10.2.A. - TOPS 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.																			
																			
ICD-10-PCS Codes																			
00CY0ZZ																			
0QB00ZZ																			
0QB03ZZ																			
0QC00ZZ																			
0QD00ZZ																			
0QH004Z																			
0QH034Z																			
0QH044Z																			
0QP004Z																			
0QP005Z																			
0QP00JZ																			
0QS004Z																			
0QS00ZZ																			
0QS034Z																			
0QS03ZZ																			
0QU007Z																			
0QU00JZ																			
0QU00KZ																			
0QU03JZ																			
0QW004Z																			
0QW00JZ																			
0S523ZZ																			
0SB00ZZ																			
0SB20ZX																			
0SB20ZZ																			
0SB23ZZ																			
0SB24ZZ																			
0SB40ZZ																			
0SH00BZ																			
0SH00CZ																			
0SH00DZ																			
0SH304Z																			
0SH30CZ																			
0SJ30ZZ																			
0SP004Z																			
0SR207Z																			
0SR20JZ																			
0SR40JZ																			
0ST20ZZ																			
0SU007Z																			
0SU00JZ																			
0SU03JZ																			
0SU04JZ																			
009Y00Z																			
009Y0ZZ																			
009Y3ZX																			
009Y40Z																			
009Y4ZX																			
00BY0ZX																			
00BY0ZZ																			
00BY3ZX																			
00BY3ZZ																			
00BY4ZZ																			
00NY0ZZ																			
00NY3ZZ																			
00NY4ZZ																			
01BB0ZZ																			
01NB0ZZ																			
01NB3ZZ																			
01NB4ZZ																			
0Q903ZZ																			
0S900ZZ																			
0S903ZX																			
0S903ZZ																			
0S923ZX																			
0SJ00ZZ																			
0SJ20ZZ																			
005T3ZZ																			
005X3ZZ																			
009T00Z																			
009T0ZZ																			
009U00Z																			
009U0ZX																			
009U0ZZ																			
009U30Z																			
009U3ZX																			
009X0ZX																			
00B14ZZ																			
00B20ZZ																			
00B70ZZ																			
00BC0ZZ																			
00BN0ZZ																			
00BT0ZX																			
00BT0ZZ																			
00BT3ZX																			
00BW0ZX																			
00BW0ZZ																			
00BX0ZX																			
00BX0ZZ																			
00BX3ZX																			
00C30ZZ																			
00CT0ZZ																			
00CU0ZZ																			
00CU4ZZ																			
00CW0ZZ																			
00CX0ZZ																			
00D20ZZ																			
00DT0ZZ																			
00HU03Z																			
00HU0MZ																			
00HU33Z																			
00HU3MZ																			
00HV0MZ																			
00HV3MZ																			
00HV4MZ																			
00JU0ZZ																			
00JU3ZZ																			
00JV0ZZ																			
00NC0ZZ																			
00NT0ZZ																			
00NW0ZZ																			
00NW3ZZ																			
00NX0ZZ																			
00NX3ZZ																			
00PU03Z																			
00PU0MZ																			
00PU3MZ																			
00PV00Z																			
00PV0JZ																			
00PV0MZ																			
00PV3MZ																			
00Q20ZZ																			
00QT0ZZ																			
00U207Z																			
00U20JZ																			
00U20KZ																			
00UT07Z																			
00UT0JZ																			
00UT0KZ																			
00UT3KZ																			
00WU03Z																			
00WU0MZ																			
00WV0MZ																			
01510ZZ																			
01580ZZ																			
01584ZZ																			
01880ZZ																			
01884ZZ																			
01B10ZZ																			
01B80ZZ																			
01BR0ZZ																			
01HY0MZ																			
01JY3ZZ																			
01N10ZZ																			
01N13ZZ																			
01N40ZZ																			
01N50ZZ																			
01N54ZZ																			
01N80ZZ																			
01N83ZZ																			
01NR0ZZ																			
01NR3ZZ																			
01PY0MZ																			
02100Z9																			
021109W																			
027034Z																			
027035Z																			
02703ZZ																			
027135Z																			
02C03ZZ																			
02CP3ZZ																			
02CQ3ZZ																			
02CR3ZZ																			
02H13DZ																			
02H633Z																			
02H63JZ																			
02HA3RZ																			
02HK3JZ																			
02HK3NZ																			
02HQ32Z																			
02HV33Z																			
02PAX3Z																			
02PYX3Z																			
031C0ZF																			
03723Z1																			
03773ZZ																			
03C83ZZ																			
03CL0ZZ																			
03H533Z																			
03HB33Z																			
03HY32Z																			
03L33ZZ																			
03LP3ZZ																			
03LY3ZZ																			
03QP0ZZ																			
03VQ3DZ																			
04703DZ																			
047C3DZ																			
047D3DZ																			
047H3DZ																			
047J3DZ																			
04HY32Z																			
04LY3DZ																			
04V03DZ																			
04V23ZZ																			
04VF3DZ																			
057B3ZZ																			
059Y3ZZ																			
05BY0ZZ																			
05CF3ZZ																			
05H533Z																			
05H833Z																			
05H933Z																			
05HA33Z																			
05HB33Z																			
05HC33Z																			
05HD33Z																			
05HF33Z																			
05HM33Z																			
05HN33Z																			
05HY32Z																			
05HY33Z																			
05JY3ZZ																			
05PY03Z																			
05WY07Z																			
06BQ4ZZ																			
06H033Z																			
06H03DZ																			
06HM33Z																			
06HN33Z																			
06HY33Z																			
06PY3DZ																			
06Q00ZZ																			
06QJ0ZZ																			
079J3ZZ																			
07B13ZX																			
07B74ZZ																			
07D23ZX																			
07DR3ZX																			
07DR3ZZ																			
07DS0ZX																			
093K8ZZ																			
09900ZZ																			
09Q0XZZ																			
0B938ZZ																			
0B963ZX																			
0B978ZZ																			
0B9C8ZX																			
0B9D8ZX																			
0B9F8ZX																			
0B9F8ZZ																			
0B9J8ZX																			
0B9L8ZX																			
0B9M8ZX																			
0BBF4ZX																			
0BBG3ZX																			
0BC78ZZ																			
0BC88ZZ																			
0BCB8ZZ																			
0BCK4ZZ																			
0BCN4ZZ																			
0BH17EZ																			
0BH18EZ																			
0BJ08ZZ																			
0BNL0ZZ																			
0BPQX0Z																			
0BUT0JZ																			
0C9M8ZZ																			
0CJS8ZZ																			
0CQM4ZZ																			
0D180Z8																			
0D1B0Z4																			
0D5P8ZZ																			
0D748ZZ																			
0D7E8DZ																			
0D7N8DZ																			
0D9670Z																			
0D9E80Z																			
0DB18ZX																			
0DB28ZX																			
0DB38ZX																			
0DB58ZX																			
0DB68ZX																			
0DB78ZX																			
0DB80ZZ																			
0DB98ZX																			
0DBE8ZX																			
0DBH0ZZ																			
0DBK8ZX																			
0DBL8ZZ																			
0DBN8ZX																			
0DBP8ZX																			
0DC98ZZ																			
0DCP8ZZ																			
0DH63UZ																			
0DH64UZ																			
0DH67UZ																			
0DH68UZ																			
0DH97UZ																			
0DHA0UZ																			
0DHA7UZ																			
0DJ08ZZ																			
0DJD8ZZ																			
0DN80ZZ																			
0DNW0ZZ																			
0DP68UZ																			
0DQW0ZZ																			
0F798DZ																			
0F9430Z																			
0FB23ZX																			
0FDC8ZX																			
0GBH3ZX																			
0HB4XZX																			
0HB6XZZ																			
0HBHXZX																			
0HBKXZX																			
0HBMXZZ																			
0HBRXZZ																			
0HD6XZZ																			
0HQ0XZZ																			
0HQ1XZZ																			
0HQ6XZZ																			
0HQFXZZ																			
0J953ZZ																			
0J9700Z																			
0J970ZZ																			
0J9730Z																			
0J990ZZ																			
0J9D3ZZ																			
0J9G0ZZ																			
0J9J3ZX																			
0J9N0ZZ																			
0JB70ZX																			
0JC40ZZ																			
0JC50ZZ																			
0JC70ZZ																			
0JD10ZZ																			
0JD70ZZ																			
0JD73ZZ																			
0JDD0ZZ																			
0JDG0ZZ																			
0JDL0ZZ																			
0JDM0ZZ																			
0JDN0ZZ																			
0JDP0ZZ																			
0JDR0ZZ																			
0JH606Z																			
0JH60BZ																			
0JH632Z																			
0JH63PZ																			
0JH63XZ																			
0JH70BZ																			
0JH70CZ																			
0JH70DZ																			
0JH70EZ																			
0JH73DZ																			
0JH73EZ																			
0JH80BZ																			
0JH80CZ																			
0JH80DZ																			
0JH80EZ																			
0JH80VZ																			
0JHD3XZ																			
0JHL0XZ																			
0JHP3XZ																			
0JJT3ZZ																			
0JN70ZZ																			
0JPT0MZ																			
0JPT0VZ																			
0JPT3MZ																			
0JPT3XZ																			
0JQ13ZZ																			
0JQ70ZZ																			
0JQG0ZZ																			
0JQJ0ZZ																			
0JU70KZ																			
0K9200Z																			
0K9300Z																			
0K9F0ZZ																			
0K9N0ZZ																			
0K9N30Z																			
0K9N3ZZ																			
0K9P3ZZ																			
0KB00ZZ																			
0KB50ZZ																			
0KBF0ZX																			
0KBF0ZZ																			
0KBG0ZZ																			
0KBN0ZZ																			
0KBR0ZZ																			
0KC20ZZ																			
0KDG0ZZ																			
0KUF07Z																			
0KUG07Z																			
0KX20ZZ																			
0KX30ZZ																			
0KXF0Z0																			
0KXF0Z1																			
0KXF0Z2																			
0KXF0Z5																			
0KXF0ZZ																			
0KXG0Z0																			
0KXG0Z1																			
0KXG0Z2																			
0KXG0Z5																			
0KXG0ZZ																			
0LQM0ZZ																			
0MBD0ZZ																			
0MCC0ZZ																			
0MQQ0ZZ																			
0MTC0ZZ																			
0NB70ZZ																			
0ND00ZZ																			
0NH004Z																			
0P9400Z																			
0PB10ZZ																			
0PB30ZZ																			
0PB40ZZ																			
0PD40ZZ																			
0PH244Z																			
0PH304Z																			
0PH404Z																			
0PH434Z																			
0PN40ZZ																			
0PP204Z																			
0PP304Z																			
0PP404Z																			
0PQ30ZZ																			
0PR30KZ																			
0PS034Z																			
0PS204Z																			
0PS304Z																			
0PS30ZZ																			
0PS334Z																			
0PS404Z																			
0PS40ZZ																			
0PS434Z																			
0PS43ZZ																			
0PS6XZZ																			
0PS904Z																			
0PSB04Z																			
0PSH04Z																			
0PSHXZZ																			
0PSJ04Z																			
0PSJXZZ																			
0PSK04Z																			
0PSM04Z																			
0PSP04Z																			
0PSQ34Z																			
0PSV34Z																			
0PU207Z																			
0PU307Z																			
0PU30JZ																			
0PU30KZ																			
0PU407Z																			
0PU40JZ																			
0PU40KZ																			
0PU43JZ																			
0PU907Z																			
0QB10ZZ																			
0QB20ZZ																			
0QB30ZZ																			
0QB40ZZ																			
0QD10ZZ																			
0QD20ZZ																			
0QH104Z																			
0QH134Z																			
0QH204Z																			
0QH234Z																			
0QH304Z																			
0QH334Z																			
0QN10ZZ																			
0QP104Z																			
0QP134Z																			
0QP304Z																			
0QPGX5Z																			
0QPY0MZ																			
0QS104Z																			
0QS134Z																			
0QS204Z																			
0QS234Z																			
0QS304Z																			
0QS334Z																			
0QS3XZZ																			
0QS404Z																			
0QS434Z																			
0QS4XZZ																			
0QS504Z																			
0QS5XZZ																			
0QSG04Z																			
0QSG05Z																			
0QSG3BZ																			
0QSGXZZ																			
0QSH04Z																			
0QSJ04Z																			
0QSK04Z																			
0QU107Z																			
0QU10JZ																			
0QW204Z																			
0QW304Z																			
0R593ZZ																			
0R960ZZ																			
0R9J0ZX																			
0R9N0ZZ																			
0RB10ZZ																			
0RB30ZX																			
0RB30ZZ																			
0RB50ZZ																			
0RB60ZZ																			
0RB90ZZ																			
0RB93ZX																			
0RB93ZZ																			
0RBB0ZZ																			
0RBJ0ZZ																			
0RH004Z																			
0RH104Z																			
0RH10BZ																			
0RH10DZ																			
0RH303Z																			
0RH404Z																			
0RH40DZ																			
0RH604Z																			
0RH60CZ																			
0RHA04Z																			
0RHA0BZ																			
0RHA0CZ																			
0RHA34Z																			
0RHA3CZ																			
0RJ60ZZ																			
0RP104Z																			
0RP30JZ																			
0RP604Z																			
0RP60JZ																			
0RPA04Z																			
0RPA0JZ																			
0RQ10ZZ																			
0RR30JZ																			
0RR50JZ																			
0RS004Z																			
0RS604Z																			
0RSA04Z																			
0RSJXZZ																			
0RT30ZZ																			
0RT40ZZ																			
0RT90ZZ																			
0RTB0ZZ																			
0RU10JZ																			
0RU30JZ																			
0RU607Z																			
0RU60JZ																			
0RU63JZ																			
0RU93JZ																			
0RUA0JZ																			
0RUA3JZ																			
0RW604Z																			
0S930ZZ																			
0S940ZZ																			
0S950ZZ																			
0S9C4ZZ																			
0SB43ZZ																			
0SB44ZZ																			
0SB50ZZ																			
0SB53ZX																			
0SB70ZZ																			
0SB80ZZ																			
0SBC0ZX																			
0SC00ZZ																			
0SC04ZZ																			
0SC20ZZ																			
0SC24ZZ																			
0SH004Z																			
0SH034Z																			
0SH03BZ																			
0SH30BZ																			
0SH704Z																			
0SH804Z																			
0SH834Z																			
0SP00JZ																			
0SP304Z																			
0SP30AZ																			
0SP704Z																			
0SP804Z																			
0SS33ZZ																			
0ST40ZZ																			
0SU30JZ																			
0SU53JZ																			
0SW00AZ																			
0SWBXJZ																			
0T2BX0Z																			
0T5B8ZZ																			
0T768DZ																			
0T778DZ																			
0T7D7ZZ																			
0T7D8ZZ																			
0T9B70Z																			
0T9B80Z																			
0T9B8ZZ																			
0THB8YZ																			
0TJB8ZZ																			
0TP98DZ																			
0TPBX0Z																			
0VB03ZX																			
0W360ZZ																			
0W3K0ZZ																			
0W3P8ZZ																			
0W9600Z																			
0W960ZZ																			
0W9630Z																			
0W9900Z																			
0W9930Z																			
0W993ZX																			
0W993ZZ																			
0W994ZZ																			
0W9B30Z																			
0W9B3ZZ																			
0W9C0ZZ																			
0W9K0ZZ																			
0W9L3ZZ																			
0WBC0ZZ																			
0WBH3ZX																			
0WCB0ZZ																			
0WCQ0ZZ																			
0WCQ8ZZ																			
0WHG33Z																			
0WJK0ZZ																			
0WJR7ZZ																			
0WQF0ZZ																			
0WQL0ZZ																			
0Y9C3ZZ																			
0YQHXZZ																			
2W15X6Z																			
2W1NX6Z																			
2W30XYZ																			
2W31X9Z																			
2W52X0Z																			
2W59X0Z																			
2W60XZZ																			
2W62X0Z																			
2W69X0Z																			
2W6CX0Z																			
30233H0																			
30233J1																			
30233K1																			
30233L1																			
30233N0																			
30233N1																			
30233P1																			
30233R1																			
30243K1																			
30243N1																			
30243R1																			
30243V1																			
30283B1																			
3C1ZX8Z																			
3E0102A																			
3E01329																			
3E013GC																			
3E013VG																			
3E0233Z																			
3E02340																			
3E0234Z																			
3E023BZ																			
3E03305																			
3E03317																			
3E03329																			
3E0333Z																			
3E0336Z																			
3E0337Z																			
3E033GC																			
3E033NZ																			
3E033XZ																			
3E04329																			
3E0436Z																			
3E043GC																			
3E043XZ																			
3E073KZ																			
3E0F7SF																			
3E0G76Z																			
3E0G8GC																			
3E0H76Z																			
3E0H8GC																			
3E0R33Z																			
3E0R3BZ																			
3E0R3GC																			
3E0R3NZ																			
3E0S33Z																			
3E0T3BZ																			
3E0U029																			
3E0U33Z																			
3E0U3BZ																			
3E0U3NZ																			
3E0V329																			
3E1H78Z																			
3E1L38Z																			
3E1M39Z																			
3E1R38Z																			
3E1S38Z																			
3E1U38Z																			
3E1U48Z																			
4A00X4Z																			
4A0234Z																			
4A023FZ																			
4A023N6																			
4A023N7																			
4A023N8																			
4A02X4A																			
4A02XM4																			
4A033BC																			
4A03X5D																			
4A1004G																			
4A1034G																			
4A1034Z																			
4A1084G																			
4A10X4G																			
4A10X4Z																			
4A1104G																			
4A1104Z																			
4A1134G																			
4A1134Z																			
4A11X4G																			
4A133B1																			
4A133J1																			
4A133R1																			
4B02XSZ																			
4B02XTZ																			
5A02210																			
5A0221D																			
5A09357																			
5A0935A																			
5A09457																			
5A0945A																			
5A09557																			
5A12012																			
5A1221Z																			
5A1223Z																			
5A1935Z																			
5A1945Z																			
5A1955Z																			
5A1D70Z																			
5A1D90Z																			
5A2204Z																			
6A550Z2																			
6A551Z2																			
6A551Z3																			
8E09XBF																			
8E09XBG																			
8E09XBZ																			
8E0H30Z																			
8E0W0CZ																			
8E0W3CZ																			
8E0W4CZ																			
8E0WXBF																			
8E0WXBG																			
8E0WXBZ																			
8E0XXBZ																			
8E0ZXY6																			
B01B1ZZ																			
B01BYZZ																			
B01BZZZ																			
B020ZZZ																			
B02B1ZZ																			
B030Y0Z																			
B030ZZZ																			
B201YZZ																			
B2111ZZ																			
B211YZZ																			
B2131ZZ																			
B213YZZ																			
B2151ZZ																			
B215YZZ																			
B2181ZZ																			
B218YZZ																			
B240ZZ3																			
B241ZZ3																			
B245ZZ4																			
B246YZZ																			
B246ZZ4																			
B246ZZZ																			
B24BYZZ																			
B24BZZ3																			
B24BZZ4																			
B24BZZZ																			
B24CZZZ																			
B3101ZZ																			
B314YZZ																			
B31D1ZZ																			
B31G1ZZ																			
B31LYZZ																			
B31M1ZZ																			
B31MYZZ																			
B31UZZZ																			
B3201ZZ																			
B3251ZZ																			
B3281ZZ																			
B32G1ZZ																			
B32R1ZZ																			
B32RZZZ																			
B32S1ZZ																			
B32T1ZZ																			
B335ZZZ																			
B338ZZZ																			
B33GZZZ																			
B33RZZZ																			
B34SZZ3																			
B4101ZZ																			
B4121ZZ																			
B4141ZZ																			
B4151ZZ																			
B419YZZ																			
B41C1ZZ																			
B41D1ZZ																			
B41FYZZ																			
B4201ZZ																			
B4211ZZ																			
B4241ZZ																			
B4281ZZ																			
B42C1ZZ																			
B5181ZA																			
B518YZA																			
B518ZZA																			
B5191ZA																			
B5191ZZ																			
B519ZZA																			
B519ZZZ																			
B51GZZA																			
B51W1ZZ																			
B543ZZA																			
B544ZZA																			
B546ZZA																			
B548ZZA																			
B549ZZA																			
B54BZZA																			
B54CZZA																			
B54MZZA																			
B54NZZA																			
BD12ZZZ																			
BF45ZZZ																			
BR101ZZ																			
BR10ZZZ																			
BR11ZZZ																			
BR12ZZZ																			
BR131ZZ																			
BR14ZZZ																			
BR16ZZZ																			
BR171ZZ																			
BR17YZZ																			
BR17ZZZ																			
BR191ZZ																			
BR19ZZZ																			
BR1BZZZ																			
BR1CZZZ																			
BR29ZZZ																			
BR30Y0Z																			
BR30ZZZ																			
BR37Y0Z																			
BR37YZZ																			
BR37ZZZ																			
BR39Y0Z																			
BR39ZZZ																			
BR47ZZZ																			
BT1D1ZZ																			
BW191ZZ																			
BW21ZZZ																			
BW241ZZ																			
D0061ZZ																			
D0063Z0																			
D020JZZ																			
DBY27ZZ																			
DPYC7ZZ																			
F06ZDZZ																			
F07L1ZZ																			
F07Z5FZ																			
F07Z5ZZ																			
F07Z9FZ																			
F07Z9ZZ																			
F08D5ZZ																			
F08Z1FZ																			
F08Z2ZZ																			
F08Z4FZ																			
F08Z4ZZ																			
F08Z7ZZ																			
HZ2ZZZZ																			
XNU0356																			
XNU4356																			
XW013S6																			
XW023S6																			
XW03372																			
XW033E5																			
XW043C6																			
XW043E5																			
XW13325																			
