0

Blood

1

Medical Services

2

Surgery

3

Consultations

4

Radiology (total component)

5

Laboratory (total component)

6

Radiation Therapy (total component)

7

Anesthesia

8

Assistant surgery

9

Other (e.g., prosthetic eyewear, contacts, ambulance)

C

Home health services

D

TB clinic

E

Eyeglasses

F

Ambulatory surgical center (ASC)/hospital-based ambulatory surgical center (HASC)

G

Genetics

I

Professional component for radiology, laboratory, or radiation therapy

J

DME purchase new

L

DME rental

R

Hearing aid

S

THSteps medical

T

Technical component for radiology, laboratory, or radiation therapy

W

THSteps dental