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Bioengineered Skin and Soft Tissue Substitutes

Section: Surgery
Effective Date: November 01, 2019
Revised Date: October 18, 2019
Last Reviewed: September 26, 2019

Description

Bio-engineered skin and soft tissue substitutes may be derived from human tissue (autologous or allogeneic), non-human tissue (xenographic), synthetic materials, or a composite of these materials. Bio-engineered skin and soft tissue substitutes are utilized in the treatment for breast reconstruction, healing of lower extremity ulcers and severe burns. Acellular dermal matrix (ADM) products are utilized in the repair of a variety of soft tissues.

Criteria

Breast reconstructive surgery using ONE of the following allogeneic ADM products may be considered medically necessary for ANY ONE of the following indications:

Product(s):

  • AlloDerm®; or
  • AlloMax™; or
  • AlloMend®; or
  • DermaMatrix™; or
  • DermACELL®; or
  • FlexHD®; or
  • GraftJacket®.

Indication(s):

  • When there is insufficient tissue expander or implant coverage by the pectoralis major muscle and additional coverage is required; or
  • When there is viable but compromised or thin post-mastectomy skin flaps that are at risk of dehiscence or necrosis; or
  • The infra-mammary fold and lateral mammary folds have been undermined during mastectomy and re-establishment of these landmarks is needed.

Services that do not meet the above criteria will be considered not medically necessary.

Procedure Codes

15271 15272 15273 15274 15777 19357 19361
19364 19366 19367 19368 19369 19380 Q4100
Q4107 Q4116 Q4128 Q4122

 

Treatment of chronic, noninfected, full-thickness diabetic lower extremity ulcers using ANY ONE of the following tissue-engineered skin substitutes may be considered medically necessary:

  • AlloPatch®; or
  • Apligraf®; or
  • Dermagraft®; or
  • Integra® Dermal Regeneration Template.

Services that do not meet the above criteria will be considered not medically necessary.

Procedure Codes

15271 15272 15273 15274 15275 15276 15277
15278 Q4101 Q4105 Q4106 Q4128

Treatment of chronic, non-infected, partial- or full-thickness lower extremity skin ulcers due to venous insufficiency, which have not adequately responded following a one (1)-month period of conventional ulcer therapy, using ANY ONE of the following tissue-engineered skin substitutes may be considered medically necessary:

  • Apligraf; or
  • Oasis™ Wound Matrix.

Services that do not meet the above criteria will be considered not medically necessary.

Procedure Codes

15271 15272 15273 15274 15275 15276 15277
15278 Q4101 Q4102

Treatment of dystrophic epidermolysis bullosa using the following tissue-engineered skin substitutes may be considered medically necessary for ALL of the following indications:

Product(s):

  • OrCel™.

Indication(s): 

  • Treatment of mitten-hand deformity when standard wound therapy has failed; and
  • When provided in accordance with the Humanitarian Device Exemption (HDE) specifications of the Food and Drug Administration (FDA).

Services that do not meet the above criteria will be considered not medically necessary.

Procedure Codes

15271 15272 15273 15274 15275 15276 15277
15278 Q4100

Treatment of second- and third-degree burns using ANY ONE of the following tissue-engineered skin substitutes may be considered medically necessary.

  • Epicel®
    • Treatment of deep dermal or full-thickness burns comprising a total body surface area greater than or equal to 30% when provided in accordance with the HDE specifications of the FDA; or
  • Integra Dermal Regeneration Template™; or
  • TransCyte™.

Services that do not meet the above criteria will be considered not medically necessary.

Procedure Codes

15150 15151 15152 15155 15156 15157 15271
15272 15273 15274 15275 15276 15277 15278
Q4100 Q4105 Q4182

TheraSkin® may be considered medically necessary for ANY ONE of the following indications:

  • In conjunction with standard therapeutic compression for the treatment of chronic, non-infected, partial or full-thickness skin ulcers due to venous insufficiency greater than one (1)-month duration and which have not adequately responded following a one (1)-month period of conventional ulcer therapy (i.e., standard dressing changes, standard therapeutic compression, etc.); or
  • In conjunction with standard diabetic foot ulcer care for the treatment of full-thickness neuropathic diabetic foot ulcers greater than one (1)-month duration which have not adequately responded following at least four (4) weeks of conventional ulcer therapy (i.e., surgical debridement, complete off-loading and standard dressing changes, etc.) which can extend through the dermis, including tendon, muscle, joint capsule or bone exposure; or
  • Other uses supported by clinical results and clinical literature include pressure sores, skin cancer excision (e.g., Mohs Surgery), large surgical wounds (i.e., club release, etc.), radiation compromised wounds and necrotizing fasciitis.

Services that do not meet the above criteria will be considered not medically necessary.

Procedure Codes

15271 15272 15273 15274 15275 15276 15277
15278 Q4121

 

ALL other skin and soft tissue substitutes not listed above are considered experimental/investigational and, therefore, non-covered, because the safety and/or effectiveness cannot be established by the available published peer-reviewed literature. This includes, but is not limited to:

  • ACell® UBM Hydrated Wound Dressing; and
  • ACell® UBM Lyophilized Wound Dressing; and
  • ActiveMatrix®; and
  • AlloSkin™; and
  • AlloSkin™ RT; and
  • Alphaplex with MariGen Omega3; and
  • Aongen™ Collagen Matrix; and
  • Architect Extracellular Matrix; and
  • ArthroFlex™ (FlexGraft); and
  • Atlas Wound Matrix; and
  • Avagen Wound Dressing; and
  • Avaulta Plus™; and
  • BellaCell HD or Surederm; and
  • Biobrane®; and
  • CellerateRX®; and
  • Collagen Sponge (Innocoll); and
  • Collagen Wound Dressing (Oasis Research); and
  • Collaguard; and
  • CollaSorb™; and
  • CollaWound™; and
  • Coll-E-Derm; and
  • Collexa®; and
  • Collieva®; and
  • Conexa™; and
  • Coreleader Colla-Pad; and
  • CorMatrix®; and
  • CRXa™; and
  • Cymetra®; and
  • Cytal; and
  • Dermadapt™ Wound Dressing; and
  • DermaGide; and
  • DermaMatrix Acellular Dermis; and
  • DermaPure™; and
  • DressSkin; and
  • Durepair Regeneration Matrix®; and
  • Endoform Dermal Template™; and
  • ENDURAgen™; and
  • Excellagen; and
  • E-Z Derm™; and
  • FlowerDerm; and
  • FlowerPatch™; and
  • FortaDerm™ Wound Dressing; and
  • GammaGraft; and
  • GraftJacket® Regenerative Tissue Matrix; and
  • GraftJacket® Xpress, injectable; and
  • HA Absorbent Wound Dressing; and
  • Helicoll; and
  • Hyalomatrix® (Laserskin®); and
  • Hyalomatrix® PA; and
  • hMatrix®; and
  • Integra™ Flowable Wound Matrix; and
  • Integra™ Bilayer Wound Matrix; and
  • Integra™ Matrix; and
  • Kerrox; and
  • MatriDerm®; and
  • MatriStem® Burn Matrix; and
  • MatriStem® Micromatrix; and
  • MatriStem® Wound Matrix; and
  • Matrix HD™; and
  • MediHoney®; and
  • Mediskin®; and
  • MemoDerm™; and
  • Miroderm; and
  • MyOwnSkin; and
  • Oasis® Burn Matrix; and
  • Oasis® Ultra Tri-Layer Matrix; and
  • Permacol™; and
  • PriMatrix; and
  • Primatrix™ Dermal Repair Scaffold; and
  • Progenamatix; and
  • Puraply; and
  • Puraply AM; and
  • Puraply XT; and
  • Puros® Dermis; and
  • Repliform®; and
  • SS Matrix™; and
  • Skin TE; and
  • Stimulen™ Collagen; and
  • StrataGraft; and
  • Strattice™ (xenograft); and
  • Suprathel®; and
  • SurgiMend®; and
  • Talymed®; and
  • TenoGlide™; and
  • Tensix™; and
  • TheraForm™ Standard/Sheet; and
  • Truskin; and
  • Unite® Biomatrix; and
  • Veritas® Collagen Matrix; and
  • Xcm Biologic Tissue Matrix.

Procedure Codes

Q4100 Q4103 Q4104 Q4108 Q4110 Q4111 Q4112
Q4113 Q4114 Q4115 Q4117 Q4118 Q4123 Q4124
Q4125 Q4126 Q4127 Q4128 Q4130 Q4134 Q4135
Q4136 Q4141 Q4142 Q4143 Q4146 Q4147 Q4149
Q4152 Q4158 Q4164 Q4166 Q4167 Q4175 Q4179
Q4193 Q4195 Q4196 Q4197 Q4200 Q4202 Q4203
Q4220 Q4222 Q4226

Outpatient HCPCS (C Codes)

C5271 C5272 C5273 C5274 C5275 C5276 C5277
C5278 C9354 C9356 C9358 C9360 C9363 C9364

Diagnosis Codes

Covered Diagnosis Codes for Procedure Code Q4100

Q81.2

Covered Diagnosis Codes for Procedure Code Q4121

L97 codes below must be billed with one of the following codes:
I83.0-I83.029, I83.2-I83.229, I87.01-I87.013, I87.03-I87.033, I87.2, I87.31-I87.313, I87.33-I87.333 or E08.621, E09.621, E10.621, E11.621, E13.621

C43.0 C43.111 C43.112 C43.121 C43.122 C43.21 C43.22
C43.31 C43.39 C43.4 C43.51 C43.52 C43.59 C43.61
C43.62 C43.71 C43.72 C43.8 C44.00 C44.01 C44.02
C44.09 C44.102 C44.109 C44.112 C44.119 C44.122 C44.129
C44.192 C44.199 C44.202 C44.209 C44.212 C44.219 C44.222
C44.229 C44.292 C44.299 C44.311 C44.319 C44.321 C44.329
C44.391 C44.399 C44.40 C44.41 C44.42 C44.49 C44.500
C44.501 C44.509 C44.510 C44.511 C44.519 C44.520 C44.521
C44.529 C44.590 C44.591 C44.599 C44.602 C44.609 C44.612
C44.619 C44.622 C44.629 C44.692 C44.699 C44.702 C44.709
C44.712 C44.719 C44.722 C44.729 C44.792 C44.799 C44.80
C44.81 C44.82 C44.89 C79.2 D03.0 D03.111 D03.112
D03.122 D03.21 D03.22 D03.39 D03.4 D03.51 D03.52
D03.59 D03.61 D03.62 D03.71 D03.72 D03.8 D04.0
D04.111 D04.112 D04.121 D04.122 D04.21 D04.22 D04.39
D04.4 D04.5 D04.61 D04.62 D04.71 D04.72 D04.8
E08.621 E09.621 E10.621 E11.621 E13.621 I83.011 I83.012
I83.013 I83.014 I83.015 I83.018 I83.019 I83.021 I83.022
I83.023 I83.024 I83.025 I83.028 I83.029 I83.211 I83.212
I83.213 I83.214 I83.215 I83.218 I83.219 I83.221 I83.222
I83.223 I83.224 I83.225 I83.228 I83.229 I87.011 I87.012
I87.013 I87.031 I87.032 I87.033 I87.2 I87.311 I87.312
I87.313 I87.331 I87.332 I87.333 L89.010 L89.012 L89.013
L89.014 L89.020 L89.022 L89.023 L89.024 L89.110 L89.112
L89.113 L89.114 L89.120 L89.122 L89.123 L89.124 L89.130
L89.132 L89.133 L89.134 L89.140 L89.142 L89.143 L89.144
L89.150 L89.152 L89.153 L89.154 L89.210 L89.212 L89.213
L89.214 L89.220 L89.222 L89.223 L89.224 L89.310 L89.312
L89.313 L89.314 L89.320 L89.322 L89.323 L89.324 L89.42
L89.43 L89.44 L89.45 L89.500 L89.502 L89.503 L89.504
L89.510 L89.512 L89.513 L89.514 L89.520 L89.522 L89.523
L89.524 L89.600 L89.602 L89.603 L89.604 L89.610 L89.612
L89.613 L89.614 L89.620 L89.622 L89.623 L89.624 L89.810
L89.812 L89.813 L89.814 L89.890 L89.892 L89.893 L89.894
L97.111 L97.112 L97.113 L97.114 L97.115 L97.116 L97.118
L97.121 L97.122 L97.123 L97.124 L97.125 L97.126 L97.128
L97.211 L97.212 L97.213 L97.214 L97.215 L97.216 L97.218
L97.221 L97.222 L97.223 L97.224 L97.225 L97.226 L97.228
L97.311 L97.312 L97.313 L97.314 L97.315 L97.316 L97.318
L97.321 L97.322 L97.323 L97.324 L97.325 L97.326 L97.328
L97.411 L97.412 L97.413 L97.414 L97.415 L97.416 L97.418
L97.421 L97.422 L97.423 L97.424 L97.425 L97.426 L97.428
L97.511 L97.512 L97.513 L97.514 L97.515 L97.516 L97.518
L97.521 L97.522 L97.523 L97.524 L97.525 L97.526 L97.528
L97.811 L97.812 L97.813 L97.814 L97.815 L97.816 L97.818
L97.821 L97.822 L97.823 L97.824 L97.825 L97.826 L97.828
L97.911 L97.912 L97.913 L97.914 L97.915 L97.916 L97.918
L97.921 L97.922 L97.923 L97.924 L97.925 L97.926 L97.928
M72.6 T81.31XA T81.31XD T81.31XS T81.33XA

Covered Diagnosis Codes for Procedure Code Q4116

C50.011 C50.012 C50.021 C50.022 C50.111 C50.112 C50.121
C50.122 C50.211 C50.212 C50.221 C50.222 C50.311 C50.312
C50.321 C50.322 C50.411 C50.412 C50.421 C50.422 C50.511
C50.512 C50.521 C50.522 C50.611 C50.612 C50.621 C50.622
C50.811 C50.812 C50.821 C50.822 C50.911 C50.912 C50.921
C50.922 C79.81 D05.01 D05.02 D05.11 D05.12 D05.81
D05.82 D05.91 D05.92 Z42.1 Z80.3 Z85.3 Z90.11
Z90.12 Z90.13

Covered Diagnosis Codes for Procedure Codes Q4101, Q4105, and Q4106

L97 codes  below must be billed with one of the E codes from this section:

E08.621 E08.622 E09.621 E09.622 E10.621 E10.622 E11.621
E11.622 E13.621 E13.622 L97.111 L97.112 L97.113 L97.114
L97.115 L97.116 L97.118 L97.121 L97.122 L97.123 L97.124
L97.125 L97.126 L97.128 L97.201 L97.202 L97.203 L97.204
L97.211 L97.212 L97.213 L97.214 L97.215 L97.216 L97.218
L97.221 L97.222 L97.223 L97.224 L97.225 L97.226 L97.228
L97.301 L97.302 L97.303 L97.304 L97.311 L97.312 L97.313
L97.314 L97.315 L97.316 L97.318 L97.321 L97.322 L97.323
L97.324 L97.325 L97.326 L97.328 L97.401 L97.402 L97.403
L97.404 L97.411 L97.412 L97.413 L97.414 L97.415 L97.416
L97.418 L97.421 L97.422 L97.423 L97.424 L97.425 L97.426
L97.428 L97.501 L97.502 L97.503 L97.504 L97.511 L97.512
L97.513 L97.514 L97.515 L97.516 L97.518 L97.521 L97.522
L97.523 L97.524 L97.525 L97.526 L97.528 L97.801 L97.802
L97.803 L97.804 L97.811 L97.812 L97.813 L97.814 L97.815
L97.816 L97.818 L97.821 L97.822 L97.823 L97.824 L97.825
L97.826 L97.828 L97.901 L97.902 L97.903 L97.904 L97.911
L97.912 L97.913 L97.914 L97.915 L97.916 L97.918 L97.921
L97.922 L97.923 L97.924 L97.925 L97.926 L97.928

Covered Diagnosis Codes for Procedure Codes Q4101 and Q4102

L97 codes below must be billed with one of the following codes:  I83.0-I83.029, I83.2-I83.229, I87.01-I87.013, I87.03-I87.033, I87.2, I87.31-I87.313, I87.33-I87.333

I83.011 I83.012 I83.013 I83.014 I83.015 I83.018 I83.019
I83.021 I83.022 I83.023 I83.024 I83.025 I83.028 I83.029
I83.211 I83.212 I83.213 I83.214 I83.215 I83.218 I83.219
I83.221 I83.222 I83.223 I83.224 I83.225 I83.228 I83.229
I87.011 I87.012 I87.013 I87.031 I87.032 I87.033 I87.2
I87.311 I87.312 I87.313 I87.331 I87.332 I87.333 L97.111
L97.112 L97.113 L97.114 L97.115 L97.116 L97.118 L97.121
L97.122 L97.123 L97.124 L97.125 L97.126 L97.128 L97.211
L97.212 L97.213 L97.214 L97.215 L97.216 L97.218 L97.221
L97.222 L97.223 L97.224 L97.225 L97.226 L97.228 L97.311
L97.312 L97.313 L97.314 L97.315 L97.316 L97.318 L97.321
L97.322 L97.323 L97.324 L97.325 L97.326 L97.328 L97.411
L97.412 L97.413 L97.414 L97.415 L97.416 L97.418 L97.421
L97.422 L97.423 L97.424 L97.425 L97.426 L97.428 L97.511
L97.512 L97.513 L97.514 L97.515 L97.516 L97.518 L97.521
L97.522 L97.523 L97.524 L97.525 L97.526 L97.528 L97.811
L97.812 L97.813 L97.814 L97.815 L97.816 L97.818 L97.821
L97.822 L97.823 L97.824 L97.825 L97.826 L97.828 L97.911
L97.912 L97.913 L97.914 L97.915 L97.916 L97.918 L97.919
L97.921 L97.922 L97.923 L97.924 L97.925 L97.926 L97.928
L97.929

Covered Diagnosis Codes for Procedure Codes Q4105 and Q4182

T20.20XA T20.20XD T20.20XS T20.211A T20.211D T20.211S T20.212A
T20.212D T20.212S T20.22XA T20.22XD T20.22XS T20.23XA T20.23XD
T20.23XS T20.24XA T20.24XD T20.24XS T20.25XA T20.25XD T20.25XS
T20.26XA T20.26XD T20.26XS T20.27XA T20.27XD T20.27XS T20.29XA
T20.29XD T20.29XS T20.30XA T20.30XD T20.30XS T20.311A T20.311D
T20.311S T20.312A T20.312D T20.312S T20.32XA T20.32XD T20.32XS
T20.33XA T20.33XD T20.33XS T20.34XA T20.34XD T20.34XS T20.35XA
T20.35XD T20.35XS T20.36XA T20.36XD T20.36XS T20.37XA T20.37XD
T20.37XS T20.39XA T20.39XD T20.39XS T20.60XA T20.60XD T20.60XS
T20.611A T20.611D T20.611S T20.612A T20.612D T20.612S T20.62XA
T20.62XD T20.62XS T20.63XA T20.63XD T20.63XS T20.64XA T20.64XD
T20.64XS T20.65XA T20.65XD T20.65XS T20.66XA T20.66XD T20.66XS
T20.67XA T20.67XD T20.67XS T20.69XA T20.69XD T20.69XS T20.70XA
T20.70XD T20.70XS T20.711A T20.711D T20.711S T20.712A T20.712D
T20.712S T20.72XA T20.72XD T20.72XS T20.73XA T20.73XD T20.73XS
T20.74XA T20.74XD T20.74XS T20.75XA T20.75XD T20.75XS T20.76XA
T20.76XD T20.76XS T20.77XA T20.77XD T20.77XS T20.79XA T20.79XD
T20.79XS T21.21XA T21.21XD T21.21XS T21.22XA T21.22XD T21.22XS
T21.23XA T21.23XD T21.23XS T21.24XA T21.24XD T21.24XS T21.25XA
T21.25XD T21.25XS T21.26XA T21.26XD T21.26XS T21.27XA T21.27XD
T21.27XS T21.29XA T21.29XD T21.29XS T21.31XA T21.31XD T21.31XS
T21.32XA T21.32XD T21.32XS T21.33XA T21.33XD T21.33XS T21.34XA
T21.34XD T21.34XS T21.35XA T21.35XD T21.35XS T21.36XA T21.36XD
T21.36XS T21.37XA T21.37XD T21.37XS T21.39XA T21.39XD T21.39XS
T21.61XA T21.61XD T21.61XS T21.62XA T21.62XD T21.62XS T21.63XA
T21.63XD T21.63XS T21.64XA T21.64XD T21.64XS T21.65XA T21.65XD
T21.65XS T21.66XA T21.66XD T21.66XS T21.67XA T21.67XD T21.67XS
T21.69XA T21.69XD T21.69XS T21.71XA T21.71XD T21.71XS T21.72XA
T21.72XD T21.72XS T21.73XA T21.73XD T21.73XS T21.74XA T21.74XD
T21.74XS T21.75XA T21.75XD T21.75XS T21.76XA T21.76XD T21.76XS
T21.77XA T21.77XD T21.77XS T21.79XA T21.79XD T21.79XS T22.20XA
T22.20XD T22.20XS T22.211A T22.211D T22.211S T22.212A T22.212D
T22.212S T22.221A T22.221D T22.221S T22.222A T22.222D T22.222S
T22.231A T22.231D T22.231S T22.232A T22.232D T22.232S T22.241A
T22.241D T22.241S T22.242A T22.242D T22.242S T22.251A T22.251D
T22.251S T22.252A T22.252D T22.252S T22.261A T22.261D T22.261S
T22.262A T22.262D T22.262S T22.291A T22.291D T22.291S T22.292A
T22.292D T22.292S T22.30XA T22.30XD T22.30XS T22.311A T22.311D
T22.311S T22.312A T22.312D T22.312S T22.321A T22.321D T22.321S
T22.322A T22.322D T22.322S T22.331A T22.331D T22.331S T22.332A
T22.332D T22.332S T22.341A T22.341D T22.341S T22.342A T22.342D
T22.342S T22.351A T22.351D T22.351S T22.352A T22.352D T22.352S
T22.361A T22.361D T22.361S T22.362A T22.362D T22.362S T22.391A
T22.391D T22.391S T22.392A T22.392D T22.392S T22.60XA T22.60XD
T22.60XS T22.611A T22.611D T22.611S T22.612A T22.612D T22.612S
T22.621A T22.621D T22.621S T22.622A T22.622D T22.622S T22.631A
T22.631D T22.631S T22.632A T22.632D T22.632S T22.641A T22.641D
T22.641S T22.642A T22.642D T22.642S T22.651A T22.651D T22.651S
T22.652A T22.652D T22.652S T22.661A T22.661D T22.661S T22.662A
T22.662D T22.662S T22.691A T22.691D T22.691S T22.692A T22.692D
T22.692S T22.70XA T22.70XD T22.70XS T22.711A T22.711D T22.711S
T22.712A T22.712D T22.712S T22.721A T22.721D T22.721S T22.722A
T22.722D T22.722S T22.731A T22.731D T22.731S T22.732A T22.732D
T22.732S T22.741A T22.741D T22.741S T22.742A T22.742D T22.742S
T22.751A T22.751D T22.751S T22.752A T22.752D T22.752S T22.761A
T22.761D T22.761S T22.762A T22.762D T22.762S T22.791A T22.791D
T22.791S T22.792A T22.792D T22.792S T23.201A T23.201D T23.201S
T23.202A T23.202D T23.202S T23.211A T23.211D T23.211S T23.212A
T23.212D T23.212S T23.221A T23.221D T23.221S T23.222A T23.222D
T23.222S T23.231A T23.231D T23.231S T23.232A T23.232D T23.232S
T23.241A T23.241D T23.241S T23.242A T23.242D T23.242S T23.251A
T23.251D T23.251S T23.252A T23.252D T23.252S T23.261A T23.261D
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T23.272A T23.272D T23.272S T23.291A T23.291D T23.291S T23.292A
T23.292D T23.292S T23.301A T23.301D T23.301S T23.302A T23.302D
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T23.321A T23.321D T23.321S T23.322A T23.322D T23.322S T23.331A
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T23.352A T23.352D T23.352S T23.361A T23.361D T23.361S T23.362A
T23.362D T23.362S T23.371A T23.371D T23.371S T23.372A T23.372D
T23.372S T23.391A T23.391D T23.391S T23.392A T23.392D T23.392S
T23.601A T23.601D T23.601S T23.602A T23.602D T23.602S T23.611A
T23.611D T23.611S T23.612A T23.612D T23.612S T23.621A T23.621D
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T23.652S T23.661A T23.661D T23.661S T23.662A T23.662D T23.662S
T23.671A T23.671D T23.671S T23.672A T23.672D T23.672S T23.691A
T23.691D T23.691S T23.692A T23.692D T23.692S T23.701A T23.701D
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T23.712A T23.712D T23.712S T23.721A T23.721D T23.721S T23.722A
T23.722D T23.722S T23.731A T23.731D T23.731S T23.732A T23.732D
T23.732S T23.741A T23.741D T23.741S T23.742A T23.742D T23.742S
T23.751A T23.751D T23.751S T23.752A T23.752D T23.752S T23.761A
T23.761D T23.761S T23.762A T23.762D T23.762S T23.771A T23.771D
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T23.792A T23.792D T23.792S T24.201A T24.201D T24.201S T24.202A
T24.202D T24.202S T24.211A T24.211D T24.211S T24.212A T24.212D
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T24.231A T24.231D T24.231S T24.232A T24.232D T24.232S T24.291A
T24.291D T24.291S T24.292A T24.292D T24.292S T24.301A T24.301D
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T24.312A T24.312D T24.312S T24.321A T24.321D T24.321S T24.322A
T24.322D T24.322S T24.331A T24.331D T24.331S T24.332A T24.332D
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T24.601A T24.601D T24.601S T24.602A T24.602D T24.602S T24.611A
T24.611D T24.611S T24.612A T24.612D T24.612S T24.621A T24.621D
T24.621S T24.622A T24.622D T24.622S T24.631A T24.631D T24.631S
T24.632A T24.632D T24.632S T24.691A T24.691D T24.691S T24.692A
T24.692D T24.692S T24.701A T24.701D T24.701S T24.702A T24.702D
T24.702S T24.711A T24.711D T24.711S T24.712A T24.712D T24.712S
T24.721A T24.721D T24.721S T24.722A T24.722D T24.722S T24.731A
T24.731D T24.731S T24.732A T24.732D T24.732S T24.791A T24.791D
T24.791S T24.792A T24.792D T24.792S T25.211A T25.211D T25.211S
T25.212A T25.212D T25.212S T25.221A T25.221D T25.221S T25.222A
T25.222D T25.222S T25.231A T25.231D T25.231S T25.232A T25.232D
T25.232S T25.291A T25.291D T25.291S T25.292A T25.292D T25.292S
T25.311A T25.311D T25.311S T25.312A T25.312D T25.312S T25.321A
T25.321D T25.321S T25.322A T25.322D T25.322S T25.331A T25.331D
T25.331S T25.332A T25.332D T25.332S T25.391A T25.391D T25.391S
T25.392A T25.392D T25.392S T25.611A T25.611D T25.611S T25.612A
T25.612D T25.612S T25.621A T25.621D T25.621S T25.622A T25.622D
T25.622S T25.631A T25.631D T25.631S T25.632A T25.632D T25.632S
T25.691A T25.691D T25.691S T25.692A T25.692D T25.692S T25.711A
T25.711D T25.711S T25.712A T25.712D T25.712S T25.721A T25.721D
T25.721S T25.722A T25.722D T25.722S T25.731A T25.731D T25.731S
T25.732A T25.732D T25.732S T25.791A T25.791D T25.791S T25.792A
T25.792D T25.792S

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