| A9270 | Non-covered item or service |
| S5165 | Home modifications; per service |
| H0022 | Alcohol and/or drug intervention service (planned facilitation) |
| A0999 | Unlisted ambulance service |
| S9986 | Not medically necessary service (patient is aware that service not medically necessary) |
| T2038 | Community transition, waiver; per service |
| A0394 | Als specialized service disposable supplies; iv drug therapy |
| H1005 | Prenatal care, at-risk enhanced service package (includes h1001-h1004) |
| H0030 | Behavioral health hotline service |
| H0032 | Mental health service plan development by non-physician |
| S0207 | Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport |
| S0208 | Paramedic intercept, hospital-based als service (non-voluntary), non-transport |
| S5035 | Home infusion therapy, routine service of infusion device (e.g., pump maintenance) |
| T2039 | Vehicle modifications, waiver; per service |
| T2024 | Service assessment/plan of care development, waiver |
