| 
                   0000 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   None Established (No Medical Evidence in File) 
                  
                | 
               
            
            
               
               | 
                   0110 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Pulmonary Tuberculosis 
                  
                | 
               
            
            
               
               | 
                   0420 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer Treated by Bone Marrow or Stem Cell Transplantation 
                  
                | 
               
            
            
               
               | 
                   0430 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Symptomatic Human Immunodeficiency Virus (HIV) Infection 
                  
                | 
               
            
            
               
               | 
                   0440 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Asymptomatic Human Immunodeficiency Virus (HIV) Infection 
                  
                | 
               
            
            
               
               | 
                   0460 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Progressive Multifocal Leukoencephalopathy 
                  
                | 
               
            
            
               
               | 
                   0930 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Cardiovascular Syphilis 
                  
                | 
               
            
            
               
               | 
                   1170 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Chronic Infections of the Skin or Mucous Membranes 
                  
                | 
               
            
            
               
               | 
                   1180 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Mycotic (Fungal) Infections 
                  
                | 
               
            
            
               
               | 
                   1350 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Sarcoidosis 
                  
                | 
               
            
            
               
               | 
                   1380 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Post-polio Syndrome 
                  
                | 
               
            
            
               
               | 
                   1390 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Opportunistic Infections Associated with HIV Infection 
                  
                | 
               
            
            
               
               | 
                   1410 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Tongue 
                  
                | 
               
            
            
               
               | 
                   1420 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Salivary Glands 
                  
                | 
               
            
            
               
               | 
                   1500 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Esophagus 
                  
                | 
               
            
            
               
               | 
                   1510 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Stomach 
                  
                | 
               
            
            
               
               | 
                   1520 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Small Intestine, Including Duodenum 
                  
                | 
               
            
            
               
               | 
                   1530 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Colon, Rectum or Anus 
                  
                | 
               
            
            
               
               | 
                   1550 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Liver and Intrahepatic Bile Ducts 
                  
                | 
               
            
            
               
               | 
                   1560 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Gallbladder and Extrahepatic Bile Ducts 
                  
                | 
               
            
            
               
               | 
                   1570 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Pancreas 
                  
                | 
               
            
            
               
               | 
                   1590 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Other and Ill-Defined Sites Within the Digestive Organs and Peritoneum (Abdomen) 
                  
                | 
               
            
            
               
               | 
                   1620 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Trachea, Bronchus, or Lung 
                  
                | 
               
            
            
               
               | 
                   1630 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Pleura 
                  
                | 
               
            
            
               
               | 
                   1640 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Mediastinum 
                  
                | 
               
            
            
               
               | 
                   1700 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Maxilla, Orbit, or Temporal Fossa 
                  
                | 
               
            
            
               
               | 
                   1710 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Connective and Other Soft Tissue 
                  
                | 
               
            
            
               
               | 
                   1720 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Malignant Melanoma 
                  
                | 
               
            
            
               
               | 
                   1730 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Skin 
                  
                | 
               
            
            
               
               | 
                   1740 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Breast 
                  
                | 
               
            
            
               
               | 
                   1760 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Pulmonary Kaposi Sarcoma 
                  
                | 
               
            
            
               
               | 
                   1780 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Skeletal System 
                  
                | 
               
            
            
               
               | 
                   1790 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Uterus 
                  
                | 
               
            
            
               
               | 
                   1800 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Carcinoma of the Cervix 
                  
                | 
               
            
            
               
               | 
                   1830 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Ovary and Other Uterine Adnexa 
                  
                | 
               
            
            
               
               | 
                   1840 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Vulva or Vagina 
                  
                | 
               
            
            
               
               | 
                   1850 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Prostate 
                  
                | 
               
            
            
               
               | 
                   1860 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Testis 
                  
                | 
               
            
            
               
               | 
                   1870 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Penis 
                  
                | 
               
            
            
               
               | 
                   1880 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Bladder 
                  
                | 
               
            
            
               
               | 
                   1890 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Kidney, Adrenal Glands, or Ureters 
                  
                | 
               
            
            
               
               | 
                   1900 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Eye 
                  
                | 
               
            
            
               
               | 
                   1910 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Nervous System 
                  
                | 
               
            
            
               
               | 
                   1920 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Neuroblastoma 
                  
                | 
               
            
            
               
               | 
                   1930 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Thyroid Gland 
                  
                | 
               
            
            
               
               | 
                   1940 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Other Endocrine Glands and Related Structures 
                  
                | 
               
            
            
               
               | 
                   1950 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Soft Tissue Tumors of Head and Neck 
                  
                | 
               
            
            
               
               | 
                   1980 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Metastatic Cancer from Unknown Primary Site 
                  
                | 
               
            
            
               
               | 
                   1990 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Unspecified Site 
                  
                | 
               
            
            
               
               | 
                   2000 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Primary Effusion Lymphoma 
                  
                | 
               
            
            
               
               | 
                   2020 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Lymphoma 
                  
                | 
               
            
            
               
               | 
                   2030 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Multiple Myeloma 
                  
                | 
               
            
            
               
               | 
                   2070 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Leukemia 
                  
                | 
               
            
            
               
               | 
                   2250 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Benign Neoplasm of Brain and Other Parts of Nervous System 
                  
                | 
               
            
            
               
               | 
                   2380 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Multicentric Castleman Disease 
                  
                | 
               
            
            
               
               | 
                   2390 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Cancer of Unspecified or Unknown Nature 
                  
                | 
               
            
            
               
               | 
                   2460 
                  
                | 
               
               
                   09 
                  
                | 
               
               
                   All Disorders of Thyroid Gland (Except Cancer) 
                  
                | 
               
            
            
               
               | 
                   2480 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Diagnosis Established – No Predetermined List Code of Medical Nature Applicable 
                  
                | 
               
            
            
               
               | 
                   2500 
                  
                | 
               
               
                   09 
                  
                | 
               
               
                   Diabetes Mellitus 
                  
                | 
               
            
            
               
               | 
                   2520 
                  
                | 
               
               
                   09 
                  
                | 
               
               
                   All Disorders of Parathyroid Gland (Except Cancer) 
                  
                | 
               
            
            
               
               | 
                   2530 
                  
                | 
               
               
                   09 
                  
                | 
               
               
                   All Disorders of Pituitary Gland (Except Cancer) 
                  
                | 
               
            
            
               
               | 
                   2550 
                  
                | 
               
               
                   09 
                  
                | 
               
               
                   All Disorders of Adrenal Glands (Except Cancer) 
                  
                | 
               
            
            
               
               | 
                   2630 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Growth Failure Due to Any Digestive Disorder 
                  
                | 
               
            
            
               
               | 
                   2630 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   HIV Wasting Syndrome (Secondary Diagnosis for HIV-0430) 
                  
                | 
               
            
            
               
               | 
                   2720 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Hyperlipidemia 
                  
                | 
               
            
            
               
               | 
                   2730 
                  
                | 
               
               
                   13 
                  
                | 
               
               
                   Macroglobulinemia or Heavy Chain Disease 
                  
                | 
               
            
            
               
               | 
                   2740 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Gout 
                  
                | 
               
            
            
               
               | 
                   2770 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Cystic Fibrosis 
                  
                | 
               
            
            
               
               | 
                   2780 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Obesity 
                  
                | 
               
            
            
               
               | 
                   2820 
                  
                | 
               
               
                   07 
                  
                | 
               
               
                   Hemolytic Anemias (Including Sickle Cell Thalassemia, and Variants) 
                  
                | 
               
            
            
               
               | 
                   2840 
                  
                | 
               
               
                   07 
                  
                | 
               
               
                   Hematological Disorders with Bone Marrow/Stem Cell Transplantation 
                  
                | 
               
            
            
               
               | 
                   2850 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Pulmonary Lymphoid Hyperplasia (PLH) 
                  
                | 
               
            
            
               
               | 
                   2860 
                  
                | 
               
               
                   07 
                  
                | 
               
               
                   Thrombosis and Hemostasis Disorder (Including Hemophilia) 
                  
                | 
               
            
            
               
               | 
                   2890 
                  
                | 
               
               
                   07 
                  
                | 
               
               
                   Bone Marrow Failure (Including Myelofibrosis and Granulocytopenia) 
                  
                | 
               
            
            
               
               | 
                   2940 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Neurocognitive Disorders 
                  
                | 
               
            
            
               
               | 
                   2950 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Schizophrenic, Paranoid and Other Psychotic Disorders 
                  
                | 
               
            
            
               
               | 
                   2960 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Depressive, Bipolar and Related Disorders 
                  
                | 
               
            
            
               
               | 
                   2990 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Autism Spectrum Disorders 
                  
                | 
               
            
            
               
               | 
                   3000 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Anxiety and Obsessive-Compulsive Disorders 
                  
                | 
               
            
            
               
               | 
                   3010 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Personality Disorders 
                  
                | 
               
            
            
               
               | 
                   3030 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Substance Addiction Disorders (Alcohol) 
                  
                | 
               
            
            
               
               | 
                   3040 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Substance Addiction Disorders (Drugs) 
                  
                | 
               
            
            
               
               | 
                   3060 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Somatic Symptom Disorders 
                  
                | 
               
            
            
               
               | 
                   3070 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Eating Disorders 
                  
                | 
               
            
            
               
               | 
                   3090 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Trauma- and Stress-Related Disorders 
                  
                | 
               
            
            
               
               | 
                   3120 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Impulse Control Disorders 
                  
                | 
               
            
            
               
               | 
                   3138 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Oppositional Defiant Disorder 
                  
                | 
               
            
            
               
               | 
                   3140 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Attention Deficit/Hyperactivity Disorder 
                  
                | 
               
            
            
               
               | 
                   3150 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Development and Emotional Disorders of Infants and Toddlers 
                  
                | 
               
            
            
               
               | 
                   3152 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Learning Disorder 
                  
                | 
               
            
            
               
               | 
                   3153 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Speech and Language Impairment 
                  
                | 
               
            
            
               
               | 
                   3180 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Intellectual Disorder 
                  
                | 
               
            
            
               
               | 
                   3195 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Borderline Intellectual Functioning 
                  
                | 
               
            
            
               
               | 
                   3210 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Arachnoiditis 
                  
                | 
               
            
            
               
               | 
                   3220 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Meningitis 
                  
                | 
               
            
            
               
               | 
                   3250 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Lung Transplant 
                  
                | 
               
            
            
               
               | 
                   3300 
                  
                | 
               
               
                   10 
                  
                | 
               
               
                   Cerebral Degenerations Usually Manifest in Childhood 
                  
                | 
               
            
            
               
               | 
                   3300 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Cerebral Degenerations Usually Manifest in Childhood 
                  
                | 
               
            
            
               
               | 
                   3310 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Cerebral Degenerations 
                  
                | 
               
            
            
               
               | 
                   3320 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Parkinson's Disease 
                  
                | 
               
            
            
               
               | 
                   3330 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Huntington Disease 
                  
                | 
               
            
            
               
               | 
                   3350 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Amyotrophic Lateral Sclerosis 
                  
                | 
               
            
            
               
               | 
                   3358 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Motor Neuron Disorders Other than ALS 
                  
                | 
               
            
            
               
               | 
                   3360 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Spinal Cord Disorders 
                  
                | 
               
            
            
               
               | 
                   3370 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Disorders of Autonomic Nervous System 
                  
                | 
               
            
            
               
               | 
                   3400 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Multiple Sclerosis 
                  
                | 
               
            
            
               
               | 
                   3430 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Cerebral Palsy 
                  
                | 
               
            
            
               
               | 
                   3450 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Epilepsy 
                  
                | 
               
            
            
               
               | 
                   3460 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Primary Headache Disorder (Including Migraine) 
                  
                | 
               
            
            
               
               | 
                   3480 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Coma or Persistent Vegetative State 
                  
                | 
               
            
            
               
               | 
                   3490 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Other Disorders of the Nervous System 
                  
                | 
               
            
            
               
               | 
                   3540 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Carpal Tunnel Syndrome 
                  
                | 
               
            
            
               
               | 
                   3570 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Peripheral Neuropathy 
                  
                | 
               
            
            
               
               | 
                   3580 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Myoneural Disorders 
                  
                | 
               
            
            
               
               | 
                   3590 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Muscular Dystrophies and Other Myopathies 
                  
                | 
               
            
            
               
               | 
                   3610 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Retinal Detachments and Defects 
                  
                | 
               
            
            
               
               | 
                   3620 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Other Retinal Disorders (Including Diabetic Retinopathy) 
                  
                | 
               
            
            
               
               | 
                   3650 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Glaucoma 
                  
                | 
               
            
            
               
               | 
                   3660 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Cataract 
                  
                | 
               
            
            
               
               | 
                   3680 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Visual Disturbances 
                  
                | 
               
            
            
               
               | 
                   3690 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Low Vision 
                  
                | 
               
            
            
               
               | 
                   3694 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Statutory Blindness 
                  
                | 
               
            
            
               
               | 
                   3750 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Heart Transplant 
                  
                | 
               
            
            
               
               | 
                   3780 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Strabismus and Other Disorders of Eye Movements 
                  
                | 
               
            
            
               
               | 
                   3860 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Disorders of Vestibular System 
                  
                | 
               
            
            
               
               | 
                   3880 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Other Disorders of Ear 
                  
                | 
               
            
            
               
               | 
                   3890 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Hearing Loss Not Treated with Cochlear Implantation 
                  
                | 
               
            
            
               
               | 
                   3910 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Acute Rheumatic Heart Disease 
                  
                | 
               
            
            
               
               | 
                   3950 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Diseases of Aortic Valve 
                  
                | 
               
            
            
               
               | 
                   3980 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Chronic Rheumatic Heart Disease 
                  
                | 
               
            
            
               
               | 
                   4010 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Essential Hypertension 
                  
                | 
               
            
            
               
               | 
                   4020 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Hypertensive Cardiovascular Disease 
                  
                | 
               
            
            
               
               | 
                   4030 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Hypertensive Vascular and Renal Disease 
                  
                | 
               
            
            
               
               | 
                   4100 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Acute Myocardial Infarction 
                  
                | 
               
            
            
               
               | 
                   4130 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Angina Pectoris Without Ischemic Heart Disease 
                  
                | 
               
            
            
               
               | 
                   4140 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Chronic Ischemic Heart Disease With or Without Angina 
                  
                | 
               
            
            
               
               | 
                   4160 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Chronic Pulmonary Hypertension 
                  
                | 
               
            
            
               
               | 
                   4160 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Chronic Pulmonary Hypertension 
                  
                | 
               
            
            
               
               | 
                   4240 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Valvular Heart Disease or Other Stenotic Defects or Valvular Regurgitation 
                  
                | 
               
            
            
               
               | 
                   4240 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Valvular Heart Disease or Other Stenotic Defects or Valvular Regurgitation 
                  
                | 
               
            
            
               
               | 
                   4250 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Cardiomyopathy 
                  
                | 
               
            
            
               
               | 
                   4270 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Cardiac Dysrhythmias (Arrhythmias) 
                  
                | 
               
            
            
               
               | 
                   4280 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Heart Failure 
                  
                | 
               
            
            
               
               | 
                   4380 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Vascular Insult to the Brain 
                  
                | 
               
            
            
               
               | 
                   4410 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Aneurysm of Aorta or Major Branches 
                  
                | 
               
            
            
               
               | 
                   4430 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Peripheral Vascular (Arterial) Disease 
                  
                | 
               
            
            
               
               | 
                   4460 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Systemic Vasculitis (Periarteritis Nodosa and Allied Conditions) 
                  
                | 
               
            
            
               
               | 
                   4510 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Phlebitis and Thrombophlebitis 
                  
                | 
               
            
            
               
               | 
                   4540 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Varicose Veins of Lower Extremities 
                  
                | 
               
            
            
               
               | 
                   4590 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Other Diseases of Circulatory System (Venous Insufficiency) 
                  
                | 
               
            
            
               
               | 
                   4690 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Small Intestine Transplantation 
                  
                | 
               
            
            
               
               | 
                   4750 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Liver Transplantation 
                  
                | 
               
            
            
               
               | 
                   4860 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Pneumonia 
                  
                | 
               
            
            
               
               | 
                   4910 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Chronic Bronchitis 
                  
                | 
               
            
            
               
               | 
                   4920 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Emphysema 
                  
                | 
               
            
            
               
               | 
                   4930 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Asthma 
                  
                | 
               
            
            
               
               | 
                   4940 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Bronchiectasis 
                  
                | 
               
            
            
               
               | 
                   4960 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Chronic Respiratory Disorders 
                  
                | 
               
            
            
               
               | 
                   5010 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Asbestosis 
                  
                | 
               
            
            
               
               | 
                   5050 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Pneumoconiosis 
                  
                | 
               
            
            
               
               | 
                   5160 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Lymphoid Interstitial Pneumonia (LIP) 
                  
                | 
               
            
            
               
               | 
                   5180 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Respiratory Failure 
                  
                | 
               
            
            
               
               | 
                   5190 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Other Disorders of the Respiratory System 
                  
                | 
               
            
            
               
               | 
                   5280 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Pancreas Transplantation 
                  
                | 
               
            
            
               
               | 
                   5300 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Diseases of Esophagus 
                  
                | 
               
            
            
               
               | 
                   5330 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Peptic Ulcer (Gastric or Duodenal) 
                  
                | 
               
            
            
               
               | 
                   5350 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Gastritis and Duodenitis 
                  
                | 
               
            
            
               
               | 
                   5530 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Hernias 
                  
                | 
               
            
            
               
               | 
                   5550 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Inflammatory Bowel Disease (IBD) 
                  
                | 
               
            
            
               
               | 
                   5690 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Other Disorders of Gastrointestinal System 
                  
                | 
               
            
            
               
               | 
                   5710 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Chronic Liver Disease 
                  
                | 
               
            
            
               
               | 
                   5780 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Gastrointestinal Hemorrhage 
                  
                | 
               
            
            
               
               | 
                   5793 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Intestinal Failure 
                  
                | 
               
            
            
               
               | 
                   5799 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Need for Supplemental Daily Enteral Feeding via Gastrostomy, Duodenostomy, or Jejunostomy
                     (Under Age 3)
                   
                  
                | 
               
            
            
               
               | 
                   5810 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Nephrotic Syndrome 
                  
                | 
               
            
            
               
               | 
                   5830 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Complications of Chronic Kidney Disease 
                  
                | 
               
            
            
               
               | 
                   5850 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Chronic Kidney Disease with Dialysis 
                  
                | 
               
            
            
               
               | 
                   5880 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Chronic Kidney Disease 
                  
                | 
               
            
            
               
               | 
                   5950 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Interstitial Cystitis 
                  
                | 
               
            
            
               
               | 
                   5990 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Other Disorders of the Urinary Tract 
                  
                | 
               
            
            
               
               | 
                   6080 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Disorders of the Male Genital Organs 
                  
                | 
               
            
            
               
               | 
                   6290 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Disorders of the Female Genital Organs 
                  
                | 
               
            
            
               
               | 
                   6490 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   None Established (Medical Evidence in File But Insufficient to Establish Diagnosis) 
                  
                | 
               
            
            
               
               | 
                   6940 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Bullous Disease 
                  
                | 
               
            
            
               
               | 
                   6950 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Ichthyosis 
                  
                | 
               
            
            
               
               | 
                   6960 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Dermatitis 
                  
                | 
               
            
            
               
               | 
                   7050 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Hidradenitis Suppurativa 
                  
                | 
               
            
            
               
               | 
                   7090 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Other Disorders of the Skin and Subcutaneous Tissues 
                  
                | 
               
            
            
               
               | 
                   7100 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Diffuse Diseases of Connective Tissue (Including Systemic Lupus Erythematosus, Systemic
                     Sclerosis (Scleroderma), Polymyositis and Dermatomyositis, Undifferentiated and Mixed
                     Connective Tissue Disease, Sjögren’s Syndrome)
                   
                  
                | 
               
            
            
               
               | 
                   7140 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Inflammatory Arthritis 
                  
                | 
               
            
            
               
               | 
                   7150 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Osteoarthrosis and Allied Disorders 
                  
                | 
               
            
            
               
               | 
                   7160 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Other and Unspecified Arthropathies 
                  
                | 
               
            
            
               
               | 
                   7200 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Ankylosing Spondylitis or Other Spondyloarthropathies 
                  
                | 
               
            
            
               
               | 
                   7210 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Lumbar Spinal Stenosis 
                  
                | 
               
            
            
               
               | 
                   7240 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Disorders of the Skeletal Spine 
                  
                | 
               
            
            
               
               | 
                   7280 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Disorders of Muscle, Ligament and Fascia 
                  
                | 
               
            
            
               
               | 
                   7300 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Osteomyelitis, Periostitis and Other Infections Involving Bone 
                  
                | 
               
            
            
               
               | 
                   7330 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Other Disorders of Bone and Cartilage (Osteoporosis) 
                  
                | 
               
            
            
               
               | 
                   7370 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Curvature of Spine 
                  
                | 
               
            
            
               
               | 
                   7400 
                  
                | 
               
               
                   10 
                  
                | 
               
               
                   Anencephalus and Catastrophic Congenital Abnormality or Disease 
                  
                | 
               
            
            
               
               | 
                   7410 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Spina Bifida (Meningomyelocele) 
                  
                | 
               
            
            
               
               | 
                   7420 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Microcephaly 
                  
                | 
               
            
            
               
               | 
                   7460 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Symptomatic Congenital Heart Disease 
                  
                | 
               
            
            
               
               | 
                   7500 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Congenital Anomalies of Upper Alimentary Tract 
                  
                | 
               
            
            
               
               | 
                   7530 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Congenital Anomalies of Urinary System 
                  
                | 
               
            
            
               
               | 
                   7590 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Genetic Photosensitivity Disorders 
                  
                | 
               
            
            
               
               | 
                   7580 
                  
                | 
               
               
                   10 
                  
                | 
               
               
                   Down Syndrome 
                  
                | 
               
            
            
               
               | 
                   7590 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Other Congenital Anomalies 
                  
                | 
               
            
            
               
               | 
                   7649 
                  
                | 
               
               
                   19 
                  
                | 
               
               
                   Low Birth Weight – Weight 1200 - 2000 grams 
                  
                | 
               
            
            
               
               | 
                   7650 
                  
                | 
               
               
                   19 
                  
                | 
               
               
                   Low Birth Weight – Weight under 1200 grams 
                  
                | 
               
            
            
               
               | 
                   7800 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Sleep-Related Breathing Disorders 
                  
                | 
               
            
            
               
               | 
                   7810 
                  
                | 
               
               
                   12 
                  
                | 
               
               
                   Tic Disorders 
                  
                | 
               
            
            
               
               | 
                   7830 
                  
                | 
               
               
                   19 
                  
                | 
               
               
                   Failure to Thrive (Growth Disorder) 
                  
                | 
               
            
            
               
               | 
                   7840 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Speech Disorder 
                  
                | 
               
            
            
               
               | 
                   7840 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Speech Disorder 
                  
                | 
               
            
            
               
               | 
                   7850 
                  
                | 
               
               
                   04 
                  
                | 
               
               
                   Growth Failure Due to Any Chronic Cardiovascular Disorder 
                  
                | 
               
            
            
               
               | 
                   7860 
                  
                | 
               
               
                   03 
                  
                | 
               
               
                   Growth Failure Due to Any Chronic Respiratory Disorder 
                  
                | 
               
            
            
               
               | 
                   7870 
                  
                | 
               
               
                   05 
                  
                | 
               
               
                   Growth Failure Due to Any Digestive Disorder 
                  
                | 
               
            
            
               
               | 
                   7880 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Growth Failure Due to Any Chronic Renal Disease 
                  
                | 
               
            
            
               
               | 
                   7950 
                  
                | 
               
               
                   14 
                  
                | 
               
               
                   Absolute CD4 Count 50 or Less 
                  
                | 
               
            
            
               
               | 
                   7960 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Disabling Impairment Previously Established – Current Evidence Insufficient to Establish
                     Impairment
                   
                  
                | 
               
            
            
               
               | 
                   8030 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Fracture of Skull Without Intracranial Injury 
                  
                | 
               
            
            
               
               | 
                   8060 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Fracture of Vertebral Column with Spinal Cord Lesion 
                  
                | 
               
            
            
               
               | 
                   8180 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Fractures of Upper Limb 
                  
                | 
               
            
            
               
               | 
                   8270 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Fractures of Lower Limb 
                  
                | 
               
            
            
               
               | 
                   8290 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Other Fractures of Bones 
                  
                | 
               
            
            
               
               | 
                   8390 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Dislocations – All Types 
                  
                | 
               
            
            
               
               | 
                   8480 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Sprains and Strains – All Types 
                  
                | 
               
            
            
               
               | 
                   8540 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Traumatic Brain Injury 
                  
                | 
               
            
            
               
               | 
                   8690 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Internal Injury 
                  
                | 
               
            
            
               
               | 
                   8790 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Other Open Wounds, Except Limbs 
                  
                | 
               
            
            
               
               | 
                   8840 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Open Wound of Upper Limb (Soft Tissue Injury) 
                  
                | 
               
            
            
               
               | 
                   8940 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Open Wound of Lower Limb (Soft Tissue Injury) 
                  
                | 
               
            
            
               
               | 
                   9050 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Amputation Due to Any Cause 
                  
                | 
               
            
            
               
               | 
                   9070 
                  
                | 
               
               
                   11 
                  
                | 
               
               
                   Late Effects of Injuries to the Nervous System 
                  
                | 
               
            
            
               
               | 
                   9330 
                  
                | 
               
               
                   20 
                  
                | 
               
               
                   Chronic Fatigue Syndrome 
                  
                | 
               
            
            
               
               | 
                   9480 
                  
                | 
               
               
                   08 
                  
                | 
               
               
                   Burns 
                  
                | 
               
            
            
               
               | 
                   9490 
                  
                | 
               
               
                   01 
                  
                | 
               
               
                   Burns (NOS) 
                  
                | 
               
            
            
               
               | 
                   9620 
                  
                | 
               
               
                   02 
                  
                | 
               
               
                   Hearing Loss Treated with Cochlear Implantation 
                  
                | 
               
            
            
               
               | 
                   9960 
                  
                | 
               
               
                   06 
                  
                | 
               
               
                   Kidney Transplant 
                  
                |