Service Req. or Q2035 S4993 Code Limit Q2036 IC T1023 V2600 PA; IC J9302 PA Q2037 V2610 PA; IC J9303 Q2038 IC V2615 PA; IC J9305 Q2043 PA V2799 PA; IC J9306 PA Q2049 IC J9307 Q2050 J9308 PA Q4074 J9310 PA Q4081 J9315 PA Q4101 J9320 Q4102 J9325 PA Q4103 IC J9328 Q4104 IC J9330 Q4106 J9340 IC Q4107 J9351 Q4108 IC J9352 Q4110 IC J9354 PA Q4121 J9355 Q4131 J9357 Q4132 J9360 J9370 Q4107 J9371 PA Service Req. or J9390 Code Limit J9395 PA Q4133 J9400 PA Q4161 IC J9999 IC Q4162 IC Q0138 Q4163 IC Q0139 Q4164 IC Q0162 Q4165 IC Q5101 Q9950 Q9980 PA; IC Service S0020 IC Req. or S0021 IC Code Limit S0023 IC Q2009 IC S0077 IC Q2017 IC S0190 IC Q2028 IC; CD (covered S0191 IC with diagnosis S0199 of lipodystrophy S0302 associated with S2260 (CPA-2); IC or secondary to S3005 HIV only) S4989 IC
Service Req. or Code Limit J9302 PA J9303 J9305 J9306 PA J9307 J9308 PA J9310 PA J9315 PA J9320 J9325 PA J9328 J9330 J9340 IC J9351 J9352 J9354 PA J9355 J9357 J9360 J9370 J9371 PA J9390 J9395 PA J9400 PA J9999 IC Q0138 Q0139 Q0162 Service Req. or Code Limit Q2009 IC Q2017 IC Q2028 IC; CD (covered with diagnosis of lipodystrophy associated with or secondary to HIV only) Q2035 Q2036 IC Q2037 Q2038 IC Q2043 PA Q2049 IC Q2050 Q4074 Q4081 Q4101 Q4102 Q4103 IC Q4104 IC Q4106 Q4107 Q4108 IC Q4110 IC Q4121 Q4131 Q4132 Q4107 Service Req. or Code Limit Q4133 Q4161 IC Q4162 IC Q4163 IC Q4164 IC Q4165 IC Q5101 Q9950 Q9980 PA; IC S0020 IC S0021 IC S0023 IC S0077 IC S0190 IC S0191 IC S0199 S0302 S2260 (CPA-2); IC S3005 S4989 IC S4993 T1023 V2600 PA; IC V2610 PA; IC V2615 PA; IC V2799 PA; IC
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