| Code | Description |
|---|---|
| Numeric TOS Codes (0-9) | |
| 0 | Whole Blood |
| 1 | Medical Care |
| 2 | Surgery |
| 3 | Consultation |
| 4 | Diagnostic Radiology |
| 5 | Diagnostic Laboratory |
| 6 | Therapeutic Radiology |
| 7 | Anesthesia |
| 8 | Assistant at Surgery |
| 9 | Other Medical Items or Services |
| Alphabetic TOS Codes (A-W) | |
| A | Used Durable Medical Equipment (DME) |
| B | High-Risk Screening Mammography |
| C | Low-Risk Screening Mammography |
| D | Ambulance |
| E | Enteral/Parenteral Nutrients/Supplies |
| F | Ambulatory Surgical Center |
| G | Immunosuppressive Drugs |
| H | Hospice |
| J | Diabetic Shoes |
| K | Hearing Items and Services |
| L | End-Stage Renal Disease (ESRD) Supplies |
| M | Monthly Capitation Payment for Dialysis |
| N | Kidney Donor |
| P | Lump-Sum Purchase of DME, Prosthetics, or Orthotics |
| Q | Vision Items or Services |
| R | Rental of Durable Medical Equipment (DME) |
| S | Surgical Dressings or Other Medical Supplies |
| T | Outpatient Mental Health Treatment Limitation |
| U | Occupational Therapy |
| V | Pneumococcal/Flu Vaccine |
| W | Physical Therapy |
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