To Date Policy - PDF document

From - To Date Policy Page 1 of
From - To Date Policy Page 1 of 9 UnitedHealthcare Oxford Reimbursement Policy Effective 11/09/2020 ©1996-2020 Oxford Health Plans, LLC FROM – TO DATE POLICY Policy Number: ADMINISTRATIVE 223.29 T0 Effective Date: November 9, 2020 Table of Contents Page INSTRUCTIONS FOR USE .......................................... 1 APPLICABLE LINES OF BUSINESS/PRODUCTS .............. 1 APPLICATION .......................................................... 1 OVERVIEW .............................................................. 1 REIMBURSEMENT GUIDELINES .................................. 2 DEFINITIONS .......................................................... 2 QUESTIONS AND ANSWERS ...................................... 3 APPLICABLE CODES ................................................. 3 REFERENCES ........................................................... 9 POLICY HISTORY/REVISION INFORMATION ................. 9 INSTRUCTIONS FOR USE The services described in Oxford policies are subject to the terms, conditions and limitations of the member's contract or certificate. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage members. Oxford reserves the right, in its sole discretion, to modify policies as necessary without prior written notice unless otherwise required by Oxford's administrative procedures or applicable state law. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies. Certain policies may not be applicable to Self-Funded members and certain insured products. Refer to the member specific benefit plan document or Certificate of Coverage to determine whether coverage is provided or if there are any exclusions or benefit limitations applicable to any of these policies. If there is a difference between any policy and the member specific benefit plan document or Certificate of Coverage, the member specific benefit plan document or Certificate of Coverage will govern. UnitedHealthcare may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice. APPLICABLE LINES OF BUSINESS/PRODUCTS This policy applies to Oxford Commercial plan membership. APPLICATION This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. With the exception of home health care, home infusion, durable medical equipment, orthotics and prosthetics suppliers, due to their monthly billing requirements unless the code description for the service or supply indicates it should be reported only once daily, this policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other health care professionals. This policy also does not apply to Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes reported for time based anesthesia services, codes with a time span in their description, unlisted codes, global maternity codes, drugs, and ambulance mileage. OVERVIEW When Grouping services, the place of service, procedure code, charges, and individual provider for each line must be identical for that service line. Grouping is allowed only for identical services on consecutive days. In those instances Related Policies None UnitedHealthcare® Oxford Reimbursement Policy From - To Date Policy Page 2 of 9 UnitedHealthcare Oxford Reimbursement Policy Effective 11/09/2020 ©1996-2020 Oxford Health Plans, LLC where Grouping of serv

ices applies, the number of units su
ices applies, the number of units submitted should be equally divided by the number of days indicated in the 'from' and 'to' dates reported. REIMBURSEMENT GUIDELINES The National Uniform Claim Committee (NUCC) develops and oversees the NUCC Data Set (NUCC-DS), which is a standardized data set for use in an electronic environment, but applicable to and consistent with evolving paper claim form standards. The NUCC 1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12 provides instruction for the completion of the 1500 Health Insurance Claim form. This manual includes the following instruction for entering the dates of service: • "If there is only one date of service, enter that date under 'From'. Leave 'To' blank or re-enter 'From' date." • "If Grouping services, the place of service, procedure code, charges, and individual provider for each line must be identical for that service line. Grouping is allowed only for services on consecutive days. The number of days must correspond to the number of units in 24G. The Centers for Medicare and Medicaid Services (CMS) Medicare Claims Processing Manual Chapter 26, also states: "When 'from' and 'to' dates are shown for a series of identical services, enter the number of days or units in column G." CMS returns a claim as unprocessable if a date of service extends more than 1 day and a valid "to" date is not present. Consistent with NUCC and CMS, Oxford will only consider reimbursement for claim lines, with a 'from' and 'to' date span greater than one day, when the units entered correspond or are equally divisible to the number of days indicated. Claim lines for which the 'from' and 'to' dates and units do not correspond, or are not equally divisible by the number of days indicated, will not be processed. The services will need to be resubmitted on separate claim form lines with the units matching the corresponding from and to dates. An example of a claim form submission where the service dates cannot be determined and therefore the claim cannot be processed: Code Modifier Units From Date To Date 99213 - 3 02/10/2009 03/19/2009 The claim should be submitted as follows: Code Modifier Units From Date To Date 99213 - 1 02/10/2009 02/10/2009 99213 - 1 02/25/2009 02/25/2009 99213 - 1 03/19/2009 03/19/2009 Oxford recognizes there are exceptions to this policy based on the uniqueness of some CPT and HCPCS codes reported for services rendered. The following types of services are exempt from this policy: • Certain CPT® and HCPCS codes, based on their description, are not intended to be reported on consecutive dates of service, but may be appropriate to report with a 'from' and 'to' date. For example, codes whose descriptions say per week, per month, per course of treatment would be considered exceptions to this policy. • Codes that represent drugs or contrast and radiopharmaceutical imaging materials • Global maternity codes. • Time based anesthesia codes • Unlisted codes For a complete list of codes exempt from this policy, refer to the Applicable Codes below. As stated in the Application section of this policy, home health care, home infusion, durable medical equipment, orthotics and prosthetics suppliers are excluded from this policy unless they report a code that by description indicates it should be reported only once daily. For example, HCPCS code S9328 describes services that would be reported once per day, therefore, units billed should correspond to ‘from’ and ‘to’ dates. Refer to the Applicable Codes section below for a listing of codes that describe ‘per diem’ or ‘per day’ services that are not excluded from this policy when billed by home health care, home infusion, durable medical equipment, orthotics and prosthetics suppliers. DEFINITIONS Grouping: Grouping refers to the reporting of services which share a procedure code, place of service, charge and individual provider. The serv

ices must have been provided on consecut
ices must have been provided on consecutive days and the number of days must correspond to the number of units reported in field 24G of the 1500 Health Insurance Claim Form. From - To Date Policy Page 3 of 9 UnitedHealthcare Oxford Reimbursement Policy Effective 11/09/2020 ©1996-2020 Oxford Health Plans, LLC QUESTIONS AND ANSWERS 1 Q: What fields on the 1500 claim form are you referencing for the "Days or Units" and "From” and "To" date? A: These claim form fields on the 1500 claim form are identified as follows: • Paper Claims with CMS Paper Format 02-12: The "From" and "To" dates are entered in 24A DATE(S) OF SERVICE field. "Days or Units" are entered in field 24G DAYS OR UNITS field for each applicable service line. For additional information, refer to the National Uniform Correct Coding (NUCC) Website: www.nucc.org. • Electronic Claims: Reference the Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines, electronic claims submitted via the 837 Professional transaction set or the NUCC website, which provides a 1500-837p crosswalk. APPLICABLE CODES CPT/HCPCS Codes From - To Policy Exceptions: Services exempt from this policy 0295T 0296T 0297T 0298T 0329T 0378T 0379T 0381T 0382T 0383T 0384T 0385T 0386T 0405T 0436T 0533T 0534T 0535T 0536T 0578T 0579T 15999 17999 19499 20999 21089 21299 21499 21899 22899 22999 23929 24999 25999 26989 27299 27599 27899 28899 29799 29999 30999 31299 31599 31899 32701 32999 33530 33999 36299 37501 37799 38129 38589 38999 39499 39599 40799 40899 41599 41899 42299 42699 42999 43289 43499 43659 43999 44238 44799 44899 44979 45399 45499 45999 46999 47379 47399 47579 47999 48999 49329 49659 49999 50549 50949 51999 53899 54699 55559 55899 58578 58579 58679 58999 59400 59410 59425 59426 59430 59510 59515 59610 59614 59618 59622 59897 59898 59899 60659 60699 61796 61797 61798 61799 62263 63198 63199 63620 63621 64999 66762 66821 66840 66999 67031 67141 67145 67208 67210 67218 67220 67229 67299 67399 67599 67999 68399 68899 69399 69799 69949 69979 76496 76497 76498 76499 76999 77299 77336 77338 77373 77399 77417 77427 77431 77435 77470 77499 77799 78099 78199 78299 78399 78499 78599 78699 78799 78804 78831 78832 78999 79999 80420 81099 81479 81599 83840 84999 85999 86486 86849 86999 87999 88099 88199 88299 88399 88749 89240 89342 89343 89344 89346 89398 90399 90749 90867 90899 90951 90952 90953 90954 90955 90956 90957 90958 90959 90960 90961 90962 90963 90964 90965 90966 90999 91299 92499 92700 93224 93225 93226 93227 93228 93229 93264 93268 93270 93271 93272 93293 93294 93295 93296 93297 93298 93784 93786 93788 93790 93799 93998 94005 94014 94015 94016 94774 94775 94776 94777 94799 95199 95250 95251 95708 95709 95710 95714 95715 95716 95719 95720 95721 95722 95723 95724 95725 95726 95782 95783 95800 95801 95803 95805 95806 95807 95808 95810 95811 95836 95999 96379 96549 96999 97039 97139 97799 98970 98971 98972 99091 99100 99116 99135 99140 99199 99339 99340 99374 99375 99377 99378 99379 99380 99421 99422 99423 99429 99454 99457 99458 99474 99487 99489 99490 99491 99495 99496 99499 99600 A0021 A0080 A0090 A0100 A0110 A0120 A0130 A0140 A0160 A0170 A0180 A0190 A0200 A0210 A0225 A0380 A0382 A0384 A0390 A0392 A0394 A0396 A0398 A0420 A0422 A0424 A0425 A0426 A0427 A0428 A0429 A0430 A0431 A0432 A0433 A0434 A0435 A0436 A0888 A0998 A0999 A4221 A4224 A4226 A4595 A4641 A4642 A47

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20 A4721 A4722 A4723 A4724 A4725 A4726 From - To Date Policy Page 4 of 9 UnitedHealthcare Oxford Reimbursement Policy Effective 11/09/2020 ©1996-2020 Oxford Health Plans, LLC CPT/HCPCS Codes From - To Policy Exceptions: Services exempt from this policy A4728 A4736 A4737 A4765 A4766 A9150 A9152 A9153 A9155 A9500 A9501 A9502 A9503 A9504 A9505 A9507 A9508 A9509 A9510 A9512 A9515 A9516 A9517 A9520 A9521 A9524 A9526 A9527 A9528 A9529 A9530 A9531 A9532 A9536 A9537 A9538 A9539 A9540 A9541 A9542 A9543 A9546 A9547 A9548 A9550 A9551 A9552 A9553 A9554 A9555 A9556 A9557 A9558 A9559 A9560 A9561 A9562 A9563 A9564 A9566 A9567 A9568 A9569 A9570 A9571 A9572 A9575 A9576 A9577 A9578 A9579 A9580 A9581 A9582 A9583 A9584 A9585 A9586 A9587 A9588 A9589 A9590 A9597 A9598 A9600 A9604 A9606 A9698 A9699 B4034 B4035 B4036 B4081 B4082 B4083 B4087 B4088 B4100 B4102 B4103 B4104 B4105 B4149 B4150 B4152 B4153 B4154 B4155 B4157 B4158 B4159 B4160 B4161 B4162 B4164 B4168 B4172 B4176 B4178 B4180 B4185 B4187 B4189 B4193 B4197 B4199 B4216 B4220 B4222 B4224 B5000 B5100 B5200 B9002 B9004 B9006 B9998 B9999 D0502 D0999 D1999 D2999 D3999 D4999 D5899 D5999 D6199 D6999 D7899 D7999 D8999 D9999 E0100 E0105 E0110 E0111 E0112 E0113 E0114 E0116 E0117 E0118 E0130 E0135 E0140 E0141 E0143 E0144 E0147 E0148 E0149 E0153 E0154 E0155 E0156 E0157 E0158 E0159 E0160 E0161 E0162 E0163 E0165 E0167 E0168 E0170 E0171 E0172 E0175 E0181 E0182 E0184 E0185 E0186 E0187 E0188 E0189 E0190 E0191 E0193 E0194 E0196 E0197 E0198 E0199 E0200 E0202 E0203 E0205 E0210 E0215 E0217 E0218 E0221 E0225 E0231 E0232 E0235 E0236 E0239 E0240 E0241 E0242 E0243 E0244 E0245 E0246 E0247 E0248 E0249 E0250 E0251 E0255 E0256 E0260 E0261 E0265 E0266 E0270 E0271 E0272 E0273 E0274 E0275 E0276 E0277 E0280 E0290 E0291 E0292 E0293 E0294 E0295 E0296 E0297 E0300 E0301 E0302 E0303 E0304 E0305 E0310 E0315 E0316 E0325 E0326 E0328 E0329 E0350 E0352 E0370 E0371 E0372 E0373 E0424 E0425 E0430 E0431 E0433 E0434 E0435 E0439 E0440 E0441 E0442 E0443 E0444 E0445 E0446 E0447 E0455 E0457 E0459 E0462 E0465 E0466 E0467 E0470 E0471 E0472 E0480 E0481 E0482 E0483 E0484 E0485 E0486 E0487 E0500 E0550 E0555 E0560 E0561 E0562 E0565 E0570 E0572 E0574 E0575 E0580 E0585 E0600 E0601 E0602 E0603 E0604 E0605 E0606 E0607 E0610 E0615 E0616 E0617 E0618 E0619 E0620 E0621 E0625 E0627 E0629 E0630 E0635 E0636 E0637 E0638 E0639 E0640 E0641 E0642 E0650 E0651 E0652 E0655 E0656 E0657 E0660 E0665 E0666 E0667 E0668 E0669 E0670 E0671 E0672 E0673 E0675 E0676 E0691 E0692 E0693 E0694 E0700 E0705 E0710 E0720 E0730 E0731 E0740 E0744 E0745 E0746 E0747 E0748 E0749 E0755 E0760 E0761 E0762 E0764 E0765 E0766 E0769 E0770 E0776 E0779 E0780 E0781 E0782 E0783 E0784 E0785 E0786 E0787 E0791 E0830 E0840 E0849 E0850 E0855 E0856 E0860 E0870 E0880 E0890 E0900 E0910 E0911 E0912 E0920 E0930 E0935 E0936 E0940 E0941 E0942 E0944 E0945 E0946 E0947 E0948 E0950 E0951 E0952 E0953 E0954 E0955 E0956 E0957 E0958 E0959 E0960 E0961 E0966 E0967 E0968 E0969 E0970 E0971 E0973 E0974 E0978 E0980 E0981 E0982 E0983 E0984 E0985 E0986 E0988 E0990 E0992 E0994 E0995 E1002 E1003 E1004 E1005 E1006 E1007 E1008 E1009 E1010 E1011 E1012 E1014 E1015 E1016 E1017 E1018 E1020 E1028 E1029 E1030 E1031 E1035 E1036 E1037 E1038 E1039 E1050

E1060 E1070 E1083 E1084 E1085
E1060 E1070 E1083 E1084 E1085 E1086 E1087 E1088 E1089 E1090 E1092 E1093 E1100 E1110 E1130 E1140 From - To Date Policy Page 5 of 9 UnitedHealthcare Oxford Reimbursement Policy Effective 11/09/2020 ©1996-2020 Oxford Health Plans, LLC CPT/HCPCS Codes From - To Policy Exceptions: Services exempt from this policy E1150 E1160 E1161 E1170 E1171 E1172 E1180 E1190 E1195 E1200 E1220 E1221 E1222 E1223 E1224 E1225 E1226 E1227 E1228 E1229 E1230 E1231 E1232 E1233 E1234 E1235 E1236 E1237 E1238 E1239 E1240 E1250 E1260 E1270 E1280 E1285 E1290 E1295 E1296 E1297 E1298 E1300 E1310 E1352 E1353 E1354 E1355 E1356 E1357 E1358 E1372 E1390 E1391 E1392 E1399 E1405 E1406 E1500 E1510 E1520 E1530 E1540 E1550 E1560 E1570 E1575 E1580 E1590 E1592 E1594 E1600 E1610 E1615 E1620 E1625 E1630 E1632 E1634 E1635 E1636 E1637 E1639 E1699 E1700 E1701 E1702 E1800 E1801 E1802 E1805 E1806 E1810 E1811 E1812 E1815 E1816 E1818 E1820 E1821 E1825 E1830 E1831 E1840 E1841 E1902 E2000 E2100 E2101 E2120 E2201 E2202 E2203 E2204 E2205 E2206 E2207 E2208 E2209 E2210 E2211 E2212 E2213 E2214 E2215 E2216 E2217 E2218 E2219 E2220 E2221 E2222 E2224 E2225 E2226 E2227 E2228 E2230 E2231 E2291 E2292 E2293 E2294 E2295 E2300 E2301 E2310 E2311 E2312 E2313 E2321 E2322 E2323 E2324 E2325 E2326 E2327 E2328 E2329 E2330 E2331 E2340 E2341 E2342 E2343 E2351 E2358 E2359 E2360 E2361 E2362 E2363 E2364 E2365 E2366 E2367 E2368 E2369 E2370 E2371 E2372 E2373 E2374 E2375 E2376 E2377 E2378 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2394 E2395 E2396 E2397 E2398 E2402 E2500 E2502 E2504 E2506 E2508 E2510 E2511 E2512 E2599 E2601 E2602 E2603 E2604 E2605 E2606 E2607 E2608 E2609 E2610 E2611 E2612 E2613 E2614 E2615 E2616 E2617 E2619 E2620 E2621 E2622 E2623 E2624 E2625 E2626 E2627 E2628 E2629 E2630 E2631 E2632 E2633 E8000 E8001 E8002 G0179 G0180 G0181 G0182 G0186 G0249 G0250 G0302 G0303 G0304 G0305 G0333 G0340 G0506 G2058 G2061 G2062 G2063 G2064 G2065 G2066 G2067 G2068 G2069 G2070 G2071 G2072 G2073 G2074 G2075 G2078 G2079 G9055 G9678 H0020 H0042 H0044 H0047 J0120 J0121 J0122 J0129 J0130 J0131 J0132 J0133 J0135 J0153 J0171 J0178 J0179 J0180 J0185 J0190 J0200 J0202 J0205 J0207 J0210 J0215 J0220 J0221 J0222 J0223 J0256 J0257 J0270 J0275 J0278 J0280 J0282 J0285 J0287 J0288 J0289 J0290 J0291 J0295 J0300 J0330 J0348 J0350 J0360 J0364 J0365 J0380 J0390 J0395 J0400 J0401 J0456 J0461 J0470 J0475 J0476 J0480 J0485 J0490 J0500 J0515 J0517 J0520 J0558 J0561 J0565 J0567 J0570 J0571 J0572 J0573 J0574 J0575 J0583 J0584 J0585 J0586 J0587 J0588 J0591 J0592 J0593 J0594 J0595 J0596 J0597 J0598 J0599 J0600 J0604 J0606 J0610 J0620 J0630 J0636 J0637 J0638 J0640 J0641 J0642 J0670 J0690 J0691 J0692 J0694 J0695 J0696 J0697 J0698 J0702 J0706 J0710 J0712 J0713 J0714 J0715 J0716 J0717 J0720 J0725 J0735 J0740 J0742 J0743 J0744 J0745 J0770 J0775 J0780 J0791 J0795 J0800 J0834 J0840 J0841 J0850 J0875 J0878 J0881 J0882 J0883 J0884 J0885 J0887 J0888 J0890 J0894 J0895 J0896 J0897 J0945 J1000 J1020 J1030 J1040 J1050 J1071 J1094 J1095 J1096 J1097 J1100 J1110 J1120 J1130 J1160 J1162 J1165 J1170 J1180 J1190 J1200 J1201 J1205 J1212 J1230 J1240 J1245 J1250 J1260 J1265 J1267 J1270 J1290 J1300 J1301 J1303 J1320 J1322 J1324 J1325 J1327 J1330 J1335 J136

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4 J1380 J1410 J1428 J1429 J1430 J1435 J1436 J1437 J1438 J1439 J1442 J1443 J1444 J1447 J1450 J1451 J1452 J1453 J1454 J1455 J1457 J1458 J1459 J1460 From - To Date Policy Page 6 of 9 UnitedHealthcare Oxford Reimbursement Policy Effective 11/09/2020 ©1996-2020 Oxford Health Plans, LLC CPT/HCPCS Codes From - To Policy Exceptions: Services exempt from this policy J1555 J1556 J1557 J1558 J1559 J1560 J1561 J1562 J1566 J1568 J1569 J1570 J1571 J1572 J1573 J1575 J1580 J1595 J1599 J1600 J1602 J1610 J1620 J1626 J1627 J1628 J1630 J1631 J1632 J1640 J1642 J1644 J1645 J1650 J1652 J1655 J1670 J1675 J1700 J1710 J1720 J1726 J1729 J1730 J1738 J1740 J1741 J1742 J1743 J1744 J1745 J1746 J1750 J1756 J1786 J1790 J1800 J1810 J1815 J1817 J1826 J1830 J1833 J1835 J1840 J1850 J1885 J1890 J1930 J1931 J1940 J1943 J1944 J1945 J1950 J1953 J1955 J1956 J1960 J1980 J1990 J2001 J2010 J2020 J2060 J2062 J2150 J2170 J2175 J2180 J2182 J2185 J2186 J2210 J2212 J2248 J2250 J2260 J2265 J2270 J2274 J2278 J2280 J2300 J2310 J2315 J2320 J2323 J2325 J2326 J2350 J2353 J2354 J2355 J2357 J2358 J2360 J2370 J2400 J2405 J2407 J2410 J2425 J2426 J2430 J2440 J2460 J2469 J2501 J2502 J2503 J2504 J2505 J2507 J2510 J2513 J2515 J2540 J2543 J2545 J2547 J2550 J2560 J2562 J2590 J2597 J2650 J2670 J2675 J2680 J2690 J2700 J2704 J2710 J2720 J2724 J2725 J2730 J2760 J2765 J2770 J2778 J2780 J2783 J2785 J2786 J2787 J2788 J2790 J2791 J2792 J2793 J2794 J2795 J2796 J2797 J2798 J2800 J2805 J2810 J2820 J2840 J2850 J2860 J2910 J2916 J2920 J2930 J2940 J2941 J2950 J2993 J2995 J2997 J3000 J3010 J3030 J3031 J3032 J3060 J3070 J3090 J3095 J3101 J3105 J3110 J3111 J3121 J3145 J3230 J3240 J3241 J3243 J3245 J3246 J3250 J3260 J3262 J3265 J3280 J3285 J3300 J3301 J3302 J3303 J3304 J3305 J3310 J3315 J3316 J3320 J3350 J3355 J3357 J3358 J3360 J3364 J3365 J3370 J3380 J3385 J3396 J3397 J3398 J3399 J3400 J3410 J3411 J3415 J3420 J3430 J3465 J3470 J3471 J3472 J3473 J3475 J3480 J3485 J3486 J3489 J3490 J3520 J3530 J3535 J3570 J3590 J3591 J7030 J7040 J7042 J7050 J7060 J7070 J7100 J7110 J7120 J7121 J7131 J7169 J7170 J7175 J7177 J7178 J7179 J7180 J7181 J7182 J7183 J7185 J7186 J7187 J7188 J7189 J7190 J7191 J7192 J7193 J7194 J7195 J7196 J7197 J7198 J7199 J7200 J7201 J7202 J7203 J7204 J7205 J7207 J7208 J7209 J7210 J7211 J7296 J7297 J7298 J7300 J7301 J7303 J7304 J7306 J7307 J7308 J7309 J7310 J7311 J7312 J7313 J7314 J7315 J7316 J7318 J7320 J7321 J7322 J7323 J7324 J7325 J7326 J7327 J7328 J7329 J7330 J7331 J7332 J7333 J7336 J7340 J7342 J7345 J7351 J7401 J7500 J7501 J7502 J7503 J7504 J7505 J7507 J7508 J7509 J7510 J7511 J7512 J7513 J7515 J7516 J7517 J7518 J7520 J7525 J7527 J7599 J7604 J7605 J7606 J7607 J7608 J7609 J7610 J7611 J7612 J7613 J7614 J7615 J7620 J7622 J7624 J7626 J7627 J7628 J7629 J7631 J7632 J7633 J7634 J7635 J7636 J7637 J7638 J7639 J7640 J7641 J7642 J7643 J7644 J7645 J7647 J7648 J7649 J7650 J7657 J7658 J7659 J7660 J7665 J7667 J7668 J7669 J7670 J7674 J7676 J7677 J7680 J7681 J7682 J7683 J7684 J7685 J7686 J7699 J7799 J7999 J8498 J8499 J8501 J8510 J8515 J8520 J8521 J8530 J8540 J8560 J8562 J8565 J8597 J8600 J8610 J8650 J8655 J8670 J8700 J8705 J8999 J9000 J9015 J9017 J9019 J9020 J9022 J9023 J9025 J9027 J9030 J9032 J9033 J9034 J9035 J9036 J9039 J9040 J904

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