64,65)	SHUNT/REPAIR
96	CONGENITAL ANOMALIES OF URINARY SYSTEM (See Guideline Notes 1,64,65)	RECONSTRUCTION
97	NECROTIZING ENTEROCOLITIS IN FETUS OR NEWBORN (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
98	TRANSPOSITION OF GREAT VESSELS (See Guideline Notes 1,6,64,65)	REPAIR
99	CONGENITAL MITRAL VALVE STENOSIS/INSUFFICIENCY (See Guideline Notes 6,64,65)	MITRAL VALVE REPAIR/REPLACEMENT
100	GUILLAIN-BARRE SYNDROME (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
101	SEVERE/MODERATE HEAD INJURY: HEMATOMA/EDEMA WITH LOSS OF CONSCIOUSNESS, COMPOUND/DEPRESSED FRACTURES OF SKULL (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
102	ACUTE LYMPHOCYTIC LEUKEMIA (CHILD) (See Guideline Notes 1,7,11,64,65)	MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY
103	ACUTE LEUKEMIAS, MYELODYSPLASTIC SYNDROME (See Guideline Notes 1,7,11,14)	BONE MARROW TRANSPLANT
104	UNDESCENDED TESTICLE	SURGICAL TREATMENT
105	PREVENTIVE DENTAL SERVICES (See Guideline Notes 17,64,65)	CLEANING AND FLUORIDE
106	HEREDITARY IMMUNE DEFICIENCIES (See Guideline Notes 1,7,11,14)	BONE MARROW TRANSPLANT
107	DIABETIC AND OTHER RETINOPATHY (See Guideline Notes 64,65)	LASER SURGERY
108	BORDERLINE PERSONALITY DISORDER (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
109	HEART FAILURE (See Guideline Notes 1,6,18,64,65)	MEDICAL THERAPY
110	CARDIOMYOPATHY, HYPERTROPHIC MUSCLE (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
111	END STAGE RENAL DISEASE (See Guideline Note 1)	RENAL TRANSPLANT
112	CONGENITAL ANOMALIES OF DIGESTIVE SYSTEM AND ABDOMINAL WALL EXCLUDING NECROSIS; CHRONIC INTESTINAL PSEUDO-OBSTRUCTION (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
113	HEMOLYTIC DISEASE DUE TO ISOIMMUNIZATION, ANEMIA DUE TO TRANSPLACENTAL HEMORRHAGE, AND FETAL AND NEONATAL JAUNDICE (See Guideline Notes 64,65)	MEDICAL THERAPY
114	POISONING BY INGESTION, INJECTION, AND NON-MEDICINAL AGENTS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
115	BOTULISM (See Guideline Notes 64,65)	MEDICAL THERAPY
116	TETRALOGY OF FALLOT (TOF) (See Guideline Notes 1,6,64,65)	TOTAL REPAIR TETRALOGY
117	CONGENITAL STENOSIS AND INSUFFICIENCY OF AORTIC VALVE (See Guideline Notes 6,64,65)	SURGICAL VALVE REPLACEMENT/VALVULOPLASTY
118	GIANT CELL ARTERITIS, KAWASAKI DISEASE, THROMBOANGIITIS OBLITERANS (See Guideline Notes 64,65)	MEDICAL THERAPY
119	FRACTURE OF RIBS AND STERNUM, OPEN (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
120	SUBACUTE MENINGITIS (EG. TUBERCULOSIS, CRYPTOCOCCOSIS) (See Guideline Notes 1,64,65)	MEDICAL THERAPY
121	PNEUMOCYSTIS CARINII PNEUMONIA (See Guideline Notes 64,65)	MEDICAL THERAPY
122	COAGULATION DEFECTS (See Guideline Notes 64,65)	MEDICAL THERAPY
123	CONGENITAL HEART BLOCK; OTHER OBSTRUCTIVE ANOMALIES OF HEART (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
124	CANCER OF TESTIS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
125	CANCER OF EYE AND ORBIT, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES RADIATION THERAPY
126	HODGKIN'S DISEASE (See Guideline Notes 7,11,14,19)	BONE MARROW TRANSPLANT
127	FOREIGN BODY IN PHARYNX, LARYNX, TRACHEA, BRONCHUS AND ESOPHAGUS (See Guideline Notes 64,65)	REMOVAL OF FOREIGN BODY
128	IRON DEFICIENCY ANEMIA AND OTHER NUTRITIONAL DEFICIENCIES (See Guideline Notes 64,65)	MEDICAL THERAPY
129	PERNICIOUS AND SIDEROBLASTIC ANEMIA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
130	ATRIAL SEPTAL DEFECT, SECUNDUM (See Guideline Notes 6,64,65)	REPAIR SEPTAL DEFECT
131	AMEBIASIS (See Guideline Notes 64,65)	MEDICAL THERAPY
132	OTHER SPECIFIED APLASTIC ANEMIAS (See Guideline Notes 7,11,14)	BONE MARROW TRANSPLANT
133	PHYSICAL AND SEXUAL ABUSE INCLUDING RAPE (See Guideline Notes 64,65)	MEDICAL THERAPY
134	ATTENTION DEFICIT DISORDERS WITH HYPERACTIVITY OR UNDIFFERENTIATED (See Guideline Notes 20,64,65)	MEDICAL/PSYCHOTHERAPY
135	PYODERMA; MODERATE/SEVERE PSORIASIS (See Guideline Notes 1,21,64,65)	MEDICAL THERAPY
136	MALARIA AND RELAPSING FEVER (See Guideline Notes 1,64,65)	MEDICAL THERAPY
137	THYROTOXICOSIS WITH OR WITHOUT GOITER, ENDOCRINE EXOPHTHALMOS; CHRONIC THYROIDITIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT, INCLUDING RADIATION THERAPY
138	BENIGN NEOPLASM OF THE BRAIN (See Guideline Notes 1,64,65)	CRANIOTOMY/CRANIECTOMY, LINEAR ACCELERATOR, MEDICAL THERAPY, WHICH INCLUDES RADI
139	ACUTE GLOMERULONEPHRITIS: WITH LESION OF RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS (See Guideline Notes 1,7,64,65)	MEDICAL THERAPY INCLUDING DIALYSIS
140	COMMON TRUNCUS (See Guideline Notes 6,64,65)	TOTAL REPAIR/REPLANT ARTERY
141	WEGENER'S GRANULOMATOSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY AND RADIATION THERAPY
142	TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION (See Guideline Notes 1,6,64,65)	COMPLETE REPAIR
143	CRUSH INJURIES OTHER THAN DIGITS (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
144	OPEN FRACTURE/DISLOCATION OF EXTREMITIES (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
145	CANCER OF CERVIX, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
146	INTERRUPTED AORTIC ARCH (See Guideline Notes 6,64,65)	TRANSVERSE ARCH GRAFT
147	TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
148	OPPORTUNISTIC INFECTIONS IN IMMUNOCOMPROMISED HOSTS; CANDIDIASIS OF STOMA; PERSONS RECEIVING CONTINUOUS ANTIBIOTIC THERAPY (See Guideline Notes 1,64,65)	MEDICAL THERAPY
149	EBSTEIN'S ANOMALY (See Guideline Notes 64,65)	REPAIR SEPTAL DEFECT/VALVULOPLASTY/REPLACEMENT
150	GLAUCOMA, OTHER THAN PRIMARY ANGLE-CLOSURE (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
151	MYASTHENIA GRAVIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY, THYMECTOMY
152	SYSTEMIC LUPUS ERYTHEMATOSUS, OTHER DIFFUSE DISEASES OF CONNECTIVE TISSUE (See Guideline Notes 1,64,65)	MEDICAL THERAPY
153	CONDITIONS INVOLVING THE TEMPERATURE REGULATION OF NEWBORNS (See Guideline Notes 64,65)	MEDICAL THERAPY
154	PNEUMOTHORAX AND HEMOTHORAX (See Guideline Notes 64,65)	TUBE THORACOSTOMY/THORACOTOMY, MEDICAL THERAPY
155	HYPOTHERMIA (See Guideline Notes 64,65)	MEDICAL THERAPY, EXTRACORPOREAL CIRCULATION
156	ANEMIA OF PREMATURITY OR TRANSIENT NEONATAL NEUTROPENIA (See Guideline Notes 64,65)	MEDICAL THERAPY
157	ENTERIC INFECTIONS AND OTHER BACTERIAL FOOD POISONING (See Guideline Notes 64,65)	MEDICAL THERAPY
158	ACQUIRED HEMOLYTIC ANEMIAS (See Guideline Notes 64,65)	MEDICAL THERAPY
159	CERVICAL VERTEBRAL DISLOCATIONS/FRACTURES, OPEN OR CLOSED; OTHER VERTEBRAL DISLOCATIONS/FRACTURES, OPEN; SPINAL CORD INJURIES WITH OR WITHOUT EVIDENCE OF VERTEBRAL INJURY (See Guideline Notes 1,6,22,64,65)	MEDICAL AND SURGICAL TREATMENT
160	CHORIOCARCINOMA, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
161	DISORDERS OF MINERAL METABOLISM, OTHER THAN CALCIUM (See Guideline Notes 64,65)	MEDICAL THERAPY
162	PYOGENIC ARTHRITIS (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
163	BENIGN NEOPLASM OF PITUITARY GLAND (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES RADIATION THERAPY
164	ACUTE VASCULAR INSUFFICIENCY OF INTESTINE (See Guideline Notes 64,65)	SURGICAL TREATMENT
165	HERPES ZOSTER; HERPES SIMPLEX AND WITH NEUROLOGICAL AND OPHTHALMOLOGICAL COMPLICATIONS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
166	TRAUMATIC AMPUTATION OF ARM(S), HAND(S), THUMB(S), AND FINGER(S) (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
167	HODGKIN'S DISEASE (See Guideline Notes 1,7,11,14,64,65)	MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY
168	CANCER OF COLON, RECTUM, SMALL INTESTINE AND ANUS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,23,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
169	CHRONIC GRANULOMATOUS DISEASE (See Guideline Notes 1,7,11,64,65)	MEDICAL THERAPY
170	BILIARY ATRESIA (See Guideline Notes 1,16)	LIVER TRANSPLANT
171	NON-HODGKIN'S LYMPHOMAS (See Guideline Notes 7,11,14,19)	BONE MARROW TRANSPLANT
172	LEUKOPLAKIA AND CARCINOMA IN SITU OF ORAL MUCOSA, INCLUDING TONGUE (See Guideline Notes 64,65)	INCISION/EXCISION, MEDICAL THERAPY
173	PREVENTIVE FOOT CARE IN HIGH RISK PATIENTS	MEDICAL AND SURGICAL TREATMENT OF TOENAILS AND HYPERKERATOSES OF FOOT
174	ANAL, RECTAL AND COLONIC POLYPS (See Guideline Note 1)	EXCISION OF POLYP
175	GONOCOCCAL AND CHLAMYDIAL INFECTIONS OF THE EYE (See Guideline Notes 64,65)	MEDICAL THERAPY
176	COMPLICATED HERNIAS; UNCOMPLICATED HERNIA IN CHILDREN UNDER AGE 18 (See Guideline Notes 24,63,64,65)	REPAIR
177	NON-DIABETIC HYPOGLYCEMIC COMA (See Guideline Notes 64,65)	MEDICAL THERAPY
178	RUPTURED SPLEEN	REPAIR/SPLENECTOMY/INCISION
179	ACUTE MASTOIDITIS (See Guideline Notes 64,65)	MASTOIDECTOMY, MEDICAL THERAPY
180	HYPERTENSIVE HEART AND RENAL DISEASE (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
181	POSTTRAUMATIC STRESS DISORDER (See Guideline Notes 25,64,65)	MEDICAL/PSYCHOTHERAPY
182	ACUTE NON-LYMPHOCYTIC LEUKEMIAS (See Guideline Notes 1,7,11,64,65)	MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY
183	GENERALIZED CONVULSIVE OR PARTIAL EPILEPSY WITHOUT MENTION OF IMPAIRMENT OF CONSCIOUSNESS (See Guideline Notes 1,19)	SINGLE FOCAL SURGERY
184	POLYARTERITIS NODOSA AND ALLIED CONDITIONS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
185	COMMON VENTRICLE (See Guideline Notes 6,64,65)	TOTAL REPAIR
186	INTRACEREBRAL HEMORRHAGE (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
187	URETERAL STRICTURE OR OBSTRUCTION; HYDRONEPHROSIS; HYDROURETER (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
188	CONDITIONS INVOLVING EXPOSURE TO NATURAL ELEMENTS (EG. LIGHTNING STRIKE, HEATSTROKE) (See Guideline Notes 64,65)	MEDICAL THERAPY, BURN TREATMENT
189	SEPTICEMIA (See Guideline Notes 64,65)	MEDICAL THERAPY
190	FRACTURE OF PELVIS, OPEN AND CLOSED (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
191	ACUTE OSTEOMYELITIS (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
192	DIVERTICULITIS OF COLON (See Guideline Notes 1,64,65)	COLON RESECTION, MEDICAL THERAPY
193	MULTIPLE VALVULAR DISEASE (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
194	CUSHING'S SYNDROME; HYPERALDOSTERONISM, OTHER CORTICOADRENAL OVERACTIVITY, MEDULLOADRENAL HYPERFUNCTION (See Guideline Notes 1,64,65)	MEDICAL THERAPY/ADRENALECTOMY
195	CONGENITAL TRICUSPID ATRESIA AND STENOSIS (See Guideline Notes 6,64,65)	REPAIR
196	CHRONIC ISCHEMIC HEART DISEASE (See Guideline Notes 1,6,13,64,65)	MEDICAL AND SURGICAL TREATMENT
197	NEOPLASMS OF ISLETS OF LANGERHANS (See Guideline Note 1)	EXCISION OF TUMOR
198	CANCER OF BREAST, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Coding Specification Below) (See Guideline Notes 1,3,7,11,26,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY, RADIATION THERAPY A
199	MULTIPLE MYELOMA (See Guideline Notes 7,11,14)	BONE MARROW TRANSPLANT
200	HEREDITARY ANEMIAS, HEMOGLOBINOPATHIES, AND DISORDERS OF THE SPLEEN (See Guideline Notes 1,64,65)	MEDICAL THERAPY
201	ACUTE PANCREATITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
202	SUBARACHNOID AND INTRACEREBRAL HEMORRHAGE/HEMATOMA; COMPRESSION OF BRAIN (See Guideline Notes 1,6,64,65)	BURR HOLES, CRANIECTOMY/CRANIOTOMY
203	BURN, PARTIAL THICKNESS WITHOUT VITAL SITE, 10-30% OF BODY SURFACE (See Guideline Notes 1,6,64,65)	FREE SKIN GRAFT, MEDICAL THERAPY
204	TETANUS NEONATORUM (See Guideline Notes 64,65)	MEDICAL THERAPY
205	CONGENITAL CYSTIC LUNG - MILD AND MODERATE (See Guideline Notes 64,65)	LUNG RESECTION, MEDICAL THERAPY
206	CHRONIC HEPATITIS; VIRAL HEPATITIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
207	CONSTITUTIONAL APLASTIC ANEMIAS (See Guideline Notes 7,11,14)	BONE MARROW TRANSPLANT
208	CANCER OF SOFT TISSUE, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
209	CANCER OF BONES, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,6,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
210	CHRONIC ORGANIC MENTAL DISORDERS INCLUDING DEMENTIAS (See Guideline Notes 1,64,65)	CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION
211	SLEEP APNEA (See Guideline Notes 1,27,64,65)	MEDICAL AND SURGICAL TREATMENT
212	ERYSIPELAS (See Guideline Notes 64,65)	MEDICAL THERAPY
213	DEPRESSION AND OTHER MOOD DISORDERS, MILD OR MODERATE (See Guideline Notes 28,64,65)	MEDICAL/PSYCHOTHERAPY
214	PNEUMOCOCCAL PNEUMONIA, OTHER BACTERIAL PNEUMONIA, BRONCHOPNEUMONIA (See Guideline Notes 64,65)	MEDICAL THERAPY
215	SUPERFICIAL ABSCESSES AND CELLULITIS (See Coding Specification Below) (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
216	ZOONOTIC BACTERIAL DISEASES (See Guideline Notes 64,65)	MEDICAL THERAPY
217	DEEP OPEN WOUND, WITH OR WITHOUT TENDON OR NERVE INVOLVEMENT (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
218	CHOANAL ATRESIA (See Guideline Notes 64,65)	REPAIR OF CHOANAL ATRESIA
219	CANCER OF UTERUS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
220	RUPTURE OF LIVER (See Guideline Notes 64,65)	SUTURE/REPAIR
221	CANCER OF THYROID, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
222	NON-HODGKIN'S LYMPHOMAS (See Guideline Notes 1,7,11,19,29,64,65)	MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY
223	PATHOLOGICAL GAMBLING (Note: This line is not priced as part of the list as funding comes from non-OHP sources.) (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
224	BULLOUS DERMATOSES OF THE SKIN (See Guideline Notes 64,65)	MEDICAL THERAPY
225	ESOPHAGEAL VARICES (See Guideline Notes 1,64,65)	MEDICAL THERAPY/SHUNT/SCLEROTHERAPY
226	TOXIC EPIDERMAL NECROLYSIS AND STAPHYLOCOCCAL SCALDED SKIN SYNDROME; STEVENS-JOHNSON SYNDROME; ECZEMA HERPETICUM (See Guideline Notes 64,65)	MEDICAL THERAPY
227	ACUTE PULMONARY HEART DISEASE AND PULMONARY EMBOLI (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
228	CANDIDIASIS OF LUNG, DISSEMINATED CANDIDIASIS, CANDIDAL ENDOCARDITIS AND MENINGITIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
229	CANCER OF KIDNEY AND OTHER URINARY ORGANS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
230	CANCER OF STOMACH, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
231	PORTAL VEIN THROMBOSIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
232	TESTICULAR CANCER (See Guideline Notes 7,11,14,30)	BONE MARROW RESCUE AND TRANSPLANT
233	PULMONARY FIBROSIS (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
234	OCCUPATIONAL LUNG DISEASES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
235	ANAPHYLACTIC SHOCK; EDEMA OF LARYNX (See Guideline Notes 64,65)	MEDICAL THERAPY
236	DISORDERS OF FLUID, ELECTROLYTE, AND ACID-BASE BALANCE (See Guideline Notes 1,7,64,65)	MEDICAL THERAPY, DIALYSIS
237	DISEASES AND DISORDERS OF AORTIC VALVE (See Guideline Notes 1,6,64,65)	AORTIC VALVE REPLACEMENT, VALVULOPLASTY, MEDICAL THERAPY
238	DISORDERS OF PARATHYROID GLAND; BENIGN NEOPLASM OF PARATHYROID GLAND; DISORDERS OF CALCIUM METABOLISM (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
239	ACUTE INFLAMMATION OF THE HEART DUE TO RHEUMATIC FEVER (See Guideline Notes 6,64,65)	MEDICAL THERAPY
240	RUPTURED VISCUS (See Guideline Notes 64,65)	REPAIR
241	INTESTINAL MALABSORPTION (See Guideline Notes 64,65)	MEDICAL THERAPY
242	FRACTURE OF FACE BONES; INJURY TO OPTIC AND OTHER CRANIAL NERVES (See Guideline Notes 64,65)	SURGERICAL TREATMENT
243	MALIGNANT MELANOMA OF SKIN, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 7,11,19,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
244	LEPTOSPIROSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
245	URINARY FISTULA (See Guideline Notes 64,65)	SURGICAL TREATMENT
246	UNSPECIFIED DISEASES DUE TO MYCOBACTERIA, ACTINOMYCOTIC INFECTIONS, AND TOXOPLASMOSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
247	HYPOPLASTIC LEFT HEART SYNDROME	REPAIR
248	ADULT RESPIRATORY DISTRESS SYNDROME; ACUTE RESPIRATORY FAILURE; RESPIRATORY CONDITIONS DUE TO PHYSICAL AND CHEMICAL AGENTS (See Guideline Notes 64,65)	MEDICAL THERAPY
249	ACUTE LYMPHOCYTIC LEUKEMIAS (ADULT) AND MULTIPLE MYELOMA (See Guideline Notes 1,7,11,64,65)	MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAPY
250	PERIPHERAL VASCULAR DISEASE, LIMB THREATENING INFECTIONS, AND VASCULAR COMPLICATIONS (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
251	TETANUS (See Guideline Notes 64,65)	MEDICAL THERAPY
252	CANCER OF OVARY, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
253	SHORT BOWEL SYNDROME - AGE 5 OR UNDER (See Guideline Notes 1,16)	INTESTINE AND INTESTINE/LIVER TRANSPLANT
254	DEFICIENCIES OF CIRCULATING ENZYMES (ALPHA 1-ANTITRYPSIN DEFICIENCY); CYSTIC FIBROSIS; EMPHYSEMA (See Guideline Notes 1,16)	HEART-LUNG AND LUNG TRANSPLANT
255	ACUTE AND SUBACUTE NECROSIS OF LIVER; SPECIFIED INBORN ERRORS OF METABOLISM (EG. MAPLE SYRUP URINE DISEASE, TYROSINEMIA)(See Guideline Notes 1,16)	LIVER TRANSPLANT
256	RESPIRATORY FAILURE DUE TO PRIMARY PULMONARY HYPERTENSION, PRIMARY PULMONARY FIBROSIS, LYMPHANGIOLEIOMYOMATOSIS, EISENMENGER?S DISEASE (See Guideline Notes 1,16,64,65)	HEART-LUNG AND LUNG TRANSPLANTS
257	DERMATOLOGICAL PREMALIGNANT LESIONS AND CARCINOMA IN SITU (See Guideline Notes 64,65)	DESTRUCT/EXCISION/MEDICAL THERAPY
258	PRIMARY ANGLE-CLOSURE GLAUCOMA (See Guideline Notes 64,65)	IRIDECTOMY, LASER SURGERY
259	CORNEAL ULCER; SUPERFICIAL INJURY OF EYE AND ADNEXA (See Guideline Notes 64,65)	CONJUNCTIVAL FLAP; MEDICAL THERAPY
260	TORSION OF OVARY (See Guideline Notes 64,65)	OOPHORECTOMY, OVARIAN CYSTECTOMY
261	TORSION OF TESTIS (See Guideline Notes 64,65)	ORCHIECTOMY, REPAIR
262	LIFE-THREATENING EPISTAXIS (See Guideline Notes 64,65)	SEPTOPLASTY/REPAIR/CONTROL HEMORRHAGE
263	RETAINED INTRAOCULAR FOREIGN BODY, MAGNETIC AND NONMAGNETIC (See Guideline Notes 64,65)	FOREIGN BODY REMOVAL
264	GLYCOGENOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
265	METABOLIC BONE DISEASE (See Guideline Notes 1,64,65)	MEDICAL THERAPY
266	PARKINSON?S DISEASE (See Guideline Notes 1,64,65)	MEDICAL THERAPY
267	CHRONIC PANCREATITIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
268	MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM (See Guideline Notes 1,64,65)	MEDICAL THERAPY
269	PSYCHOLOGICAL FACTORS AGGRAVATING PHYSICAL CONDITION (EG. ASTHMA, CHRONIC GI CONDITIONS, HYPERTENSION) (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
270	ARTERIAL EMBOLISM/THROMBOSIS: ABDOMINAL AORTA, THORACIC AORTA (See Guideline Note 6)	SURGICAL TREATMENT
271	CHRONIC OSTEOMYELITIS (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
272	MULTIPLE ENDOCRINE NEOPLASIA (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
273	DEFORMITIES OF HEAD (See Guideline Notes 1,6,64,65)	CRANIOTOMY/CRANIECTOMY
274	DISEASES OF MITRAL AND TRICUSPID VALVES (See Guideline Notes 1,6,64,65)	VALVULOPLASTY, VALVE REPLACEMENT, MEDICAL THERAPY
275	CANCER OF PENIS AND OTHER MALE GENITAL ORGANS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
276	CANCER OF ENDOCRINE SYSTEM, EXCLUDING THYROID, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL; CARCINOID SYNDROME (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
277	CANCER OF RETROPERITONEUM, PERITONEUM, OMENTUM AND MESENTERY, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
278	CANCER OF LUNG, BRONCHUS, PLEURA, TRACHEA, MEDIASTINUM AND OTHER RESPIRATORY ORGANS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,19,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
279	CONGESTIVE HEART FAILURE, CARDIOMYOPATHY, TRANSPOSITION OF GREAT VESSELS, HYPOPLASTIC LEFT HEART SYNDROME (See Guideline Notes 1,6,16,18,64,65)	CARDIAC TRANSPLANT
280	CHRONIC NON-LYMPHOCYTIC LEUKEMIA (See Guideline Notes 7,11,14)	BONE MARROW TRANSPLANT
281	TRACHOMA (See Guideline Notes 64,65)	MEDICAL THERAPY
282	ACUTE, SUBACUTE, CHRONIC AND OTHER TYPES OF IRIDOCYCLITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
283	RICKETTSIAL AND OTHER ARTHROPOD-BORNE DISEASES (See Guideline Notes 64,65)	MEDICAL THERAPY
284	DIABETES INSIPIDUS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
285	SYMPATHETIC UVEITIS AND DEGENERATIVE DISORDERS AND CONDITIONS OF GLOBE (See Guideline Notes 64,65)	ENUCLEATION
286	CANCER OF BLADDER AND URETER, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
287	TRAUMATIC AMPUTATION OF FOOT/FEET (COMPLETE)(PARTIAL) WITH AND WITHOUT COMPLICATION (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
288	ACUTE POLIOMYELITIS (See Guideline Notes 6,64,65)	MEDICAL THERAPY
289	LEPROSY, YAWS, PINTA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
290	UROLOGIC INFECTIONS (See Guideline Notes 64,65)	MEDICAL THERAPY
291	CANCER OF SKIN, EXCLUDING MALIGNANT MELANOMA, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
292	INJURY TO BLOOD VESSELS OF THE THORACIC CAVITY (See Guideline Notes 1,6,64,65)	REPAIR
293	RUPTURE OF BLADDER, NONTRAUMATIC (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
294	OTHER PSYCHOTIC DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
295	HYDROPS FETALIS (See Guideline Notes 64,65)	MEDICAL THERAPY
296	DEFORMITY/CLOSED DISLOCATION OF JOINT (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
297	SENSORINEURAL HEARING LOSS - AGE 5 OR UNDER (See Guideline Note 31)	COCHLEAR IMPLANT
298	RETINAL DETACHMENT AND OTHER RETINAL DISORDERS (See Guideline Notes 64,65)	RETINAL REPAIR, VITRECTOMY
299	ARTHROPOD-BORNE VIRAL DISEASES (See Guideline Notes 64,65)	MEDICAL THERAPY
300	HYPOPLASIA AND DYSPLASIA OF LUNG (See Guideline Notes 64,65)	MEDICAL THERAPY
301	CHRONIC RHEUMATIC PERICARDITIS, RHEUMATIC MYOCARDITIS (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
302	BUDD-CHIARI SYNDROME, AND OTHER VENOUS EMBOLISM AND THROMBOSIS (See Guideline Notes 64,65)	THROMBECTOMY/LIGATION
303	LIFE-THREATENING CARDIAC ARRHYTHMIAS (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT
304	ANOREXIA NERVOSA (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
305	CHRONIC OBSTRUCTIVE PULMONARY DISEASE; CHRONIC RESPIRATORY FAILURE (See Guideline Notes 1,64,65)	MEDICAL THERAPY
306	DISSECTING OR RUPTURED AORTIC ANEURYSM (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
307	COMPLICATIONS OF A PROCEDURE ALWAYS REQUIRING TREATMENT (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
308	RUPTURE OF PAPILLARY MUSCLE (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
309	CHRONIC LEUKEMIAS; POLYCYTHEMIA RUBRA VERA (See Guideline Notes 1,7,11,64,65)	MEDICAL THERAPY, WHICH INCLUDES CHEMOTHERAPY, RADIATION AND RADIONUCLEIDE THERAP
310	CANCER OF VAGINA, VULVA AND OTHER FEMALE GENITAL ORGANS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
311	CANCER OF ORAL CAVITY, PHARYNX, NOSE AND LARYNX, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
312	CONSTITUTIONAL APLASTIC ANEMIA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
313	OSTEOPETROSIS (See Guideline Notes 1,7,11,14)	BONE MARROW RESCUE AND TRANSPLANT
314	CRUSH INJURIES OF DIGITS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
315	ACUTE STRESS DISORDER (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
316	ADRENAL OR CUTANEOUS HEMORRHAGE OF FETUS OR NEONATE (See Guideline Notes 64,65)	MEDICAL THERAPY
317	NEUROLOGICAL DYSFUNCTION IN POSTURE AND MOVEMENT CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 1,6,64,65)	MEDICAL AND SURGICAL TREATMENT (EG. DURABLE MEDICAL EQUIPMENT AND ORTHOPEDIC PRO
318	ANOMALIES OF GALLBLADDER, BILE DUCTS, AND LIVER (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
319	CANCER OF BRAIN AND NERVOUS SYSTEM, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	LINEAR ACCELERATOR, MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY
320	CATARACT, EXCLUDING CONGENITAL (See Guideline Notes 32,64,65)	EXTRACTION OF CATARACT
321	AFTER CATARACT	DISCISSION, LENS CAPSULE
322	FISTULA INVOLVING FEMALE GENITAL TRACT (See Guideline Notes 64,65)	CLOSURE OF FISTULA
323	VITREOUS DISORDERS (See Guideline Notes 64,65)	VITRECTOMY
324	CLEFT PALATE AND/OR CLEFT LIP (See Guideline Notes 64,65)	EXCISION AND REPAIR VESTIBULE OF MOUTH, ORTHODONTICS
325	GOUT AND CRYSTAL ARTHROPATHIES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
326	PERTUSSIS AND DIPTHERIA (See Guideline Notes 64,65)	MEDICAL THERAPY
327	THROMBOCYTOPENIA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
328	DISORDERS OF AMINO-ACID TRANSPORT AND METABOLISM (NON PKU) (See Guideline Notes 64,65)	MEDICAL THERAPY
329	PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3 (See Guideline Notes 64,65)	MEDICAL THERAPY
330	DISORDERS OF ARTERIES, OTHER THAN CAROTID OR CORONARY (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
331	PARALYTIC ILEUS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
332	CIRRHOSIS OF LIVER OR BILIARY TRACT; BUDD-CHIARI SYNDROME; HEPATIC VEIN THROMBOSIS; INTRAHEPATIC VASCULAR MALFORMATIONS; CAROLI?S DISEASE (See Coding Specification Below) (See Guideline Notes 1,16)	LIVER TRANSPLANT, LIVER-KIDNEY TRANSPLANT
333	CHRONIC INFLAMMATORY DISORDER OF ORBIT (See Guideline Notes 64,65)	MEDICAL THERAPY
334	CONGENITAL DISLOCATION OF HIP; COXA VARA AND VALGA (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
335	CORNEAL OPACITY AND OTHER DISORDERS OF CORNEA (See Guideline Notes 64,65)	KERATOPLASTY
336	DISORDERS INVOLVING THE IMMUNE SYSTEM (See Guideline Notes 1,64,65)	MEDICAL THERAPY
337	CANCER OF ESOPHAGUS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,33,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
338	CANCER OF LIVER, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,33,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
339	CANCER OF PANCREAS, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,33,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
340	STROKE (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
341	HEREDITARY ANGIOEDEMA; ANGIONEUROTIC EDEMA (See Guideline Notes 64,65)	MEDICAL THERAPY
342	PURULENT ENDOPHTHALMITIS (See Guideline Notes 64,65)	VITRECTOMY
343	FOREIGN BODY IN CORNEA AND CONJUNCTIVAL SAC (See Guideline Notes 64,65)	REMOVAL CONJUNCTIVAL FOREIGN BODY
344	OTHER ANEURYSM OF PERIPHERAL ARTERY	SURGICAL TREATMENT
345	SIALOADENITIS, ABSCESS, FISTULA OF SALIVARY GLANDS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
346	CYSTICERCOSIS, OTHER CESTODE INFECTION, TRICHINOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
347	NON-DISSECTING ANEURYSM WITHOUT RUPTURE (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
348	ARTERIAL ANEURYSM OF NECK (See Guideline Note 6)	REPAIR
349	FUNCTIONAL AND MECHANICAL DISORDERS OF THE GENITOURINARY SYSTEM INCLUDING BLADDER OUTLET OBSTRUCTION (See Coding Specification Below) (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
350	ACUTE GLOMERULONEPHRITIS AND OTHER ACUTE RENAL FAILURE (See Guideline Notes 1,7,64,65)	MEDICAL THERAPY INCLUDING DIALYSIS
351	VESICULAR FISTULA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
352	COCCIDIOIDOMYCOSIS, HISTOPLASMOSIS, BLASTOMYCOTIC INFECTION, OPPORTUNISTIC AND OTHER MYCOSES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
353	DISSEMINATED INTRAVASCULAR COAGULATION (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
354	CANCER OF PROSTATE GLAND, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
355	SYSTEMIC SCLEROSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
356	ANAEROBIC INFECTIONS REQUIRING HYPERBARIC OXYGEN	HYPERBARIC OXYGEN
357	DENTAL CONDITIONS (EG. DENTAL CARIES, FRACTURED TOOTH) (See Guideline Note 34)	BASIC RESTORATIVE
358	BENIGN CEREBRAL CYSTS	DRAINAGE
359	ALCOHOLIC FATTY LIVER OR ALCOHOLIC HEPATITIS, CIRRHOSIS OF LIVER (See Guideline Notes 1,64,65)	MEDICAL THERAPY
360	SCLERITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
361	RUBEOSIS IRIDIS (See Guideline Notes 64,65)	LASER SURGERY
362	DISEASES OF ENDOCARDIUM (See Guideline Notes 6,64,65)	MEDICAL THERAPY
363	WOUND OF EYE GLOBE (See Guideline Notes 64,65)	SURGICAL REPAIR
364	ACUTE NECROSIS OF LIVER (See Guideline Notes 64,65)	MEDICAL THERAPY
365	NEPHROTIC SYNDROME AND OTHER RENAL DISORDERS (See Guideline Notes 1,7,64,65)	MEDICAL THERAPY INCLUDING DIALYSIS
366	IDIOPATHIC OR VIRAL MYOCARDITIS AND PERICARDITIS (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
367	HEREDITARY HEMORRHAGIC TELANGIECTASIA	EXCISION
368	RHEUMATIC FEVER (See Guideline Notes 6,64,65)	MEDICAL THERAPY
369	HEREDITARY FRUCTOSE INTOLERANCE, INTESTINAL DISACCHARIDASE AND OTHER DEFICIENCIES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
370	ACROMEGALY AND GIGANTISM, OTHER AND UNSPECIFIED ANTERIOR PITUITARY HYPERFUNCTION, BENIGN NEOPLASM OF THYROID GLAND AND OTHER ENDOCRINE GLANDS (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES RADIATION THERAPY
371	RETROLENTAL FIBROPLASIA	CRYOSURGERY
372	NEUROLOGICAL DYSFUNCTION IN COMMUNICATION CAUSED BY CHRONIC CONDITIONS (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
373	CARDIAC ARRHYTHMIAS (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY, PACEMAKER
374	MILD/MODERATE BIRTH TRAUMA FOR BABY (See Guideline Notes 1,64,65)	MEDICAL THERAPY
375	ATHEROSCLEROSIS, PERIPHERAL (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
376	URINARY TRACT CALCULUS (See Guideline Notes 64,65)	CYSTOURETHROSCOPY WITH FRAGMENTATION OF CALCULUS, MEDICAL THERAPY
377	CONGENITAL ABSENCE OF VAGINA	ARTIFICIAL VAGINA
378	PENETRATING WOUND OF ORBIT (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
379	CLOSED FRACTURE OF EXTREMITIES (EXCEPT TOES) (See Guideline Notes 6,64,65)	OPEN OR CLOSED REDUCTION
380	HEARING LOSS - AGE 5 OR UNDER (See Guideline Notes 64,65)	MEDICAL THERAPY INCLUDING HEARING AIDS
381	RHEUMATOID ARTHRITIS, OSTEOARTHRITIS, OSTEOCHONDRITIS DISSECANS, AND ASEPTIC NECROSIS OF BONE (See Guideline Notes 6,15,64,65)	ARTHROPLASTY/RECONSTRUCTION
382	ANEURYSM OF PULMONARY ARTERY (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
383	BODY INFESTATIONS (EG. LICE, SCABIES) (See Guideline Notes 64,65)	MEDICAL THERAPY
384	LYME DISEASE AND OTHER ARTHROPOD BORNE DISEASES (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY
385	DYSTONIA (UNCONTROLLABLE); LARYNGEAL SPASM AND STENOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
386	CYST AND PSEUDOCYST OF PANCREAS (See Guideline Notes 64,65)	DRAINAGE OF PANCREATIC CYST
387	CONVERSION DISORDER, CHILD (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
388	ACUTE SINUSITIS (See Guideline Notes 35,64,65)	MEDICAL AND SURGICAL TREATMENT
389	HYPHEMA	REMOVAL OF BLOOD CLOT
390	ENTROPION	REPAIR
391	SPONTANEOUS ABORTION (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
392	STREPTOCOCCAL SORE THROAT AND SCARLET FEVER; VINCENT?S DISEASE; HYPERTROPHY OF TONSILS AND ADENOIDS; ULCER OF TONSIL (See Guideline Notes 36,64,65)	MEDICAL THERAPY, TONSILLECTOMY/ADENOIDECTOMY
393	GIARDIASIS, INTESTINAL HELMINTHIASIS (See Guideline Notes 64,65)	MEDICAL THERAPY
394	AMBLYOPIA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
395	SOMATIZATION DISORDER; SOMATOFORM PAIN DISORDER (See Guideline Notes 64,65)	CONSULTATION/BEHAVIORAL MANAGEMENT
396	TOXIC EFFECT OF GASES, FUMES, AND VAPORS REQUIRING HYPERBARIC OXYGEN	HYPERBARIC OXYGEN
397	DISORDERS OF SPINE WITH NEUROLOGIC IMPAIRMENT (See Guideline Notes 1,6,37,64,65)	MEDICAL AND SURGICAL TREATMENT
398	ENCEPHALOCELE	SURGICAL TREATMENT
399	BENIGN NEOPLASM OF RESPIRATORY AND INTRATHORACIC ORGANS (See Guideline Notes 64,65)	LOBECTOMY, MEDICAL THERAPY, WHICH INCLUDES RADIATION THERAPY
400	IMPERFORATE HYMEN; ABNORMALITIES OF VAGINAL SEPTUM	SURGICAL TREATMENT
401	RETINAL TEAR (See Guideline Notes 64,65)	LASER PROPHYLAXIS
402	CHOLESTEATOMA; INFECTIONS OF THE PINNA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
403	DISRUPTIONS OF THE LIGAMENTS AND TENDONS OF THE ARMS AND LEGS, EXCLUDING THE KNEE, GRADE II AND III (See Guideline Notes 6,64,65)	REPAIR
404	DYSFUNCTION RESULTING IN LOSS OF ABILITY TO MAXIMIZE LEVEL OF INDEPENDENCE IN SELF- DIRECTED CARE CAUSED BY CHRONIC CONDITIONS THAT CAUSE NEUROLOGICAL DYSFUNCTION (See Guideline Notes 1,6,38,64,65)	MEDICAL THERAPY (SHORT TERM REHABILITATION WITH DEFINED GOALS)
405	ANEMIAS DUE TO DISEASE OR TREATMENT AND OTHER APLASTIC ANEMIAS (See Guideline Notes 64,65)	MEDICAL THERAPY
406	ESOPHAGEAL STRICTURE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
407	CHRONIC ULCER OF SKIN (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
408	ESOPHAGITIS; ESOPHAGEAL AND INTRAESOPHAGEAL HERNIAS	SURGICAL TREATMENT
409	BULIMIA NERVOSA (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
410	SUPERFICIAL INJURIES WITH INFECTION (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
411	PITUITARY DWARFISM (See Guideline Notes 64,65)	MEDICAL THERAPY
412	SEPARATION ANXIETY DISORDER (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
413	ACUTE OTITIS MEDIA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
414	PANIC DISORDER; AGORAPHOBIA (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
415	CROUP SYNDROME, EPIGLOTTITIS, ACUTE LARYNGOTRACHEITIS (See Guideline Notes 64,65)	MEDICAL THERAPY, INTUBATION, TRACHEOTOMY
416	ACHALASIA, NON-NEONATAL (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
417	ENDOMETRIOSIS AND ADENOMYOSIS (See Guideline Notes 1,39,64,65)	MEDICAL AND SURGICAL TREATMENT
418	CALCULUS OF BLADDER OR KIDNEY (See Guideline Notes 64,65)	OPEN RESECTION, PERCUTANEOUS NEPHROSTOLITHOTOMY, NEPHROLITHOTOMY, LITHOTRIPSY
419	ESOPHAGITIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
420	ANOGENITAL VIRAL WARTS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
421	EATING DISORDER NOS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
422	LYMPHADENITIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
423	UTERINE LEIOMYOMA (See Guideline Notes 40,64,65)	TOTAL HYSTERECTOMY OR MYOMECTOMY
424	APHAKIA AND OTHER DISORDERS OF LENS (See Guideline Notes 64,65)	INTRAOCULAR LENS
425	BILATERAL ANOMALIES OF EXTERNAL EAR WITH IMPAIRMENT OF HEARING (See Guideline Notes 64,65)	RECONSTRUCT OF EAR CANAL
426	DISSOCIATIVE DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
427	EPIDERMOLYSIS BULLOSA (See Guideline Notes 1,64,65)	MEDICAL THERAPY
428	DELIRIUM DUE TO MEDICAL CAUSES (See Guideline Notes 64,65)	MEDICAL THERAPY
429	SPINAL DEFORMITY, CLINICALLY SIGNIFICANT (See Guideline Notes 1,6,41,64,65)	MEDICAL AND SURGICAL TREATMENT
430	MIGRAINE HEADACHES (See Guideline Notes 1,64,65)	MEDICAL THERAPY
431	SCHIZOTYPAL PERSONALITY DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
432	BALANOPOSTHITIS AND OTHER DISORDERS OF PENIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
433	SICCA SYNDROME; POLYMYALGIA RHEUMATICA (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
434	TRANSIENT CEREBRAL ISCHEMIA; OCCLUSION/STENOSIS OF PRECEREBRAL ARTERIES WITHOUT OCCLUSION (See Guideline Notes 64,65)	MEDICAL THERAPY; THROMBOENDARTERECTOMY
435	PERIPHERAL NERVE ENTRAPMENT (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
436	MENIERE?S DISEASE (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
437	DISORDERS OF SHOULDER, INCLUDING SPRAINS/STRAINS GRADE 3 THROUGH 6 (See Guideline Notes 6,64,65)	REPAIR/RECONSTRUCTION
438	INCONTINENCE OF FECES (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
439	OPPOSITIONAL DEFIANT DISORDER (See Guideline Notes 42,64,65)	MEDICAL/PSYCHOTHERAPY
440	SARCOIDOSIS (See Guideline Notes 1,64,65)	MEDICAL THERAPY
441	COMPLICATIONS OF A PROCEDURE USUALLY REQUIRING TREATMENT (See Guideline Notes 6,43,64,65)	MEDICAL AND SURGICAL TREATMENT
442	MENSTRUAL BLEEDING DISORDERS (See Guideline Notes 1,44,64,65)	MEDICAL AND SURGICAL TREATMENT
443	ADRENOGENITAL DISORDERS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
444	NON-MALIGNANT OTITIS EXTERNA (See Guideline Notes 64,65)	MEDICAL THERAPY
445	VAGINITIS, TRICHOMONIASIS (See Guideline Notes 64,65)	MEDICAL THERAPY
446	STRABISMUS WITHOUT AMBLYOPIA AND OTHER DISORDERS OF BINOCULAR EYE MOVEMENTS; CONGENITAL ANOMALIES OF EYE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
447	NONINFLAMMATORY DISORDERS AND BENIGN NEOPLASMS OF OVARY, FALLOPIAN TUBES AND UTERUS; OVARIAN CYSTS; STREAK OVARIES (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
448	URETHRAL FISTULA (See Guideline Notes 64,65)	EXCISION, MEDICAL THERAPY
449	INTERNAL DERANGEMENT OF KNEE AND LIGAMENTOUS DISRUPTIONS OF THE KNEE, GRADE II AND III (See Guideline Notes 6,64,65)	REPAIR, MEDICAL THERAPY
450	OPEN WOUND OF EAR DRUM	TYMPANOPLASTY
451	CHRONIC DEPRESSION (DYSTHYMIA) (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
452	HYPOSPADIAS AND EPISPADIAS (See Guideline Notes 64,65)	REPAIR
453	CANCER OF GALLBLADDER AND OTHER BILIARY, WHERE TREATMENT WILL RESULT IN A GREATER THAN 5% 5-YEAR SURVIVAL (See Guideline Notes 1,7,11,33,64,65)	MEDICAL AND SURGICAL TREATMENT, WHICH INCLUDES CHEMOTHERAPY AND RADIATION THERAP
454	DYSTROPHY OF VULVA (See Guideline Notes 64,65)	MEDICAL THERAPY
455	RECURRENT EROSION OF THE CORNEA (See Guideline Notes 64,65)	CORNEAL TATTOO, REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATIO
456	STEREOTYPY/HABIT DISORDER AND SELF-ABUSIVE BEHAVIOR DUE TO NEUROLOGICAL DYSFUNCTION (See Guideline Notes 1,64,65)	CONSULTATION/MEDICATION MANAGEMENT/LIMITED BEHAVIORAL MODIFICATION
457	FOREIGN BODY IN UTERUS, VULVA AND VAGINA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
458	RESIDUAL FOREIGN BODY IN SOFT TISSUE	REMOVAL
459	VENOUS TRIBUTARY (BRANCH) OCCLUSION; CENTRAL RETINAL VEIN OCCLUSION (See Guideline Notes 64,65)	LASER SURGERY
460	TRIGEMINAL AND OTHER NERVE DISORDERS (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT, RADIATION THERAPY
461	MALUNION AND NONUNION OF FRACTURE (See Guideline Notes 6,64,65)	SURGICAL TREATMENT
462	ADJUSTMENT DISORDERS (See Coding Specification Below) (See Guideline Notes 45,64,65)	MEDICAL/PSYCHOTHERAPY
463	HEARING LOSS - OVER AGE OF FIVE (See Guideline Notes 1,64,65)	MEDICAL THERAPY INCLUDING HEARING AIDS
464	TOURETTE'S DISORDER AND TIC DISORDERS (See Guideline Notes 1,64,65)	MEDICAL/PSYCHOTHERAPY
465	ATHEROSCLEROSIS, AORTIC AND RENAL (See Guideline Notes 1,64,65)	MEDICAL AND SURGICAL TREATMENT
466	DEGENERATION OF MACULA AND POSTERIOR POLE (See Guideline Notes 46,64,65)	VITRECTOMY, LASER SURGERY
467	REACTIVE ATTACHMENT DISORDER OF INFANCY OR EARLY CHILDHOOD (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
468	DISORDERS OF REFRACTION AND ACCOMMODATION (See Guideline Notes 64,65)	MEDICAL THERAPY
469	EXOPHTHALMOS AND CYSTS OF THE EYE AND ORBIT (See Guideline Notes 64,65)	SURGICAL TREATMENT
470	URINARY INCONTINENCE (See Guideline Notes 1,47,64,65)	MEDICAL AND SURGICAL TREATMENT
471	DISORDERS OF PLASMA PROTEIN METABOLISM (See Guideline Notes 64,65)	MEDICAL THERAPY
472	FACTITIOUS DISORDERS (See Guideline Notes 64,65)	CONSULTATION
473	NEONATAL CONJUNCTIVITIS, DACRYOCYSTITIS AND CANDIDA INFECTION (See Guideline Notes 64,65)	MEDICAL THERAPY
474	DENTAL CONDITIONS (EG. TOOTH LOSS) (See Guideline Note 48)	SPACE MAINTENANCE AND PERIODONTAL MAINTENANCE
475	SIMPLE AND SOCIAL PHOBIAS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
476	ACUTE BRONCHITIS AND BRONCHIOLITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
477	CENTRAL PTERYGIUM (See Guideline Notes 64,65)	EXCISION OR TRANSPOSITION OF PTERYGIUM WITHOUT GRAFT, RADIATION THERAPY
478	BRANCHIAL CLEFT CYST; THYROGLOSSAL DUCT CYST; CYST OF PHARYNX OR NASOPHARYNX (See Guideline Notes 64,65)	EXCISION, MEDICAL THERAPY
479	OBSESSIVE-COMPULSIVE DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
480	OVERANXIOUS DISORDER; GENERALIZED ANXIETY DISORDER; ANXIETY DISORDER, UNSPECIFIED (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
481	OSTEOARTHRITIS AND ALLIED DISORDERS (See Guideline Notes 1,6,64,65)	MEDICAL THERAPY, INJECTIONS
482	ATELECTASIS (COLLAPSE OF LUNG) (See Guideline Notes 64,65)	MEDICAL THERAPY
483	SENSORINEURAL HEARING LOSS - OVER AGE OF FIVE (See Guideline Notes 1,49)	COCHLEAR IMPLANT
484	BRACHIAL PLEXUS LESIONS (See Guideline Notes 64,65)	MEDICAL THERAPY
485	UTERINE PROLAPSE; CYSTOCELE (See Guideline Notes 50,64,65)	SURGICAL REPAIR
486	OVARIAN DYSFUNCTION, GONADAL DYSGENISIS, MENOPAUSAL MANAGEMENT (See Guideline Notes 64,65)	OOPHORECTOMY, ORCHIECTOMY, HORMONAL REPLACEMENT FOR PURPOSES OTHER THAN INFERTIL
487	FUNCTIONAL ENCOPRESIS (See Guideline Notes 1,64,65)	MEDICAL/PSYCHOTHERAPY
488	PTOSIS (ACQUIRED) WITH VISION IMPAIRMENT (See Guideline Notes 64,65)	PTOSIS REPAIR
489	CHRONIC SINUSITIS (See Guideline Notes 35,64,65)	MEDICAL AND SURGICAL TREATMENT
490	KERATOCONJUNCTIVITS, CORNEAL ABSCESS AND NEOVASCULARIZATION (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
491	SELECTIVE MUTISM (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
492	THROMBOSED AND COMPLICATED HEMORRHOIDS (See Guideline Notes 64,65)	HEMORRHOIDECTOMY, INCISION
493	CHRONIC OTITIS MEDIA (See Guideline Notes 51,64,65)	PE TUBES/ADENOIDECTOMY/TYMPANOPLASTY, MEDICAL THERAPY
494	RECTAL PROLAPSE (See Guideline Notes 64,65)	PARTIAL COLECTOMY
495	OTOSCLEROSIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
496	FOREIGN BODY IN EAR AND NOSE (See Guideline Notes 64,65)	REMOVAL OF FOREIGN BODY
497	CHRONIC ANAL FISSURE (See Guideline Notes 52,64,65); ANAL FISTULA	SPHINCTEROTOMY, FISSURECTOMY, FISTULECTOMY, MEDICAL THERAPY
498	CLOSED DISLOCATIONS/FRACTURES OF NON-CERVICAL VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY (See Guideline Notes 6,22,64,65)	MEDICAL AND SURGICAL TREATMENT
499	DENTAL CONDITIONS (EG. SEVERE TOOTH DECAY) (See Guideline Note 53)	STABILIZATION OF PERIODONTAL HEALTH, COMPLEX RESTORATIVE, AND REMOVABLE PROSTHOD
500	CONDUCT DISORDER, AGE 18 OR UNDER (See Guideline Note 54,64,65)	MEDICAL/PSYCHOTHERAPY
501	BREAST CYSTS AND OTHER DISORDERS OF THE BREAST (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
502	CERVICITIS, ENDOCERVICITIS, HEMATOMA OF VULVA, AND NONINFLAMMATORY DISORDERS OF THE VAGINA (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
503	CYSTS OF BARTHOLIN'S GLAND AND VULVA (See Guideline Notes 64,65)	INCISION AND DRAINAGE, MEDICAL THERAPY
504	LICHEN PLANUS (See Guideline Notes 64,65)	MEDICAL THERAPY
505	DENTAL CONDITIONS (EG. BROKEN APPLIANCES) (See Guideline Notes 64,65)	PERIODONTICS AND COMPLEX PROSTHETICS
506	RUPTURE OF SYNOVIUM	REMOVAL OF BAKER'S CYST
507	ENOPHTHALMOS (See Guideline Notes 64,65)	ORBITAL IMPLANT
508	BELL'S PALSY, EXPOSURE KERATOCONJUNCTIVITIS (See Guideline Notes 64,65)	TARSORRHAPHY
509	PERIPHERAL ENTHESOPATHIES (See Guideline Notes 6,64,65)	MEDICAL THERAPY
510	DERMATOPHYTOSIS OF NAIL, GROIN, AND FOOT AND OTHER DERMATOMYCOSIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
511	CONVERSION DISORDER, ADULT (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
512	FRACTURES OF RIBS AND STERNUM, CLOSED (See Guideline Notes 64,65)	MEDICAL THERAPY
513	SPASTIC DIPLEGIA	RHIZOTOMY
514	GENDER IDENTIFICATION DISORDER, PARAPHILIAS AND OTHER PSYCHOSEXUAL DISORDERS (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
515	HEPATORENAL SYNDROME (See Guideline Notes 64,65)	MEDICAL THERAPY
516	ECTROPION, TRICHIASIS OF EYELID, BENIGN NEOPLASM OF EYELID	ECTROPION REPAIR
517	PHIMOSIS	SURGICAL TREATMENT
518	CERUMEN IMPACTION (See Guideline Notes 64,65)	REMOVAL OF EAR WAX
519	SIALOLITHIASIS, MUCOCELE, DISTURBANCE OF SALIVARY SECRETION, OTHER AND UNSPECIFIED DISEASES OF SALIVARY GLANDS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
520	CHRONIC CONJUNCTIVITIS, BLEPHAROCONJUNCTIVITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
521	OTHER DISORDERS OF SYNOVIUM, TENDON AND BURSA, COSTOCHONDRITIS, AND CHONDRODYSTROPHY (See Guideline Notes 64,65)	MEDICAL THERAPY
522	TOXIC ERYTHEMA, ACNE ROSACEA, DISCOID LUPUS (See Guideline Notes 64,65)	MEDICAL THERAPY
523	PERIPHERAL ENTHESOPATHIES	SURGICAL TREATMENT
524	NASAL POLYPS, OTHER DISORDERS OF NASAL CAVITY AND SINUSES (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
525	CIRCUMSCRIBED SCLERODERMA (See Guideline Notes 64,65)	MEDICAL THERAPY
526	PERIPHERAL NERVE DISORDERS (See Guideline Notes 64,65)	MEDICAL THERAPY
527	CLOSED FRACTURE OF GREAT TOE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
528	DYSFUNCTION OF NASOLACRIMAL SYSTEM; LACRIMAL SYSTEM LACERATION (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
529	BENIGN NEOPLASM OF KIDNEY AND OTHER URINARY ORGANS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
530	VERTIGINOUS SYNDROMES AND OTHER DISORDERS OF VESTIBULAR SYSTEM (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
531	CLOSED FRACTURE OF ONE OR MORE PHALANGES OF THE FOOT, NOT INCLUDING THE GREAT TOE	MEDICAL AND SURGICAL TREATMENT
532	PHLEBITIS AND THROMBOPHLEBITIS, SUPERFICIAL (See Guideline Notes 64,65)	MEDICAL THERAPY
533	DISORDERS OF SWEAT GLANDS (See Guideline Notes 64,65)	MEDICAL THERAPY
534	SEXUAL DYSFUNCTION (See Guideline Notes 64,65)	PSYCHOTHERAPY, MEDICAL AND SURGICAL TREATMENT
535	PARALYSIS OF VOCAL CORDS OR LARYNX (See Guideline Notes 64,65)	INCISION/EXCISION/ENDOSCOPY
536	DELUSIONAL DISORDER (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
537	CYSTIC ACNE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
538	UNCOMPLICATED HERNIA (See Guideline Notes 64,65)	REPAIR
539	BENIGN NEOPLASM OF NASAL CAVITIES, MIDDLE EAR AND ACCESSORY SINUSES	EXCISION, RECONSTRUCTION
540	BENIGN NEOPLASM BONE AND ARTICULAR CARTILAGE INCLUDING OSTEOID OSTEOMAS; BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT, RADIATION THERAPY
541	OTHER NONINFECTIOUS GASTROENTERITIS AND COLITIS (See Hospitalization for Acute Viral Infections Statement of Intent) (See Guideline Notes 64,65)	MEDICAL THERAPY
542	DEFORMITIES OF UPPER BODY AND ALL LIMBS (See Guideline Notes 64,65)	REPAIR/REVISION/RECONSTRUCTION/RELOCATION/MEDICAL THERAPY
543	DISORDERS OF FUNCTION OF STOMACH AND OTHER FUNCTIONAL DIGESTIVE DISORDERS (See Guideline Notes 64,65)	MEDICAL THERAPY
544	PELVIC PAIN SYNDROME, DYSPAREUNIA (See Guideline Notes 55,64,65)	MEDICAL AND SURGICAL TREATMENT
545	ATOPIC DERMATITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
546	CONTACT DERMATITIS AND OTHER ECZEMA (See Guideline Notes 64,65)	MEDICAL THERAPY
547	HYPOTENSION (See Guideline Notes 64,65)	MEDICAL THERAPY
548	VIRAL, SELF-LIMITING ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS (See Hospitalization for Acute Viral Infections Statement of Intent) (See Guideline Notes 64,65)	MEDICAL THERAPY
549	PERIPHERAL NERVE DISORDERS	SURGICAL TREATMENT
550	ICHTHYOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
551	LESION OF PLANTAR NERVE; PLANTAR FASCIAL FIBROMATOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY, EXCISION
552	ACUTE AND CHRONIC DISORDERS OF SPINE WITHOUT NEUROLOGIC IMPAIRMENT (See Guideline Notes 6,56,64,65)	MEDICAL AND SURGICAL TREATMENT
553	RAYNAUD'S SYNDROME (See Guideline Notes 64,65)	MEDICAL THERAPY
554	TENSION HEADACHES (See Guideline Notes 64,65)	MEDICAL THERAPY
555	MILD PSORIASIS (See Guideline Notes 57,64,65); DERMATOPHYTOSIS: SCALP, HAND, BODY, DEEP-SEATED	MEDICAL THERAPY
556	DEFORMITIES OF FOOT (See Guideline Notes 64,65)	FASCIOTOMY/INCISION/REPAIR/ARTHRODESIS
557	GRANULOMA OF MUSCLE, GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE (See Guideline Notes 64,65)	REMOVAL OF GRANULOMA
558	HYDROCELE (See Guideline Notes 64,65)	MEDICAL THERAPY, EXCISION
559	SYMPTOMATIC URTICARIA (See Guideline Notes 64,65)	MEDICAL THERAPY
560	IMPULSE DISORDERS EXCLUDING PATHOLOGICAL GAMBLING (See Guideline Notes 58,64,65)	MEDICAL/PSYCHOTHERAPY
561	SUBLINGUAL, SCROTAL, AND PELVIC VARICES (See Guideline Notes 64,65)	VENOUS INJECTION, VASCULAR SURGERY
562	ASEPTIC MENINGITIS (See Hospitalization for Acute Viral Infections Statement of Intent) (See Guideline Notes 64,65)	MEDICAL THERAPY
563	TMJ DISORDER (See Guideline Notes 64,65)	TMJ SPLINTS
564	XEROSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
565	CHRONIC DISEASE OF TONSILS AND ADENOIDS (See Guideline Notes 64,65)	TONSILLECTOMY AND ADENOIDECTOMY
566	SHYNESS DISORDER OF CHILDHOOD OR ADOLESCENCE (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
567	HEMATOMA OF AURICLE OR PINNA AND HEMATOMA OF EXTERNAL EAR (See Guideline Notes 64,65)	DRAINAGE
568	KERATODERMA, ACANTHOSIS NIGRICANS, STRIAE ATROPHICAE, AND OTHER HYPERTROPHIC OR ATROPHIC CONDITIONS OF SKIN (See Guideline Notes 64,65)	MEDICAL THERAPY
569	CHRONIC PROSTATITIS, OTHER DISORDERS OF PROSTATE (See Guideline Notes 64,65)	MEDICAL THERAPY
570	CHONDROMALACIA (See Guideline Notes 6,64,65)	MEDICAL THERAPY
571	MACROMASTIA	SUBCUTANEOUS TOTAL MASTECTOMY, BREAST REDUCTION
572	DYSMENORRHEA (See Guideline Notes 59,64,65)	MEDICAL AND SURGICAL TREATMENT
573	OPEN WOUND OF EAR DRUM (See Guideline Notes 64,65)	MEDICAL THERAPY
574	ALLERGIC RHINITIS AND CONJUNCTIVITIS, CHRONIC RHINITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
575	CANCER OF LIVER AND INTRAHEPATIC BILE DUCTS (See Guideline Note 16)	LIVER TRANSPLANT
576	POSTCONCUSSION SYNDROME (See Guideline Notes 64,65)	MEDICAL THERAPY
577	BENIGN NEOPLASM OF EXTERNAL FEMALE GENITAL ORGANS	EXCISION
578	RUMINATION DISORDER OF INFANCY	MEDICAL/PSYCHOTHERAPY
579	HORDEOLUM AND OTHER DEEP INFLAMMATION OF EYELID; CHALAZION (See Guideline Notes 64,65)	INCISION AND DRAINAGE, MEDICAL THERAPY
580	CONDUCTIVE HEARING LOSS	AUDIANT BONE CONDUCTORS
581	ACUTE ANAL FISSURE (See Guideline Notes 64,65)	FISSURECTOMY, MEDICAL THERAPY
582	PLEURISY (See Guideline Notes 64,65)	MEDICAL THERAPY
583	CENTRAL SEROUS RETINOPATHY	LASER SURGERY
584	PERITONEAL ADHESION	SURGICAL TREATMENT
585	DERMATITIS DUE TO SUBSTANCES TAKEN INTERNALLY (See Guideline Notes 64,65)	MEDICAL THERAPY
586	BLEPHARITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
587	UNSPECIFIED URINARY OBSTRUCTION AND BENIGN PROSTATIC HYPERPLASIA WITHOUT OBSTRUCTION (See Guideline Notes 64,65)	MEDICAL THERAPY
588	OTHER COMPLICATIONS OF A PROCEDURE (See Guideline Notes 6,64,65)	MEDICAL AND SURGICAL TREATMENT
589	LYMPHEDEMA (See Guideline Notes 43,64,65)	MEDICAL THERAPY, OTHER OPERATION ON LYMPH CHANNEL
590	ACUTE NON-SUPPURATIVE LABYRINTHITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
591	DEVIATED NASAL SEPTUM, ACQUIRED DEFORMITY OF NOSE, OTHER DISEASES OF UPPER RESPIRATORY TRACT (See Guideline Notes 64,65)	EXCISION OF CYST/RHINECTOMY/PROSTHESIS
592	STOMATITIS AND OTHER DISEASES OF ORAL SOFT TISSUES (See Guideline Notes 64,65)	INCISION AND DRAINAGE, MEDICAL THERAPY
593	CAVUS DEFORMITY OF FOOT; FLAT FOOT; POLYDACTYLY AND SYNDACTYLY OF TOES (See Guideline Notes 64,65)	MEDICAL THERAPY, ORTHOTIC
594	ERYTHEMA MULTIFORME (See Guideline Notes 64,65)	MEDICAL THERAPY
595	INFECTIOUS MONONUCLEOSIS (See Guideline Notes 64,65)	MEDICAL THERAPY
596	CONGENITAL ANOMALIES OF FEMALE GENITAL ORGANS EXCLUDING VAGINA (See Guideline Notes 64,65)	SURGICAL TREATMENT
597	SPINAL DEFORMITY, NOT CLINICALLY SIGNIFICANT (See Guideline Notes 60,64,65)	ARTHRODESIS/REPAIR/RECONSTRUCTION, MEDICAL THERAPY
598	ANTI-SOCIAL PERSONALITY DISORDER (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
599	SPASTIC DYSPHONIA (See Guideline Notes 64,65)	MEDICAL THERAPY
600	URETHRITIS, NON-SEXUALLY TRANSMITTED (See Guideline Notes 64,65)	MEDICAL THERAPY
601	PERSONALITY DISORDERS EXCLUDING BORDERLINE, SCHIZOTYPAL AND ANTI-SOCIAL (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
602	CANDIDIASIS OF MOUTH, SKIN AND NAILS (See Guideline Notes 64,65)	MEDICAL THERAPY
603	BENIGN NEOPLASM OF MALE GENITAL ORGANS: TESTIS, PROSTATE, EPIDIDYMIS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
604	ATROPHY OF EDENTULOUS ALVEOLAR RIDGE	VESTIBULOPLASTY, GRAFTS, IMPLANTS
605	OLD LACERATION OF CERVIX AND VAGINA (See Guideline Notes 64,65)	MEDICAL THERAPY
606	VULVAL VARICES (See Guideline Notes 64,65)	VASCULAR SURGERY
607	DISEASE OF NAILS, HAIR AND HAIR FOLLICLES (See Guideline Notes 64,65)	MEDICAL THERAPY
608	OBESITY (See Guideline Note 61)	NUTRITIONAL/PHYSICAL ACTIVITY COUNSELING AND BEHAVIORAL INTERVENTIONS; BARIATRIC
609	ACUTE TONSILLITIS OTHER THAN BETA-STREPTOCOCCAL (See Guideline Notes 64,65)	MEDICAL THERAPY
610	CORNS AND CALLUSES (See Guideline Notes 64,65)	MEDICAL THERAPY
611	SYNOVITIS AND TENOSYNOVITIS (See Guideline Notes 6,64,65)	MEDICAL THERAPY
612	PROLAPSED URETHRAL MUCOSA (See Guideline Notes 64,65)	SURGICAL TREATMENT
613	SECONDARY AND ILL-DEFINED MALIGNANT NEOPLASMS (See Guideline Notes 7,11,64,65)	MEDICAL AND SURGICAL TREATMENT
614	GANGLION (See Guideline Notes 64,65)	EXCISION
615	EPISCLERITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
616	DIAPER RASH (See Guideline Notes 64,65)	MEDICAL THERAPY
617	TONGUE TIE AND OTHER ANOMALIES OF TONGUE	FRENOTOMY, TONGUE TIE
618	CYSTS OF ORAL SOFT TISSUES (See Guideline Notes 64,65)	INCISION AND DRAINAGE
619	CONGENITAL DEFORMITIES OF KNEE (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
620	CHRONIC PANCREATITIS	SURGICAL TREATMENT
621	HERPES SIMPLEX WITHOUT COMPLICATIONS, EXCLUDING GENITAL HERPES (See Guideline Notes 64,65)	MEDICAL THERAPY
622	CONGENITAL ANOMALIES OF THE EAR WITHOUT IMPAIRMENT OF HEARING; UNILATERAL ANOMALIES OF THE EAR	OTOPLASTY, REPAIR AND AMPUTATION
623	KELOID SCAR; OTHER ABNORMAL GRANULATION TISSUE	INTRALESIONAL INJECTIONS/DESTRUCTION/EXCISION, RADIATION THERAPY
624	DISORDERS OF SOFT TISSUE (See Guideline Notes 64,65)	MEDICAL THERAPY
625	MINOR BURNS (See Guideline Notes 64,65)	MEDICAL THERAPY
626	DISORDERS OF SLEEP WITHOUT SLEEP APNEA (See Guideline Notes 64,65)	MEDICAL THERAPY
627	ORAL APHTHAE (See Guideline Notes 64,65)	MEDICAL THERAPY
628	SPRAINS AND STRAINS OF ADJACENT MUSCLES AND JOINTS, MINOR (See Guideline Notes 6,64,65)	MEDICAL THERAPY
629	ASYMPTOMATIC URTICARIA (See Guideline Notes 64,65)	MEDICAL THERAPY
630	DENTAL CONDITIONS (EG. ORTHODONTICS) (See Guideline Notes 64,65)	COSMETIC DENTAL SERVICES
631	FINGERTIP AVULSION	REPAIR WITHOUT PEDICLE GRAFT
632	MINOR HEAD INJURY: HEMATOMA/EDEMA WITH NO LOSS OF CONSCIOUSNESS (See Guideline Notes 64,65)	MEDICAL THERAPY
633	VIRAL WARTS EXCLUDING VENEREAL WARTS (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT, CRYOSURGERY
634	ACUTE UPPER RESPIRATORY INFECTIONS AND COMMON COLD (See Guideline Notes 64,65)	MEDICAL THERAPY
635	OTHER VIRAL INFECTIONS, EXCLUDING PNEUMONIA DUE TO RESPIRATORY SYNCYTIAL VIRUS IN PERSONS UNDER AGE 3 (See Hospitalization for Acute Viral Infections Statement of Intent) (See Guideline Notes 64,65)	MEDICAL THERAPY
636	PHARYNGITIS AND LARYNGITIS AND OTHER DISEASES OF VOCAL CORDS (See Guideline Notes 64,65)	MEDICAL THERAPY
637	ANOMALIES OF RELATIONSHIP OF JAW TO CRANIAL BASE, MAJOR ANOMALIES OF JAW SIZE, OTHER SPECIFIED AND UNSPECIFIED DENTOFACIAL ANOMALIES (See Guideline Notes 64,65)	OSTEOPLASTY, MAXILLA/MANDIBLE
638	GALACTORRHEA, MASTODYNIA, ATROPHY, BENIGN NEOPLASMS AND UNSPECIFIED DISORDERS OF THE BREAST (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
639	HYPERTELORISM OF ORBIT (See Guideline Notes 64,65)	ORBITOTOMY
640	OPEN WOUND OF INTERNAL STRUCTURES OF MOUTH WITHOUT COMPLICATION (See Guideline Notes 64,65)	REPAIR SOFT TISSUES
641	SEBACEOUS CYST (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
642	SEBORRHEIC KERATOSIS, DYSCHROMIA, AND VASCULAR DISORDERS, SCAR CONDITIONS, AND FIBROSIS OF SKIN (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
643	REDUNDANT PREPUCE (See Guideline Notes 64,65)	ELECTIVE CIRCUMCISION
644	STENOSIS OF NASOLACRIMAL DUCT (ACQUIRED)	DACRYOCYSTORHINOSTOMY
645	CONJUNCTIVAL CYST (See Guideline Notes 64,65)	EXCISION OF CONJUNCTIVAL CYST
646	BENIGN NEOPLASMS OF SKIN AND OTHER SOFT TISSUES (See Guideline Notes 64,65)	MEDICAL THERAPY
647	DISEASE OF CAPILLARIES	EXCISION
648	NONINFLAMMATORY DISORDERS OF CERVIX; HYPERTROPHY OF LABIA (See Guideline Notes 64,65)	MEDICAL THERAPY
649	CYST, HEMORRHAGE, AND INFARCTION OF THYROID (See Guideline Notes 64,65)	SURGICAL TREATMENT
650	PICA (See Guideline Notes 64,65)	MEDICAL/PSYCHOTHERAPY
651	ACUTE VIRAL CONJUNCTIVITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
652	MUSCULAR CALCIFICATION AND OSSIFICATION (See Guideline Notes 64,65)	MEDICAL THERAPY
653	SUPERFICIAL WOUNDS WITHOUT INFECTION AND CONTUSIONS (See Guideline Notes 64,65)	MEDICAL THERAPY
654	CHRONIC BRONCHITIS (See Guideline Notes 64,65)	MEDICAL THERAPY
655	BENIGN POLYPS OF VOCAL CORDS (See Guideline Notes 64,65)	MEDICAL THERAPY, STRIPPING
656	BENIGN NEOPLASMS OF DIGESTIVE SYSTEM (See Guideline Notes 64,65)	SURGICAL TREATMENT
657	VARICOSE VEINS OF LOWER EXTREMITIES WITHOUT ULCER OR INFLAMMATION (See Guideline Notes 64,65)	STRIPPING/SCLEROTHERAPY, MEDICAL THERAPY
658	CYST OF KIDNEY, ACQUIRED (See Guideline Notes 64,65)	MEDICAL AND SURGICAL TREATMENT
659	GALLSTONES WITHOUT CHOLECYSTITIS (See Guideline Notes 64,65)	MEDICAL THERAPY, CHOLECYSTECTOMY
660	DENTAL CONDITIONS WHERE TREATMENT RESULTS IN MARGINAL IMPROVEMENT (See Guideline Notes 62,64,65)	ELECTIVE DENTAL SERVICES
661	GYNECOMASTIA	MASTECTOMY
662	TMJ DISORDERS (See Guideline Notes 64,65)	TMJ SURGERY
663	EDEMA AND OTHER CONDITIONS INVOLVING THE INTEGUMENT OF THE FETUS AND NEWBORN (See Guideline Notes 64,65)	MEDICAL THERAPY
664	CONGENITAL CYSTIC LUNG - SEVERE	LUNG RESECTION
665	AGENESIS OF LUNG (See Guideline Notes 64,65)	MEDICAL THERAPY
666	CENTRAL RETINAL ARTERY OCCLUSION	PARACENTESIS OF AQUEOUS
667	BENIGN LESIONS OF TONGUE (See Guideline Notes 64,65)	EXCISION
668	UNCOMPLICATED HEMORRHOIDS (See Guideline Notes 64,65)	HEMORRHOIDECTOMY, MEDICAL THERAPY
669	MENTAL DISORDERS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
670	INTRACRANIAL CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
671	INFECTIOUS DISEASES WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
672	ENDOCRINE AND METABOLIC CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
673	CARDIOVASCULAR CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
674	SENSORY ORGAN CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
675	NEUROLOGIC CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
676	DERMATOLOGICAL CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 29,64,65)	EVALUATION
677	RESPIRATORY CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
678	GENITOURINARY CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
679	MUSCULOSKELETAL CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION
680	GASTROINTESTINAL CONDITIONS WITH NO EFFECTIVE TREATMENTS OR NO TREATMENT NECESSARY (See Guideline Notes 64,65)	EVALUATION