10.8.A. - CYTALUX® (ovarian) 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-CM Codes		ICD-10-PCS Codes															
C563		0UB00ZZ															
C7963		0UB10ZZ															
C561		0UB20ZZ															
C562		0UB40ZZ															
C569		0UB50ZZ															
C5700		0UB60ZZ															
C5701		0UB70ZZ															
C5702		0UB90ZZ															
C7960		0UBF0ZZ															
C7961		0UT00ZZ															
C7962		0UT10ZZ															
C7982		0UT20ZZ															
D0739		0UT50ZZ															
D3910		0UT60ZZ															
D3911		0UT70ZZ															
D3912		0UT40ZZ															
D398		0UT90ZL															
		0UT90ZZ															
