10.1.A. - 4WEB Medical Ankle Truss System Codes - FY 2024																			
																			
Note:  The applicant provided the following codes and/or MS-DRGs that were used in performing a cost analysis for the Charges section of the new technology add-on payment application.																			
																			
Analysis 1 Identified MS-DRGs 1		Analysis 2 Identified MS-DRGs 1																	
493		493																	
494		494																	
492		492																	
982		982																	
981		981																	
469		469																	
478		478																	
463		463																	
464		464																	
853		853																	
629		629																	
003		003																	
040		040																	
041		041																	
042		042																	
252		252																	
264		264																	
465		465																	
466		466																	
467		467																	
470																			
471																			
475																			
477																			
479																			
480																			
481																			
483																			
488																			
577																			
623																			
628																			
674																			
854																			
855																			
856																			
857																			
901																			
904																			
907																			
908																			
939																			
940																			
941																			
956																			
957																			
958																			
983																			
987																			
																			
"1 For the MS-DRG desciptions, refer to Table 5 associated with the applicable fiscal year IPPS/LTCH PPS proposed rule."																			
