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Definitions
- Drug Name: Brand or Common Name of the HCPCS code
- Authorization Required: If there is a check mark in this column, then this medication requires authorization prior to administration
- Covered (No PA Required): If there is a check mark in this column, then there is No Authorization Required
- Not Covered: If there is a check mark in this column, then this HCPCS code is not a covered benefit
- Auth Required if Prescribed for an Oncology/Hematology Indication
- If there is a check mark in this column, the corresponding HCPCS code will require authorization if prescribed for an Oncology/Hematology ICD-10 diagnosis code found on the ICD-10 Codes listing.
- If not prescribed for an Oncology/Hematology Indication, the HCPCS Code is No Authorization Required.
- If there is a check mark in this column, the corresponding HCPCS code will require authorization if prescribed for an Oncology/Hematology ICD-10 diagnosis code found on the ICD-10 Codes listing.
- Medicaid Listing
- Medicaid Medical Pharmacy Benefit HCPCS
- Commercial Listing
- Commercial Medical Pharmacy Benefit HCPCS
- INTEGRITY (MMP) Listing
- Integrity (MMP) Medical Pharmacy Benefit HCPCS
- EFP (Extended Family Planning) Listing
- EFP Medical Pharmacy Benefit Covered HCPCS
- ICD-10 Codes Listing
- Listing of indications that require prior authorization for a designated HCPCS code that has a check mark in Auth Required if Prescribed for an Oncology/Hematology Indication.
- Medical Pharmacy Benefit Authorization Criteria
- Medicare Part B Step Therapy Document
Last Updated 5/2/2022
MEDICAIDINTEGRITY (MMP)CommercialEFP FormularyICD10 Codes
HCPCS CODE | HCPCS CODE DESCRIPTION | DRUG NAME | MEDICAID - Authorization Required | MEDICAID - Covered (No PA Required) | MEDICAID- Not Covered | Auth Required if Prescribed for an Oncology/Hematology Related Indication |
---|---|---|---|---|---|---|
90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use | Synagis | Yes | |||
A9513 | Lutetium lu 177, dotatate, therapeutic, 1 millicurie | Lutathera | Yes | |||
A9517 | Iodine- i-131 sodium iodide capsule(s), therapeutic, per millicurie | Hicon | Yes | |||
A9543 | Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries | Zevalin Y-90 | Yes | |||
A9590 | Iodine i-131, iobenguane, 1 millicurie | Azedra | Yes | |||
A9600 | Strontium sr-89 chloride, therapeutic, per millicurie | Metastron | Yes | |||
A9604 | Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries | Quadramet | Yes | |||
A9606 | Radium ra-223 dichloride, therapeutic, per microcurie | Xofigo | Yes | |||
C9046 | COCAINE HCL NASAL SOLUTION | Goprelto | Yes | |||
C9047 | Injection, caplacizumab-yhdp, 1 mg (Cablivi) | Cablivi | Yes | |||
C9113 | INJECTION, PANTOPRAZOLE SODIUM, PER VIAL | Protonix | Yes | |||
C9248 | Inj, clevidipine butyrate | Cleviprex | Yes | |||
C9250 | Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml | Artiss | Yes | |||
C9254 | Injection, lacosamide | Vimpat | Yes | |||
C9257 | Bevacizumab injection | Avastin | Yes | |||
C9285 | Patch, lidocaine/tetracaine | Synera | Yes | |||
C9290 | INJ, BUPIVACAINE LIPOSOME | Exparel | Yes | |||
C9293 | INJECTION, GLUCARPIDASE | Voraxaze | Yes | |||
C9460 | INJECTION, CANGRELOR | Kengreal | Yes | |||
C9462 | INJECTION, DELAFLOXACIN | Baxdela | Yes | |||
C9482 | SOTALOL HYDROCHLORIDE IV | Sotalol Hcl | Yes | |||
C9488 | CONIVAPTAN HCL | Vaprisol | Yes | |||
J0121 | Injection, omadacycline, 1 mg | Nuzyra | Yes | |||
J0122 | Injection, eravacycline, 1 mg | Xerava | Yes | |||
J0129 | INJECTION ABATACEPT 10 MG | Orencia Clickject | Yes | |||
J0130 | INJECTION ABCIXIMAB, 10 MG | Reopro | Yes | |||
J0131 | Acetaminophen injection, not otherwise specified, 10mg | Ofirmev | Yes | |||
J0132 | INJECTION, ACETYLCYSTEINE, 100 MG | Acetadote | Yes | |||
J0133 | INJECTION, ACYCLOVIR, 5 MG | Acyclovir Sodium | Yes | |||
J0135 | INJECTION, ADALIMUMAB, 20 MG | Humira Pen | Yes | |||
J0153 | ADENOSINE INJ 1MG | Adenoscan | Yes | |||
J0171 | Adrenalin epinephrine inject | Epinephrine Pf | Yes | |||
J0178 | Injection, aflibercept, 1 mg | Eylea | Yes | |||
J0179 | Injection, brolucizumab-dbll, 1 mg | Beovu | Yes | |||
J0180 | INJECTION, AGALSIDASE BETA, 1 MG | Fabrazyme | Yes | |||
J0185 | INJ., APREPITANT, 1 MG | Cinvanti | Yes | |||
J0202 | INJECTION, ALEMTUZUMAB | Lemtrada | Yes | |||
J0207 | INJECTION, AMIFOSTINE, 500 MG | Ethyol | Yes | |||
J0210 | INJECTION, METHYLDOPATE HCL, UP TO 250 MG | Methyldopate Hcl | Yes | |||
J0221 | Injection, alglucosidase alfa, 10 mg | Lumizyme | Yes | |||
J0222 | Injection, patisiran, 0.1 mg | Onpattro | Yes | |||
J0223 | Injection, givosiran, 0.5 mg | Givlaari | Yes | |||
J0256 | INJECTION, ALPHA 1 - PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG | Prolastin-c | Yes | |||
J0257 | INJECTION, ALPHA 1 - PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG | Glassia | Yes | |||
J0270 | ALPROSTADIL, PER 1.25MCG | Caverject | Yes | |||
J0275 | ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRU | Muse | Yes | |||
J0278 | INJECTION, AMIKACIN SULFATE, 100 MG | Amikacin Sulfate | Yes | |||
J0280 | INJECTION, AMINOPHYLLIN, UP TO 250 MG | Aminophylline | Yes | |||
J0282 | INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG | Amiodarone Hcl | Yes | |||
J0285 | INJECTION, AMPHOTERICIN B, 50 MG | Amphotericin B | Yes | |||
J0287 | INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG | Abelcet | Yes | |||
J0289 | INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG | Ambisome | Yes | |||
J0290 | INJECTION, AMPICILLIN SODIUM, UP TO 500MG | Ampicillin Sodium | Yes | |||
J0291 | Injection, plazomicin, 5 mg | Zemdri | Yes | |||
J0295 | INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM | Unasyn | Yes | |||
J0300 | INJECTION, AMOBARBITAL, UP TO 125 MG | Amytal Sodium | Yes | |||
J0330 | INJECTION, SUCCINYCHOLINE CHLORIDE, UP TO 20 MG | Quelicin | Yes | |||
J0348 | INJECTION, ANIDULAFUNGIN, 1 MG | Eraxis | Yes | |||
J0360 | INJECTION, HYDRALAZINE HCL, UP TO 20 MG | Hydralazine Hcl | Yes | |||
J0364 | INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG | Apokyn | Yes | |||
J0401 | INJ ARIPIPRAZOLE EXT REL 1MG | Abilify Maintena | Yes | |||
J0456 | INJECTION, AZITHROMYCIN, 500 MG | Zithromax | Yes | |||
J0461 | Atropine sulfate injection | Atropine Sulfate | Yes | |||
J0470 | INJECTION, DIMECAPROL, UP TO 100 MG | Bal In Oil | Yes | |||
J0475 | INJECTION, BACLOFEN, 10 MG | Baclofen | Yes | |||
J0476 | INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL | Lioresal | Yes | |||
J0480 | INJECTION, BASILIXIMAB, 20 MG | Simulect | Yes | |||
J0485 | BELATACEPT INJECTION | Nulojix | Yes | |||
J0490 | Belimumab injection | Benlysta | Yes | |||
J0500 | INJECTION, DICYCLOMINE, UP TO 20 MG | Bentyl | Yes | |||
J0515 | INJECTION, BENZTROPINE | Cogentin | Yes | |||
J0517 | INJ., BENRALIZUMAB, 1 MG | Fasenra | yes | |||
J0558 | PenG benzathine/procaine inj | Bicillin C-R | Yes | |||
J0561 | Penicillin g benzathine inj | Bicillin L-A | Yes | |||
J0565 | INJ, BEZLOTOXUMAB, 10 MG | Zinplava | Yes | |||
J0567 | INJ., CERLIPONASE ALFA 1 MG | Brineura | Yes | |||
J0570 | BUPRENORPHINE IMPLANT, 74.2 MG | Probuphine Implant Kit | Yes | |||
J0571 | BUPRENORPHINE ORAL 1MG | Subutex | Yes | |||
J0572 | BUPRENORPHIN/NALOX UP TO 3MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0573 | BUPRENORPH/NALOX 3.1 TO 6MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0574 | BUPRENORPH/NALOX 6.1 TO 10MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0575 | BUPRENORPH/NALOX OVER 10MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0583 | INJECTION, BIVALIRUDIN, 1 MG | Angiomax | Yes | |||
J0584 | INJECTION, BUROSUMAB-TWZA 1M | Crysvita | Yes | |||
J0585 | BOTULINUM TOXIN TYPE A, PER UNIT | Botox | Yes | |||
J0586 | AbobotulinumtoxinA | Dysport | Yes | |||
J0587 | RimabotulinumtoxinB | Myobloc | Yes | |||
J0588 | IncobotulinumtoxinA | Xeomin | Yes | |||
J0591 | Injection, deoxycholic acid, 1 mg | Kybella | Yes | |||
J0592 | INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG | Buprenex | Yes | |||
J0593 | Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) | Takhzyro | Yes | |||
J0594 | INJECTION BUSULFAN 1 MG | Busulfex | Yes | |||
J0595 | INJECTION, BUTORPHANOL TARTRATE, 1 MG | Butorphanol Tartrate | Yes | |||
J0596 | Injection, C1 esterase inhibitor (recombinant), ruconest, 10 units | Ruconest | Yes | |||
J0597 | Injection, c-1 esterase inhibitor (human), berinert, 10 units | Berinert | Yes | |||
J0598 | Injection, c-1 esterase inhibitor (human), cinryze, 10 units | Cinryze | Yes | |||
J0599 | Injection, c-1 esterase inhibitor (human), haegarda, 10 units | Haegarda | Yes | |||
J0600 | INJECTION, EDETATE CALCIUM DISODIUM, UP TO 200 MG | Calcium Disodium Versenate | Yes | |||
J0604 | CINACALCET, ORAL, ESRD ON DIALYSIS | Sensipar | Yes | |||
J0606 | INJ, ETELCALCETIDE, 0.1 MG | Parsabiv | Yes | |||
J0610 | INJECTION, CALCIUM GLUCONATE(fresenius kabi), PER 10 ML | Calcium Gluconate | Yes | |||
J0630 | INJECTION, CALCITONIN SALMON, UP TO 400 UNITS | Miacalcin | Yes | |||
J0636 | INJECTION, CALCITRIOL, 0.1 MCG | Calcitriol | Yes | |||
J0637 | INJECTION, CASPOFUNGIN ACETATE, 5 MG | Cancidas | Yes | |||
J0638 | Canakinumab injection | Ilaris | Yes | |||
J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG | Leucovorin Calcium | Yes | |||
J0641 | Levoleucovorin injection | Levoleucovorin Calcium Pf | Yes | |||
J0642 | Injection, levoleucovorin (Khapzory), 0.5 mg | Khapzory | Yes | |||
J0670 | INJECTION, MEPIVACAINE | Polocaine-mpf | Yes | |||
J0690 | INJECTION, CEFAZOLIN SODIUM, UP TO 500 MG | Cefazolin Sodium | Yes | |||
J0691 | Injection, lefamulin, 1 mg | Xenleta | Yes | |||
J0692 | INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG | Cefepime Hcl | Yes | |||
J0694 | INJECTION, CEFOXITIN SODIUM, 1 GM | Cefoxitin Sodium | Yes | |||
J0695 | INJ CEFTOLOZANE AND TAZOBACTAM | Zerbaxa | Yes | |||
J0696 | INJECTION, CEFTRIAXONE SODIUM, PER 250 MG (ROCEPHIN) | Ceftriaxone Sodium | Yes | |||
J0697 | INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG | Zinacef | Yes | |||
J0698 | CEFOTAXIME SODIUM, PER GM | Cefotaxime Sodium | Yes | |||
J0702 | INJECTION; BETAMETHASONE ACETATE & SODIUM PHOSPHATE | Betamethasone Sod Phos & Acet | Yes | |||
J0706 | INJECTION, CAFFEINE CITRATE, 5MG | Caffeine Citrate | Yes | |||
J0712 | Ceftaroline fosamil inj | Teflaro | Yes | |||
J0713 | INJ CEFTAZIDIME PER 500 MG | Ceftazidime | Yes | |||
J0714 | CEFTAZIDIME AND AVIBACTAM | Avycaz | Yes | |||
J0716 | CENTRUROIDES IMMUNE F(AB) | Anascorp | Yes | |||
J0717 | CERTOLIZUMAB PEGOL INJ 1MG | Cimzia Starter Kit | Yes | |||
J0720 | INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM | Chloramphenicol Sod Succinate | Yes | |||
J0725 | INJECTION, CHORIONIC GONADOTROPIN | Novarel | Yes | |||
J0735 | INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG | Duraclon | Yes | |||
J0740 | INJECTION, CIDOFOVIR, 375 MG | Cidofovir | Yes | |||
J0742 | Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg | Recarbrio | Yes | |||
J0743 | INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG | Primaxin | Yes | |||
J0744 | INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG | Cipro IV | Yes | |||
J0770 | INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG | Coly-Mycin M | Yes | |||
J0775 | Collagenase, clost hist inj | Xiaflex | Yes | |||
J0780 | INJECTION, PROCHLORPERAZINE, UP TO 10 MG | Prochlorperazine Edisylate | Yes | |||
J0791 | Injection, crizanlizumab-tmca, 5 mg | Adakveo | Yes | |||
J0795 | INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM | Acthrel | Yes | |||
J0800 | INJECTION, CORTICOTROPIN, UP TO 40 UNITS | Acthar | Yes | |||
J0834 | Cosyntropin cortrosyn inj | Cosyntropin | Yes | |||
J0840 | Crotalidae poly immune fab | Crofab | Yes | |||
J0841 | INJ CROTALIDAE IM F(AB')2 EQ | Anavip | Yes | |||
J0850 | Injection, cytomegalovirus immune globulin IV | Cytogam | Yes | |||
J0875 | INJECTION, DALBAVANCIN | Dalvance | Yes | |||
J0878 | INJECTION, DAPTOMYCIN, 1 MG | Cubicin | Yes | |||
J0881 | INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE) | Aranesp | Yes | |||
J0882 | INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS) | Aranesp | Yes | |||
J0883 | ARGATROBAN NONESRD USE 1MG | Argatroban | Yes | |||
J0884 | ARGATROBAN ESRD DIALYSIS 1MG | Argatroban | Yes | |||
J0885 | INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS | Epogen, Procrit | Yes | |||
J0887 | EPOETIN BETA ESRD USE | Mircera | Yes | |||
J0888 | EPOETIN BETA NON ESRD | Mircera | Yes | |||
J0894 | INJECTION DECITABINE 1 MG | Decitabine | Yes | |||
J0895 | INJECTION, DEFEROXAMINE MESYLATE, 500 MG PER 5 CC | Desferal | Yes | |||
J0896 | Injection, luspatercept-aamt, 0.25 mg | Reblozyl | Yes | |||
J0897 | Denosumab injection | Prolia, Xgeva | Yes | |||
J1000 | INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG | Depo-estradiol | Yes | |||
J1020 | INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG | Depo-medrol | Yes | |||
J1030 | INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG | Methylprednisolone Acetate | Yes | |||
J1040 | INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG | Methylprednisolone Acetate | Yes | |||
J1050 | INJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG(DEPO PROVERA) | Depo-provera | Yes | |||
J1071 | INJ TESTOSTERONE CYPIONATE | Testosterone Cypionate | Yes | |||
J1095 | INJECTION, DEXAMETHASONE 9 PERCENT, INTRAOCULAR, 1 | Dexycu | Yes | |||
J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | Dextenza | Yes | |||
J1097 | Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | Omidria | Yes | |||
J1100 | INJECTION, DEXAMETHOSONE SODIUM PHOSPHATE, UP TO 4MG/ML | Dexamethasone Sodium Phosphate | Yes | |||
J1110 | INJECTION, DEHYDROERGOTAMINE, UP TO 1 MG | Dihydroergotamine Mesylate | Yes | |||
J1120 | INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG | Acetazolamide Sodium | Yes | |||
J1130 | INJ DICLOFENAC SODIUM 0.5MG | Dyloject | Yes | |||
J1160 | INJECTION, DIGOXIN, UP TO 0.5 MG | Lanoxin | Yes | |||
J1162 | INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL | Digifab | Yes | |||
J1165 | INJECTION, PHENYTOIN SODIUM | Phenytoin Sodium | Yes | |||
J1170 | INJECTION, HYDROMORPHONE, UP TO 4 MG | Dilaudid | Yes | |||
J1190 | INJECTION, DEXRAZOXANE HCL, PER 250 MG | Dexrazoxane Hcl | Yes | |||
J1200 | INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG | Diphenhydramine Hcl | Yes | |||
J1201 | Injection, cetirizine hydrochloride, 0.5 mg | Quzyttir | Yes | |||
J1205 | INJECTION, CHLOROTHIAZIDE SODIUM | Diuril | Yes | |||
J1212 | INJECTION, DMSO, DIMETHYL SULFOXIDE | Rimso-50 | Yes | |||
J1230 | INJECTION, METHADONE HCL, UP TO 10 MG | Methadone Hcl | Yes | |||
J1240 | INJECTION, DIMENHYDRINATE, UP TO 50 MG | Dimenhydrinate | Yes | |||
J1245 | INJECTION, DIPYRIDAMOLE, PER 10 MG | Dipyridamole | Yes | |||
J1250 | INJ DOBUTAMINE HCL/250 MG | Dobutamine Hcl | Yes | |||
J1260 | INJECTION, DOLASETRON MESYLATE, 10 MG | Anzemet | Yes | |||
J1265 | INJECTION, DOPAMINE HCL, 40 MG | Dopamine Hcl | Yes | |||
J1267 | Doripenem injection | Doribax | Yes | |||
J1270 | INJECTION, DOXERCALCIFEROL, 1 MCG | Hectorol | Yes | |||
J1290 | Ecallantide injection | Kalbitor | Yes | |||
J1300 | Eculizumab injection | Soliris | Yes | |||
J1301 | INJECTION, EDARAVONE, 1 MG | Radicava | Yes | |||
J1303 | Injection, ravulizumab-cwvz, 10 mg | Ultomiris | Yes | |||
J1322 | ELOSULFASE ALFA, INJECTION | Vimizim | Yes | |||
J1324 | Enfuvirtide injection | Fuzeon | Yes | |||
J1325 | INJECTION, EPOPROSTENOL, 0.5 MG | Flolan, Veletri | Yes | |||
J1327 | INJECTION, EPTIFIBATIDE, 5 MG | Integrilin | Yes | |||
J1335 | INJECTION, ERTAPENEM SODIUM, 500 MG | Invanz | Yes | |||
J1364 | INJECTION; ERYTHROMYCIN LACTOBIONA | Erythrocin Lactobionate | Yes | |||
J1380 | INJECTION, ESTRADIOL VALERATE, UP TO 10 MG | Estradiol Valerate | Yes | |||
J1410 | INJECTION, ESTROGEN CONJUGATED, UP TO 2 MG OR 20,000 UNITS | Premarin | Yes | |||
J1428 | INJ, ETEPLIRSEN, 10 MG | Exondys 51 | Yes | |||
J1429 | Injection, golodirsen, 10 mg | Vyondys 53 | Yes | |||
J1430 | INJECTION, ETHANOLAMINE OLEATE, 100 MG | Ethamolin | Yes | |||
J1437 | Injection, ferric derisomaltose, 10 mg | Monoferric | Yes | |||
J1438 | INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | Enbrel | Yes | |||
J1439 | INJ FERRIC CARBOXYMALTOSE 1MG | Injectafer | Yes | |||
J1442 | INJ, FILGRASTIM G-CSF 1MCG | Neupogen | Yes | |||
J1443 | Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron | Triferic | Yes | |||
J1444 | Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron | Triferic | Yes | |||
J1447 | INJ TBO FILGRASTIM 1 MICROG | Granix | Yes | |||
J1450 | INJECTION FLUCONAZOLE, 200 MG | Fluconazole In Sodium Chloride | Yes | |||
J1451 | INJECTION, FOMEPIZOLE, 15 MG | Fomepizole | Yes | |||
J1453 | Fosaprepitant injection | Emend | Yes | |||
J1454 | INJ FOSNETUPITANT AND PALONOSETRON | Akynzeo | Yes | |||
J1455 | INJECTION, FOSCARNET SODIUM, PER 1000 MG | Foscavir | Yes | |||
J1458 | INJECTION GALSULFASE 1 MG | Naglazyme | Yes | |||
J1459 | Inj IVIG privigen 500 mg | Privigen | Yes | |||
J1460 | INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC | Gamastan | Yes | |||
J1555 | INJ, IMMUNE GLOBULIN, CUVITRU, 100 MG | Cuvitru | Yes | |||
J1556 | INJ, IMM GLOB BIVIGAM, 500MG | Bivigam | Yes | |||
J1557 | Inj, immune globulin, Gammaplex, 500 mg | Gammaplex | Yes | |||
J1558 | Injection, immune globulin (xembify), 100 mg | Xembify | Yes | |||
J1559 | Inj, immune globulin, Hizentra, 100 mg | Hizentra | Yes | |||
J1560 | INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC | Gamastan | Yes | |||
J1561 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, PER 500 MG. | Gammaked, Gamunex-C | Yes | |||
J1566 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P | Carimune Nf | Yes | |||
J1568 | Octagam injection | Octagam | Yes | |||
J1569 | Gammagard liquid injection | Gammagard Liquid | Yes | |||
J1570 | INJECTION, GANCICLOVIR SODIUM, 500 MG | Ganciclovir Sodium | Yes | |||
J1571 | HepaGam B IM injection | Hepagam B | Yes | |||
J1572 | Flebogamma injection | Flebogamma Dif | Yes | |||
J1573 | Hepagam B intravenous, inj | Hepagam B | Yes | |||
J1575 | HYQVIA 100MG IMMUNEGLOBULIN | Hyqvia | Yes | |||
J1580 | INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG | Gentamicin Sulfate | Yes | |||
J1595 | INJECTION, GLATIRAMER ACETATE, 20 MG | Copaxone | Yes | |||
J1599 | Ivig non-lyophilized, NOS | Panzyga, Asceniv | Yes | |||
J1602 | GOLIMUMAB FOR IV USE 1MG | Simponi Aria | Yes | |||
J1610 | INJECTION; GLUCAGON HYDROCHLORIDE | Glucagon Emergency | Yes | |||
J1626 | INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG | Granisetron Hcl | Yes | |||
J1627 | INJ, GRANISETRON, XR, 0.1 MG | Sustol | Yes | |||
J1628 | INJ., GUSELKUMAB, 1 MG | Tremfya | Yes | |||
J1630 | INJECTION, HALOPERIDOL, UP TO 5 MG | Haldol Lactate | Yes | |||
J1631 | INJECTION, HALOPERIDOL DECANOATE, PER 50 MG | Haldol Decanoate | Yes | |||
J1632 | Injection, brexanolone, 1 mg | Zulresso | Yes | |||
J1640 | INJECTION, HEMIN, 1 MG | Panhematin | Yes | |||
J1642 | HEPARIN SODIUM PER 10 UNITS | Heparin Lock Flush | Yes | |||
J1644 | INJECTION, HEPARIN SODIUM, PER 1000 units | Heparin Sodium (porcine) | Yes | |||
J1645 | INJECTION, DALTEPARIN SODIUM, PER 2500 IU | Fragmin | Yes | |||
J1650 | INJ ENOXAPARIN SODIUM 30 MG | Lovenox | Yes | |||
J1652 | INJECTION, FONDAPARINUX SODIUM, 0.5 MG | Arixtra | Yes | |||
J1670 | INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS | Hypertet S/D | Yes | |||
J1675 | INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS | Vantas | Yes | |||
J1720 | INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG | Solu-cortef | Yes | |||
J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | Makena | Yes | |||
J1729 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | Hydroxyprogesterone Caproate | Yes | |||
J1730 | INJECTION, DIAZOXIDE, UP TO 300 MG | Yes | ||||
J1738 | Injection, meloxicam, 1 mg | Anjeso | Yes | |||
J1740 | INJECTION IBANDRONATE SODIUM 1 MG | Boniva | Yes | |||
J1741 | INJECTION, IBUPROFEN, 100 MG | Caldolor | Yes | |||
J1742 | INJECTION, IBUTILIDE FUMARATE, 1 MG | Corvert | Yes | |||
J1743 | Idursulfase injection | Elaprase | Yes | |||
J1744 | ICATIBANT INJECTION | Firazyr | Yes | |||
J1745 | INJECTION INFLIXIMAB, 10 MG | Remicade | Yes | |||
J1746 | INJ., IBALIZUMAB-UIYK, 10 MG | Trogarzo | Yes | |||
J1750 | INJECTION, IRON DEXTRAN, 50 MG | Infed | Yes | |||
J1756 | INJECTION, IRON SUCROSE, 1 MG | Venofer | Yes | |||
J1786 | Injection, imiglucerase, 10 units | Cerezyme | Yes | |||
J1790 | INJECTION, DROPERIDOL, UP TO 5 MG | Droperidol | Yes | |||
J1800 | INJECTION, PROPRANOLOL HCL, UP TO 1 MG | Propranolol Hcl | Yes | |||
J1815 | INJECTION, INSULIN, PER 5 UNITS | Multiple | Yes | |||
J1817 | INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS | Multiple | Yes | |||
J1826 | Interferon Beta-1A inj | Avonex Pen | Yes | |||
J1830 | INJECTION; INTERFERON BETA-1B | Betaseron | Yes | |||
J1833 | INJECTION, ISAVUCONAZONIUM | Cresemba | Yes | |||
J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | Toradol | Yes | |||
J1930 | Injection, lanreotide, 1 mg | Somatuline Depot | Yes | |||
J1931 | INJECTION, LARONIDASE, 0.1 MG | Aldurazyme | Yes | |||
J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | Lasix | Yes | |||
J1943 | Injection, aripiprazole lauroxil, (Aristada Initio), 1 mg | Aristada Initio | Yes | |||
J1944 | Injection, aripiprazole lauroxil, (Aristada), 1 mg | Aristada | Yes | |||
J1950 | Injection, leuprolide acetate, per 3.75mg | Lupron Depot | Yes | |||
J1953 | Levetiracetam injection | Keppra | Yes | |||
J1955 | INJ LEVOCARNITINE PER 1 GM | Carnitor | Yes | |||
J1956 | INJECTION, LEVOFLOXACIN, 250 MG | Levaquin | Yes | |||
J1980 | INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG | Levsin | Yes | |||
J2001 | INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG | Xylocaine | Yes | |||
J2010 | INJECTION, LINCOMYCIN HCL, UP TO 300 MG | Lincocin | Yes | |||
J2020 | INJECTION, LINEZOLID, 200MG | Zyvox | Yes | |||
J2060 | INJECTION, LORAZEPAM, 2 MG | Ativan | Yes | |||
J2062 | LOXAPINE FOR INHALATION 1 MG | Adasuve | Yes | |||
J2150 | INJECTION, MANNITOL, 25% IN 50 ML | Osmitrol | Yes | |||
J2170 | Mecasermin injection | Increlex | Yes | |||
J2175 | INJECTION, MEPERIDINE; PER 100MG | Demerol | Yes | |||
J2182 | INJECTION, MEPOLIZUMAB, 1MG | Nucala | Yes | |||
J2185 | INJECTION, MEROPENEM, 100 MG | Merrem | Yes | |||
J2186 | INJECTION, MEROPENEM AND VABORBACTAM, 10MG/10MG, (20 MG) | Vabomere | Yes | |||
J2210 | INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG | Methergine | Yes | |||
J2212 | METHYLNALTREXONE INJECTION | Relistor | Yes | |||
J2248 | INJECTION MICAFUNGIN SODIUM 1 MG | Mycamine | Yes | |||
J2250 | INJ MIDAZOLAM HYDROCHLORIDE (VERSED) | Versed | Yes | |||
J2260 | INJECTION; MILRIONONE LACTATE | Milrinone Lactate | Yes | |||
J2265 | Minocycline hydrochloride | Minocin | Yes | |||
J2270 | INJECTION, MORPHINE SULFATE, UP TO 10 MG | Morphine Sulfate | Yes | |||
J2274 | IN MORPHINE PRESERVATIV FREE | Morphine Sulfate (pf) | Yes | |||
J2278 | INJECTION, ZICONOTIDE, 1 MICROGRAM | Prialt | Yes | |||
J2280 | INJECTION, MOXIFLOXACIN, 100 MG | Avelox | Yes | |||
J2300 | INJ NALBUPHINE HYDROCHLORIDE | Nalbuphine Hcl | Yes | |||
J2310 | INJ NALOXONE HYDROCHLORIDE | Narcan | Yes | |||
J2315 | INJECTION NALTREXONE DEPOT FORM 1 MG | Vivitrol | Yes | |||
J2323 | Natalizumab injection | Tysabri | Yes | |||
J2325 | INJECTION, NESIRITIDE, 0.1 MG | Natrecor | Yes | |||
J2326 | INJ, NUSINERSEN, 0.1MG | Spinraza | Yes | |||
J2350 | Injection, ocrelizumab, 1 mg | Ocrevus | Yes | |||
J2353 | INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG | Sandostatin LAR Depot | Yes | |||
J2354 | INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJ, 25 MCG | Sandostatin | Yes | |||
J2357 | INJECTION, OMALIZUMAB, 5 MG | Xolair | Yes | |||
J2358 | Olanzapine long-acting inj | Zyprexa Relprevv | Yes | |||
J2360 | INJECTION, ORPHENADRINE, UP TO 60 MG | Orphenate | Yes | |||
J2370 | INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML | Phenylephrine Hcl | Yes | |||
J2405 | INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG | Zofran | Yes | |||
J2407 | INJECTION, ORITAVANCIN | Orbactiv | Yes | |||
J2410 | INJECTION, OXYMORPHONE HCL, UP TO 1 MG | Opana | Yes | |||
J2425 | INJECTION, PALIFERMIN, 50 MICROGRAMS | Kepivance | Yes | |||
J2426 | Inj, paliperidone palmitate extended release, 1 mg | Invega Sustenna, Invega Trinza | Yes | |||
J2430 | INJECTION; PAMIDRONATE DISODIUM | Aredia | Yes | |||
J2440 | INJECTION, PAPAVERINE HCL, UP TO 60 MG | Papaverine Hcl | Yes | |||
J2469 | INJECTION, PALONOSETRON HCL, 25 MCG | Aloxi | Yes | |||
J2501 | INJECTION, PARICALCITOL, 1 MCG | Zemplar | Yes | |||
J2502 | INJ, PASIREOTIDE LONG ACTING | Signifor LAR | Yes | |||
J2503 | INJECTION, PEGAPTANIB SODIUM, 0.3 MG | Macugen | Yes | |||
J2504 | INJECTION, PEGADEMASE BOVINE, 25 IU | Adagen | Yes | |||
J2507 | Pegloticase injection | Krystexxa | Yes | |||
J2510 | INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS | Penicillin G Procaine | Yes | |||
J2515 | INJECTION, PENTOBARBITAL SODIUM | Nembutal | Yes | |||
J2540 | INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS | Pfizerpen | Yes | |||
J2543 | INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS) | Zosyn | Yes | |||
J2545 | Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg | Nebupent | Yes | |||
J2547 | INJECTION, PERAMIVIR | Rapivab | Yes | |||
J2550 | INJECTION, PROMETHAZINE HCL, UP TO 50 MG | Phenergan | Yes | |||
J2560 | INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG | Phenobarbital Sodium | Yes | |||
J2562 | Plerixafor injection | Mozobil | Yes | |||
J2590 | INJECTION, OXYTOCIN, UP TO 10 UNITS | Pitocin | Yes | |||
J2597 | INJECTION DESMOPRESSIN ACETATE, PER 1 MCG | DDAVP | Yes | |||
J2675 | INJECTION, PROGESTERONE, PER 50MG | Progesterone in Oil | Yes | |||
J2680 | INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG | Prolixin Decanoate | Yes | |||
J2690 | INJECTION, PROCAINAMIDE HCL, UP TO 1 GM | Pronestyl | Yes | |||
J2700 | INJECTION, OXACILLIN SODIUM, UP TO 250 MG | Bactocill | Yes | |||
J2704 | INJ, PROPOFOL, 10 MG | Diprivan | Yes | |||
J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | Bloxiverz | Yes | |||
J2720 | INJECTION, PROTAMINE SULFATE, UP TO 5 ML | Protamine Sulfate | Yes | |||
J2724 | Injection, protein c concentrate, intravenous, human, 10 iu | Ceprotin | Yes | |||
J2730 | INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM | Protopam | Yes | |||
J2760 | INJECTION, PHENTOLAINE MESYLATE, UP TO 5 MG(REGITINE) | Phentolamine Mesylate | Yes | |||
J2765 | INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG | Reglan | Yes | |||
J2770 | INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350) | Synercid | Yes | |||
J2778 | Ranibizumab injection | Lucentis | Yes | |||
J2780 | INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG | Zantac | Yes | |||
J2783 | INJECTION, RASBURICASE, 0.5 MG | Elitek | Yes | |||
J2785 | Regadenoson injection | Lexiscan | Yes | |||
J2786 | INJECTION, RESLIZUMAB, 1MG | Cinqair | Yes | |||
J2787 | Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml | Photrexa Viscous | Yes | |||
J2788 | Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) | HyperRHO S/D | Yes | |||
J2790 | Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) | HyperRHO S/D, Rhogam Ultra-filtered Plus | Yes | |||
J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | Rhophylac | Yes | |||
J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | WinRho SDF | Yes | |||
J2793 | Rilonacept injection | Arcalyst | Yes | |||
J2794 | Injection, risperidone (Risperdal CONSTA), 0.5 mg | Risperdal Consta | Yes | |||
J2795 | INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG | Naropin | Yes | |||
J2796 | Romiplostim injection | Nplate | Yes | |||
J2797 | INJ., ROLAPITANT, 0.5 MG | Varubi | Yes | |||
J2798 | Injection, risperidone, (Perseris), 0.5 mg | Perseris | Yes | |||
J2800 | INJECTION, METHOCARBAMOL, UP TO 10 ML | Robaxin | Yes | |||
J2805 | INJECTION, SINCALIDE, 5 MICROGRAMS | Kinevac | Yes | |||
J2810 | INJECTION, THEOPHYLLINE, UP TO 2 ML | Theophylline | Yes | |||
J2820 | INJECTION, SARGRAMOSTIM (CM-CSF), 50 MCG | Leukine | Yes | |||
J2840 | INJECTION, SEBELIPASE ALFA, 1 MG | Kanuma | Yes | |||
J2850 | INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM | ChiRhoStim | Yes | |||
J2860 | INJECTION, SILTUXIMAB | Sylvant | Yes | |||
J2916 | INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG | Ferrlecit | Yes | |||
J2920 | INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG | Solu-medrol | Yes | |||
J2930 | INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG | Solu-medrol | Yes | |||
J2941 | INJECTION, SOMATROPIN, 1 MG | Serostim, Humatrope, Genotropin,Norditropin,Nutropin,Omnitrope,Saizen,Zomacton,Zorbtive | Yes | |||
J2993 | INJECTION, RETEPLASE, 18.1 MG | Retavase | Yes | |||
J2997 | INJECTION, ALTEPLASE RECOMBINANT, 1 MG | Activase | Yes | |||
J3000 | INJECTION, STREPTOMYCIN, UP TO 1 GM | Streptomycin Sulfate | Yes | |||
J3010 | INJECTION, FENTANYL CITRATE, 0.1 MG | Sublimaze | Yes | |||
J3030 | INJECTION; SUMATRIPTAN SUCCINATE; 6MG | Imitrex, Sumavel | Yes | |||
J3031 | Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered) | Ajovy | Yes | |||
J3032 | Injection, eptinezumab-jjmr, 1 mg | Vyepti | Yes | |||
J3060 | Injection, taliglucerase alfa, 10 units | Elelyso | Yes | |||
J3070 | INJECTION, PENTAZOCINE HCL, UP TO 30 MG | Talwin | Yes | |||
J3090 | INJ TEDIZOLID PHOSPHATE | Sivextro | Yes | |||
J3095 | Televancin injection | Vibativ | Yes | |||
J3101 | Tenecteplase injection | TNKase | Yes | |||
J3105 | INJECTION, TERBUTALINE SULFATE, UP TO 1 MG | Terbutaline Sulfate | Yes | |||
J3110 | INJECTION, TERIPARATIDE, 10 MCG | Forteo | Yes | |||
J3111 | Injection, romosozumab-aqqg, 1 mg | Evenity | Yes | |||
J3121 | INJ TESTOSTERO ENANTHATE 1MG | Delatestryl | Yes | |||
J3145 | TESTOSTERONE UNDECANOATE 1MG | Aveed | Yes | |||
J3230 | INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG | Thorazine | Yes | |||
J3240 | INJECTION, THYROTROPIN, UP TO 10 I.U. | Thyrogen | Yes | |||
J3241 | Injection, teprotumumab-trbw, 10 mg | Tepezza | Yes | |||
J3243 | INJECTION TIGECYCLINE 1 MG | Tygacil | Yes | |||
J3245 | INJ., TILDRAKIZUMAB, 1 MG | Ilumya | Yes | |||
J3246 | INJECTION, TIROFIBAN HCL, 0.25MG | Aggrastat | Yes | |||
J3250 | INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG | Tigan | Yes | |||
J3260 | INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG | Nebcin | Yes | |||
J3262 | Tocilizumab injection | Actemra | Yes | |||
J3285 | INJECTION, TREPROSTINIL, 1 MG | Remodulin | Yes | |||
J3300 | Triamcinolone A inj PRS-free | Triesence | Yes | |||
J3301 | INJECTION TRIAMCINOLONE ACETONIDE, PER 10MG | Kenalog | Yes | |||
J3303 | INJECTION TRIAMCINOLONE HEXACETONIDE, PER 5MG | Aristospan | Yes | |||
J3304 | INJ TRIAMCINOLONE ACE XR 1MG | Zilretta | Yes | |||
J3315 | INJECTION, TRIPTORELIN PAMOATE, 3.75 MG | Trelstar | Yes | |||
J3316 | INJ., TRIPTORELIN XR 3.75 MG | Triptodur | Yes | |||
J3355 | INJECTION, UROFOLLITROPIN, 75 IU | Bravelle | Yes | |||
J3357 | Ustekinumab, for subcutaneous injection, 1 mg | Stelara | Yes | |||
J3358 | Ustekinumab, for intravenous injection, 1 mg | Stelara | Yes | |||
J3360 | INJECTION, DIAZEPAM, UP TO 5 MG | Valium | Yes | |||
J3370 | INJECTION, VANCOMYCIN HCL, UP TO 500 MG | Vancocin | Yes | |||
J3380 | INJECTION, VEDOLIZUMAB | Entyvio | Yes | |||
J3385 | Velaglucerase alfa | Vpriv | Yes | |||
J3396 | INJECTION, VERTEPORFIN, 0.1 MG | Visudyne | Yes | |||
J3397 | INJ., VESTRONIDASE ALFA-VJBK | Mepsevii | Yes | |||
J3398 | Injection, voretigene neparvovec-rzyl, 1 billion vector genomes | Luxturna | Yes | |||
J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes | Zolgensma | Yes | |||
J3410 | INJECTION, HYDROXYZINE HCL, UP TO 25 MG | Vistaril | Yes | |||
J3411 | INJECTION, THIAMINE HCL, 100 MG | Thiamine Hcl | Yes | |||
J3415 | INJECTION, PYRIDOXINE HCL, 100 MG | Pyridoxine Hcl | Yes | |||
J3420 | INJECTION, VITAMIN B- 12 CYANOCOBALAMIN, UP TO 1000 MCG | Cyanocobalamin | Yes | |||
J3430 | Injection, phytonadione (vitamin k), per 1 mg | Aqua-Mephyton | Yes | |||
J3465 | INJECTION, VORICONAZOLE, 10 MG | Vfend IV | Yes | |||
J3470 | INJECTION, HYALURONIDASE, UP TO 150 UNITS | Amphadase | Yes | |||
J3471 | INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 US | Vitrase | Yes | |||
J3473 | INJECTION HYALURONIDASE RECOMBINANT 1 USP UNIT | Hylenex | Yes | |||
J3475 | INJ MAGNESIUM SULFATE | Magnesium Sulfate | Yes | |||
J3480 | INJ POTASSIUM CHLORIDE-2 MEQ | Potassium Chloride | Yes | |||
J3485 | INJECTION, ZIDOVUDINE, 10 MG | Retrovir | Yes | |||
J3486 | INJECTION, ZIPRASIDONE MESYLATE, 10 MG | Geodon | Yes | |||
J3489 | ZOLEDRONIC ACID 1MG | Reclast, Zometa | Yes | |||
J3490 | Unclassified drugs | Unclassified drugs | Yes | |||
J3590 | Unclassified biologics | Unclassified biologics | Yes | |||
J7030 | INFUSION, NORMAL SALINE SOLUTION , 1000 CC | Sodium Chloride | Yes | |||
J7040 | INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) | Sodium Chloride | Yes | |||
J7042 | 5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT) | Dextrose 5%-0.9% NaCl | Yes | |||
J7050 | INFUSION, NORMAL SALINE SOLUTION , 250 CC | Sodium Chloride | Yes | |||
J7060 | 5% DEXTROSE/WATER (500 ML = 1 UNIT) | Dextrose in water | Yes | |||
J7070 | INFUSION, D5W, 1000 CC | Dextrose in water | Yes | |||
J7100 | INFUSION, DEXTRAN 40, 500 ML | LMD | Yes | |||
J7120 | RINGERS LACTATE INFUSION, UP TO 1000 CC | Lactated Ringers | Yes | |||
J7121 | 5% DEXTROSE IN LAC RINGERS | Dextrose In Lactated Ringers | Yes | |||
J7169 | Injection, coagulation Factor Xa (recombinant), inactivated-zhzo (Andexxa), 10 mg | Andexxa | Yes | |||
J7170 | INJ., EMICIZUMAB-KXWH 0.5 MG | Hemlibra | Yes | |||
J7175 | INJ, FACTOR X, (HUMAN), 1IU | Coagadex | Yes | |||
J7177 | Injection, human fibrinogen concentrate (fibryga), 1 mg | Fibryga | Yes | |||
J7178 | HUMAN FIBRINOGEN CONC INJ | Riastap | Yes | |||
J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco | Vonvendi | Yes | |||
J7180 | Factor XIII anti-hem factor | Corifact | Yes | |||
J7181 | FACTOR XIII RECOMB A-SUBUNIT | Tretten | Yes | |||
J7182 | FACTOR VIII RECOMB NOVOEIGHT | Novoeight | Yes | |||
J7183 | Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco | Wilate | Yes | |||
J7185 | Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. | Xyntha | Yes | |||
J7186 | Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. | Alphanate/VWF Complex/Human | Yes | |||
J7187 | INJECTION VON WILLEBRAND FACTOR COMPLEX HUMAN RISTOCETIN COFACTOR PER IV | Humate-p | Yes | |||
J7188 | FACTOR VIII RECOMB OBIZUR | Obizur | Yes | |||
J7189 | Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram | NovoSeven RT | Yes | |||
J7190 | FACTOR VIII, (ANTI-HEMOPHILIC FACTOR (HUMAN)), PER I.U. | Hemofil M, Koate | Yes | |||
J7192 | FACTOR VIII (ANTIHEMOPHILIC FACTOR (RECOMBINANT)), PER I.U. | Recombinate, Advate, Kogenate, Helixate FS | Yes | |||
J7193 | FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U. | Mononine, Alphanine | Yes | |||
J7194 | FACTOR IX, COMPLEX, PER I.U. | Profilnine SD | Yes | |||
J7195 | FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U. | Ixinity, BeneFIX | Yes | |||
J7196 | Antithrombin recombinant | Atryn | Yes | |||
J7197 | ANTITHROMBIN III (HUMAN), PER I.U. | Thrombate III | Yes | |||
J7198 | ANTI-INHIBITOR, PER I.U. | Feiba NF | Yes | |||
J7200 | FACTOR IX RECOMBINAN RIXUBIS | Rixubis | Yes | |||
J7201 | FACTOR IX FC FUSION RECOMB | Alprolix | Yes | |||
J7202 | FACTOR IX IDELVION INJ | Idelvion | Yes | |||
J7203 | FACTOR IX RECOMB GLY REBINYN | Rebinyn | Yes | |||
J7204 | Injection, Factor VIII, antihemophilic factor (recombinant), (Esperoct), glycopegylated-exei, per IU | Esperoct | Yes | |||
J7205 | FACTOR VIII FC FUSION RECOMB | Eloctate | Yes | |||
J7207 | FACTOR VIII PEGYLATED RECOMB | Adynovate | Yes | |||
J7208 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. | Jivi | Yes | |||
J7209 | FACTOR VIII NUWIQ RECOMB 1IU | Nuwiq | Yes | |||
J7210 | INJ, AFSTYLA, 1 I.U. | Afstyla | Yes | |||
J7211 | INJ, KOVALTRY, 1 I.U. | Kovaltry | Yes | |||
J7296 | LEVONORGESTREL IU, KYLEENA, 19.5 MG | Kyleena | Yes | |||
J7297 | LEVONORGESTREL IU 52MG 3 YR | Liletta (52 Mg) | Yes | |||
J7298 | LEVONORGESTREL IU 52MG 5 YR | Mirena (52 Mg) | Yes | |||
J7300 | IUD COPPER | Paragard Intrauterine Copper | Yes | |||
J7301 | LEVONORGESTREL IU, SKYLA, 13.5MG | Skyla | Yes | |||
J7304 | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH | Xulane | Yes | |||
J7307 | Etonogestrel implant system | Nexplanon | Yes | |||
J7308 | AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOS | Levulan Kerastick | Yes | |||
J7311 | FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT | Retisert | Yes | |||
J7312 | Dexamethasone intravitreal implant | Ozurdex | Yes | |||
J7313 | FLUOCINOL ACET INTRAVITREAL IMPLANT | Iluvien | Yes | |||
J7314 | Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg | Yutiq | Yes | |||
J7315 | OPTHALMIC MITOMYCIN | Mitosol | Yes | |||
J7316 | INJ, OCRIPLASMIN, 0.125 MG | Jetrea | Yes | |||
J7318 | INJ, DUROLANE 1 MG | Durolane | Yes | |||
J7320 | HYALURONAN OR DERIVITIVE, GENVISC 850, FOR INTRA-ARTICULAR INJ, 1 MG | Genvisc 850 | Yes | |||
J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | Hyalgan; Supartz;Visco-3 | Yes | |||
J7322 | HYALURONAN OR DERIVATIVE, HYMOVIS, FOR INTRA-ARTICULAR INJECTION, 1 MG | Hymovis | Yes | |||
J7323 | Euflexxa inj per dose | Euflexxa | Yes | |||
J7324 | Orthovisc inj per dose | Orthovisc | Yes | |||
J7325 | Synvisc or Synvisc-One | Synvisc, Synvisc-One | Yes | |||
J7326 | Gel-one | Gel-one | Yes | |||
J7327 | MONOVISC INJ PER DOSE | Monovisc | Yes | |||
J7328 | GEL-SYN INJECTION 0.1 MG | Gelsyn-3 | Yes | |||
J7329 | INJ, TRIVISC 1 MG | Trivisc | Yes | |||
J7330 | AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT | MACI | Yes | |||
J7331 | Hyaluronan or derivative, SYNOJOYNT, for intra-articular injection, 1 mg | Synojoynt | Yes | |||
J7332 | Hyaluronan or derivative, Triluron, for intra-articular injection, 1 mg | Triluron | Yes | |||
J7336 | CAPSAICIN 8% PATCH | Qutenza | Yes | |||
J7340 | CARBIDOPA LEVODOPA ENTERAL | Duopa | Yes | |||
J7342 | Instillation, ciprofloxacin otic suspension, 6 mg | Otiprio | Yes | |||
J7345 | Aminolevulinic acid HCl for topical administration, 10% gel, 10mg | Ameluz | Yes | |||
J7351 | Injection, bimatoprost, intracameral implant, 1 mcg | Durysta | Yes | |||
J7500 | Azathioprine, oral, 50 mg | Imuran | Yes | |||
J7501 | Azathioprine, parenteral, 100 mg | Azathioprine Sodium | Yes | |||
J7502 | CYCLOSPORINE, ORAL, 100 MG | Sandimmune; Gengraf; Neoral | Yes | |||
J7503 | TACROL ENVARSUS EXT REL ORAL | Envarsus XR | Yes | |||
J7504 | LYMPHOCYTE IMMUNE GLOBULIN, ANTITYMOCYTE GLOBULIN - PARENTERAL, AMP, 5 | Atgam | Yes | |||
J7507 | TACROLIMUS, ORAL | Prograf | Yes | |||
J7508 | TACROLIMUS EXT REL ORAL 0.1MG | Astagraf XL | Yes | |||
J7509 | METHYLPREDNISOLONE ORAL | Medrol | Yes | |||
J7510 | PREDNISOLONE ORAL PER 5 MG | Prednisolone | Yes | |||
J7511 | LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, | Thymoglobulin | Yes | |||
J7512 | PREDNISONE IR OR DR ORAL 1MG | Deltasone | Yes | |||
J7513 | DACLIZUMAB, PARENTERAL, 25 MG | Zinbryta | Yes | |||
J7515 | CYCLOSPORINE, ORAL, 25 MG | Sandimmune; Gengraf, Neoral | Yes | |||
J7516 | CYCLOSPORIN, PARENTERAL, 250 MG | SandIMMUNE | Yes | |||
J7517 | MYCOPHENOLATE MOFETIL, ORAL, 250 MG | CellCept | Yes | |||
J7518 | MYCOPHENOLIC ACID, ORAL, 180 MG | Myfortic | Yes | |||
J7520 | SIROLIMUS, ORAL, 1 MG | Rapamune | Yes | |||
J7525 | TACROLIMUS, PARENTERAL, 5 MG | Prograf | Yes | |||
J7527 | ORAL EVEROLIMUS | Zortress | Yes | |||
J7605 | Arformoterol non-comp unit | Brovana | Yes | |||
J7606 | Formoterol fumarate, inh | Perforomist | Yes | |||
J7608 | ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE | Acetylcysteine | Yes | |||
J7611 | ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CO | Albuterol Sulfate | Yes | |||
J7612 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg | Xopenex | Yes | |||
J7613 | ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UN | Albuterol Sulfate | Yes | |||
J7614 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg | Xopenex | Yes | |||
J7620 | ALBUTEROL AND IPRATROPIUM INHAL.SOLUTION ADMIN. VIA DME | Ipratropium-albuterol | Yes | |||
J7626 | BUDESONIDE INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE FORM | Pulmicort Respules | Yes | |||
J7631 | CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE | Cromolyn Sodium | Yes | |||
J7639 | DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE F | Pulmozyme | Yes | |||
J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT | Atrovent | Yes | |||
J7665 | Mannitol for inhaler | Aridol | Yes | |||
J7674 | METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION TH | Provocholine | Yes | |||
J7677 | revefenacin inhalation solution | Yupelri | Yes | |||
J7682 | TOBRAMYCIN, UNIT DOSE FORM, 300 MG, INHALATION SOLUTION, ADMINISTERED THROUGH DME | Tobi; Bethkis; Kitabis | Yes | |||
J7686 | Treprostinil, non-comp unit | Tyvaso | Yes | |||
J8499 | Prescription drug, oral, non chemotherapeutic, nos | Prescription drug, oral, non chemotherapeutic, nos | Yes | |||
J8501 | APREPITANT, ORAL, 5 MG | Emend | Yes | |||
J8510 | BUSULFAN; ORAL, 2 MG | Myleran | Yes | |||
J8515 | CABERGOLINE, ORAL, 0.25 MG | Cabergoline | Yes | |||
J8520 | CAPECITABINE, ORAL, 150 MG | Xeloda | Yes | |||
J8521 | CAPECITABINE, ORAL, 500 MG | Xeloda | Yes | |||
J8530 | CYCLOPHOSPHAMIDE, ORAL | Cyclophosphamide | Yes | |||
J8540 | DEXAMETHASONE, ORAL, 0.25 MG | Dexamethasone | Yes | |||
J8560 | ETOPOSIDE, ORAL | VePesid | Yes | |||
J8565 | GEFITINIB, ORAL, 250 MG | Iressa | Yes | |||
J8600 | MELPHALAN | Alkeran | Yes | |||
J8610 | METHOTREXATE, ORAL | Methotrexate | Yes | |||
J8650 | Nabilone oral | Cesamet | Yes | |||
J8655 | NETUPITANT AND PALONOSETRON, ORAL | Akynzeo | Yes | |||
J8670 | ROLAPITANT, ORAL, 1MG | Varubi | Yes | |||
J8700 | TEMOZOLOMIDE, ORAL, 5 MG | Temodar | Yes | |||
J8705 | Topotecan oral | Hycamtin | Yes | |||
J8999 | Prescription drug, oral, chemotherapeutic, NOS | Prescription drug, oral, chemotherapeutic, NOS | Yes | |||
J9000 | DOXORUBICIN HCL, 10 MG | Adriamycin | Yes | |||
J9015 | ALDESLEUKIN/SINGLE USE VIAL | Proleukin | Yes | |||
J9017 | ARSENIC TRIOXIDE, 1MG | Trisenox | Yes | |||
J9019 | Injection, asparaginase (erwinaze), 1,000 iu | Erwinaze | Yes | |||
J9022 | INJ, ATEZOLIZUMAB,10 MG | Tecentriq | Yes | |||
J9023 | INJECTION, AVELUMAB, 10 MG | Bavencio | Yes | |||
J9025 | INJECTION, AZACITIDINE, 1 MG | Vidaza | Yes | |||
J9027 | INJECTION, CLOFARABINE, 1 MG | Clolar | Yes | |||
J9030 | Bcg live intravesical instillation, 1 mg | Tice BCG | Yes | |||
J9032 | INJECTION, BELINOSTAT, 10MG | Beleodaq | Yes | |||
J9033 | Bendamustine injection | Treanda | Yes | |||
J9034 | Inj., bendamustine hcl (bendeka), 1 mg | Bendeka | Yes | |||
J9035 | INJECTION, BEVACIZUMAB, 10 MG | Avastin | Yes | |||
J9036 | Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg | Belrapzo | Yes | |||
J9039 | INJECTION, BLINATUMOMAB | Blincyto | Yes | |||
J9040 | BLEOMYCIN SULFATE, 15 UNITS | Bleomycin Sulfate | Yes | |||
J9041 | INJECTION, BORTEZOMIB(VELCADE), 0.1 MG | Velcade | Yes | |||
J9042 | BRENTUXIMAB VEDOTIN INJ | Adcetris | Yes | |||
J9043 | Cabazitaxel injection | Jevtana | Yes | |||
J9045 | CARBOPLATIN, 50 MG | Paraplatin | Yes | |||
J9047 | INJECTION, CARFILZOMIB, 1 MG | Kyprolis | Yes | |||
J9050 | CARMUSTINE, 100 MG | BiCNU | Yes | |||
J9055 | INJECTION, CETUXIMAB, 10 MG | Erbitux | Yes | |||
J9057 | INJ., COPANLISIB, 1 MG | Aliqopa | Yes | |||
J9060 | CISPLATIN, POWDER OR S0LUTION, PER 10 MG | Platinol AQ | Yes | |||
J9065 | INJECTION; CLADRIBINE | Leustatin | Yes | |||
J9070 | CYCLOPHOSPHAMIDE, 100 MG | Cytoxan | Yes | |||
J9098 | CYTARABINE LIPOSOME, 10 MG | Depocyt | Yes | |||
J9100 | CYTARABINE 100 MG | Cytarabine (pf) | Yes | |||
J9118 | Injection, calaspargase pegol-mknl, 10 units | Asparlas | Yes | |||
J9119 | Injection, cemiplimab-rwlc, 1 mg | Libtayo | Yes | |||
J9120 | DACTINOMYCIN, 0.5 MG | Cosmegen | Yes | |||
J9130 | DACARBAZINE, 100 MG | DTIC-DOME IV | Yes | |||
J9145 | INJECTION, DARATUMUMAB 10 MG | Darzalex | Yes | |||
J9150 | DAUNORUBICIN HYDROCHLORIDE, 10 MG | Cerubidine | Yes | |||
J9151 | DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG | Daunoxome | Yes | |||
J9153 | INJ, LIPOSOMAL, DAUNORUBICIN AND CYTARABINE | Vyxeos | Yes | |||
J9155 | Degarelix injection | Firmagon | Yes | |||
J9171 | Docetaxel injection | Taxotere | Yes | |||
J9173 | INJ., DURVALUMAB, 10 MG | Imfinzi | Yes | |||
J9175 | INJECTION, ELLIOTTS' B SOLUTION, 1 ML | Elliotts B | Yes | |||
J9176 | INJECTION, ELOTUZUMAB, 1MG | Empliciti | Yes | |||
J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | Padcev | Yes | |||
J9178 | INJECTION, EPIRUBICIN HCL, 2 MG | Ellence | Yes | |||
J9179 | Eribulin mesylate injection | Halaven | Yes | |||
J9181 | ETOPOSIDE, 10 MG | Etoposide | Yes | |||
J9185 | FLUDARABINE PHOSPHATE, 50 MG | Fludara | Yes | |||
J9190 | FLUOROURACIL, 500 MG | Adrucil | Yes | |||
J9198 | Injection, gemcitabine hydrochloride, (Infugem), 100 mg | Infugem | Yes | |||
J9200 | FLOXURIDINE, 500 MG | Floxuridine | Yes | |||
J9201 | GEMCITABINE HCL, 200 MG | Gemzar | Yes | |||
J9202 | GOSERELIN ACETATE IMPLANT, PER 3.6 MG | Zoladex | Yes | |||
J9203 | GEMTUZUMAB OZOGAMICIN 0.1 MG | Mylotarg | Yes | |||
J9204 | Injection, mogamulizumab-kpkc, 1 mg | Poteligeo | Yes | |||
J9205 | INJ IRINOTECAN LIPOSOME 1 MG | Onivyde | Yes | |||
J9206 | IRINOTECAN, 20 MG | Camptosar | Yes | |||
J9207 | Ixabepilone injection | Ixempra Kit | Yes | |||
J9208 | IFOSFAMIDE, 1 GM | Ifex | Yes | |||
J9209 | MESNA, 200 MG | Mesnex | Yes | |||
J9210 | Injection, emapalumab-lzsg, 1 mg | Gamifant | Yes | |||
J9211 | IDARUBICIN HYDROCHLORIDE, 5 MG | Idamycin PFS | Yes | |||
J9214 | INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS | Intron A | Yes | |||
J9215 | INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU | Alferon N | Yes | |||
J9216 | INTERFERON, GAMMA 1-B, 3 MILLION UNITS | Actimmune | Yes | |||
J9217 | LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG | Eligard, Lupron Depot | Yes | |||
J9218 | LEUPROLIDE ACETATE, PER 1 MG | Leuprolide Acetate | Yes | |||
J9225 | HISTRELIN IMPLANT, 50 MG | Vantas | Yes | |||
J9226 | Supprelin LA implant | Supprelin LA | Yes | |||
J9227 | Injection, isatuximab-irfc, 10 mg | Sarclisa | Yes | |||
J9228 | Ipilimumab injection | Yervoy | Yes | |||
J9229 | INJ INOTUZUMAB OZOGAM 0.1 MG | Besponsa | Yes | |||
J9230 | MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG | Mustargen | Yes | |||
J9245 | INJECTION; MELPHALAN HCL | Alkeran | Yes | |||
J9246 | Injection, melphalan (Evomela), 1 mg | Evomela | Yes | |||
J9250 | METHOTREXATE SODIUM, 5 MG | Methotrexate Sodium | Yes | |||
J9260 | METHOTREXATE SODIUM, 50 MG | Methotrexate Sodium | Yes | |||
J9261 | INJECTION NELARABINE 50 MG | Arranon | Yes | |||
J9262 | INJ, OMACETAXINE MEP, 0.01MG | Synribo | Yes | |||
J9263 | INJECTION, OXALIPLATIN, 0.5 MG | Eloxatin | Yes | |||
J9264 | INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG | Abraxane | Yes | |||
J9266 | PEGASPARGASE/SINGL DOSE VIAL | Oncaspar | Yes | |||
J9267 | PACLITAXEL INJECTION | Taxol | Yes | |||
J9268 | PENTOSTATIN, PER 10 MG (NIPENT) | Nipent | Yes | |||
J9269 | Injection, tagraxofusp-erzs, 10 mcg | Elzonris | Yes | |||
J9271 | INJ PEMBROLIZUMAB | Keytruda | Yes | |||
J9280 | MITOMYCIN, 5 MG | Mutamycin | Yes | |||
J9285 | INJ, OLARATUMAB, 10 MG | Lartruvo | Yes | |||
J9293 | MITOXANTRONE HYDROCHLORIDE, 20 MG-1994,1995=5MG | Novantrone | Yes | |||
J9295 | INJECTION, NECITUMUMAB, 1 MG | Portrazza | Yes | |||
J9299 | INJECTION, NIVOLUMAB | Opdivo | Yes | |||
J9301 | OBINUTUZUMAB INJ | Gazyva | Yes | |||
J9302 | Ofatumumab injection | Arzerra | Yes | |||
J9303 | Panitumumab injection | Vectibix | Yes | |||
J9304 | Injection, pemetrexed (Pemfexy), 10 mg | Pemfexy | Yes | |||
J9305 | INJECTION, PEMETREXED, not otherwise specified, 10 MG | Alimta | Yes | |||
J9306 | INJECTION, PERTUZUMAB, 1 MG | Perjeta | Yes | |||
J9307 | Pralatrexate injection | Folotyn | Yes | |||
J9308 | INJECTION, RAMUCIRUMAB | Cyramza | Yes | |||
J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | Polivy | Yes | |||
J9311 | INJ RITUXIMAB, HYALURONIDASE | Rituxan Hycela | Yes | |||
J9312 | INJ., RITUXIMAB, 10 MG | Rituxan | Yes | |||
J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | Lumoxiti | Yes | |||
J9320 | STREPTOZOCIN, 1 GM | Zanosar | Yes | |||
J9325 | INJ TALIMOGENE LAHERPAREPVEC | Imlygic | Yes | |||
J9328 | Temozolomide injection | Temodar | Yes | |||
J9330 | Temsirolimus injection | Torisel | Yes | |||
J9340 | THIOTEPA, 15 MG | Tepadina | Yes | |||
J9351 | Topotecan injection | Hycamtin | Yes | |||
J9352 | INJECTION TRABECTEDIN 0.1MG | Yondelis | Yes | |||
J9354 | INJ, ADO-TRASTUZUMAB EMT 1MG | Kadcyla | Yes | |||
J9355 | TRASTUZUMAB, 10 MG | Herceptin | Yes | |||
J9356 | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk | Herceptin Hylecta | Yes | |||
J9357 | VALRUBICIN, INTRAVESICAL, 200 MG | Valstar | Yes | |||
J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | Enhertu | Yes | |||
J9360 | VINBLASTINE SULFATE, 1 MG | Vinblastine Sulfate | Yes | |||
J9370 | VINCRISTINE SULFATE, 1 MG | Vincasar PFS | Yes | |||
J9371 | INJ, VINCRISTINE SUL LIP 1MG | Marqibo | Yes | |||
J9390 | VINORELBINE TARTRATE/10 MG | Navelbine | Yes | |||
J9395 | INJECTION, FULVESTRANT, 25 MG | Faslodex | Yes | |||
J9400 | INJ, ZIV-AFLIBERCEPT, 1MG | Zaltrap | Yes | |||
J9600 | PORFIMER SODIUM, 75 MG | Photofrin | Yes | |||
P9045 | INFUSION, ALBUMIN (HUMAN), 5%, 250 ML | Plasbumin-5 | Yes | |||
P9046 | INFUSION, ALBUMIN (HUMAN), 25%, 20 ML | Albutein | Yes | |||
P9047 | INFUSION, ALBUMIN (HUMAN), 25%, 50 ML | Albuminar-25 | Yes | |||
Q0138 | Ferumoxytol, non-esrd | Feraheme | Yes | |||
Q0139 | Ferumoxytol, esrd use | Feraheme | Yes | |||
Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | Zithromax | Yes | |||
Q0162 | Ondansetron oral | Zofran | Yes | |||
Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION AN | Benadryl | Yes | |||
Q0164 | PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EM | Compazine | Yes | |||
Q0166 | GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EM | Kytril | Yes | |||
Q0167 | DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE | Marinol | Yes | |||
Q0169 | PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANT | Phenergan | Yes | |||
Q0175 | PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE | Perphenazine | Yes | |||
Q0177 | HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, | Vistaril | Yes | |||
Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml | Renacidin | Yes | |||
Q2009 | INJECTION, FOSPHENYTOIN, 50 MG | Cerebyx | Yes | |||
Q2028 | INJ, SCULPTRA, 0.5MG | Sculptra | Yes | |||
Q2041 | Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Yescarta | Yes | |||
Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Kymriah | Yes | |||
Q2043 | Sipuleucel-T auto CD54+ | Provenge | Yes | |||
Q2050 | Inj, doxorubicin, liposomal, not otherwise specified, 10 mg | Doxil | Yes | |||
Q3027 | INJ BETA INTERFERON IM 1 MCG | Avonex | Yes | |||
Q3028 | INJ BETA INTERFERON SQ 1 MCG | Rebif | Yes | |||
Q4074 | Iloprost non-comp unit dose | Ventavis | Yes | |||
Q4081 | INJECTION EPOETIN ALFA 100 UNITS (FOR ESRD ON DIALYSIS) | Epogen, Procrit | Yes | |||
Q5101 | INJ FILGRASTIM G-CSF BIOSIM | Zarxio | Yes | |||
Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | Inflectra | Yes | |||
Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | Renflexis | Yes | |||
Q5105 | Inj, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Retacrit | Yes | |||
Q5106 | Inj, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Retacrit | Yes | |||
Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | Mvasi | Yes | |||
Q5108 | Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg | Fulphila | Yes | |||
Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg | Ixifi | Yes | |||
Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 mcg | Nivestym | Yes | |||
Q5111 | Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg | Udenyca | Yes | |||
Q5112 | Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg | Ontruzant | Yes | |||
Q5113 | Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg | Herzuma | Yes | |||
Q5114 | Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg | Ogivri | Yes | |||
Q5115 | Injection, rituximab-abbs, biosimilar, 10 mg | Truxima | Yes | |||
Q5116 | Injection, trastuzumab-qyyp, biosimilar, (Trazimera), 10 mg | Trazimera | Yes | |||
Q5117 | Injection, trastuzumab-anns, biosimilar, (Kanjinti), 10 mg | Kanjinti | Yes | |||
Q5118 | Injection, bevacizumab-bvcr, biosimilar, (Zirabev), 10 mg | Zirabev | Yes | |||
Q5119 | Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg | Ruxience | Yes | |||
Q5120 | Injection, pegfilgrastim-bmez, biosimilar, (ZIEXTENZO), 0.5 mg | Ziextenzo | Yes | |||
Q5121 | Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mg | Avsola | Yes | |||
Q9991 | BUPRENORPH XR 100 MG OR LESS | Sublocade | Yes | |||
Q9992 | BUPRENORPHINE XR OVER 100 MG | Sublocade | Yes | |||
S0012 | BUTORPHANOL TARTRATE, NASAL SPRAY, 25 MG | Butorphanol Tartrate | Yes | |||
S0017 | INJECTION, AMINOCAPROIC ACID, 5 GRAMS | Aminocaproic Acid | Yes | |||
S0020 | INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML | Marcaine; Sensorcaine | Yes | |||
S0028 | INJECTION, FAMOTIDINE, 20 MG | Pepcid | Yes | |||
S0030 | INJECTION, METRONIDAZOLE, 500 MG | Flagyl | Yes | |||
S0032 | INJECTION, NAFCILLIN SODIUM, 2 GRAMS | Nafcillin Sodium | Yes | |||
S0039 | INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML | Sulfamethoxazole-trimethoprim | Yes | |||
S0073 | INJECTION, AZTREONAM, 500 MG | Azactam | Yes | |||
S0074 | INJECTION, CEFOTETAN DISODIUM, 500 MG | Cefotan | Yes | |||
S0077 | INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG | Cleocin Phosphate | Yes | |||
S0078 | INJECTION, FOSPHENYTOIN SODIUM, 750 MG | Cerebyx | Yes | |||
S0080 | INJECTION, PENTAMIDINE ISETHIONATE, 300 MG | Pentam | Yes | |||
S0088 | Imatinib, 100 mg | Gleevec | Yes | |||
S0090 | SILDENAFIL CITRATE, 25 MG | Viagra | Yes | |||
S0091 | Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166) | Kytril | Yes | |||
S0092 | Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) | Dilaudid | Yes | |||
S0093 | INJECTION, MORPHINE SULFATE, 500 MG (LOADING DOSE FOR INFUSION PUMP) | Morphine Sulfate | Yes | |||
S0104 | ZIDOVUDINE, ORAL, 100 MG | Retrovir | Yes | |||
S0106 | BUPROPION HCL SUSTAINED RELEASE TABLET, 150 MG, PER BOTTLE OF 60 TABLETS | Wellbutrin SR | Yes | |||
S0108 | MERCAPTOPURINE, ORAL, 50 MG | Purixan | Yes | |||
S0109 | METHADONE, ORAL, 5MG | Dolophine; Methadose | Yes | |||
S0117 | TRETINOIN, TOPICAL, 5 GRAMS | Retin-A; Altreno | Yes | |||
S0119 | Ondansetron 4 mg | Zofran | Yes | |||
S0122 | INJECTION, MENOTROPINS, 75 IU | Menopur | Yes | |||
S0126 | INJECTION, FOLLITROPIN ALFA, 75 IU | Gonal-f Rff | Yes | |||
S0128 | INJECTION, FOLLITROPIN BETA, 75 IU | Follistim AQ | Yes | |||
S0132 | INJECTION, GANIRELIX ACETATE, 250 MCG | Ganirelix Acetate | Yes | |||
S0136 | CLOZAPINE, 25 MG | Clozaril | Yes | |||
S0137 | DIDANOSINE (DDI), 25 MG | Videx; Videx EC | Yes | |||
S0138 | FINASTERIDE, 5 MG | Proscar | Yes | |||
S0139 | MINOXIDIL, 10 MG | Minoxidil | Yes | |||
S0140 | SAQUINAVIR, 200 MG | Invirase | Yes | |||
S0145 | INJECTION, PEGYLATED INTERFERON ALFA-2A, 180 MCG PER ML | Pegasys | Yes | |||
S0148 | Peg interferon alfa-2b, 10 mcg | PegIntron; Sylatron | Yes | |||
S0155 | STERILE DILUTANT FOR EPOPROSTENOL, 50ML | Diluent For Epoprostenol | Yes | |||
S0156 | EXEMESTANE, 25 MG | Aromasin | Yes | |||
S0157 | BECAPLERMIN GEL 0.01%, 0.5 GM | Regranex | Yes | |||
S0160 | DEXTROAMPHETAMINE SULFATE, 5 MG | Dexedrine | Yes | |||
S0164 | INJECTION, PANTOPRAZOLE SODIUM, 40 MG | Protonix | Yes | |||
S0166 | INJECTION, OLANZAPINE, 2.5 MG | Zyprexa | Yes | |||
S0169 | Calcitrol, 0.25 mcg | Rocaltrol | Yes | |||
S0170 | ANASTROZOLE, ORAL, 1MG | Arimidex | Yes | |||
S0171 | INJECTION, BUMETANIDE, 0.5MG | Bumex | Yes | |||
S0172 | CHLORAMBUCIL, ORAL, 2MG | Leukeran | Yes | |||
S0174 | DOLASETRON MESYLATE, ORAL 50MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDI | Anzemet | Yes | |||
S0175 | FLUTAMIDE, ORAL, 125MG | Eulexin | Yes | |||
S0176 | HYDROXYUREA, ORAL, 500MG | Hydrea | Yes | |||
S0178 | LOMUSTINE, ORAL, 10MG | Gleostine | Yes | |||
S0179 | MEGESTROL ACETATE, ORAL, 20MG | Megace ES | Yes | |||
S0182 | PROCARBAZINE HYDROCHLORIDE, ORAL, 50MG | Matulane | Yes | |||
S0183 | PROCHLORPERAZINE MALEATE, ORAL, 5MG (FOR CIRCUMSTANCES FALLING UNDER THE | Compazine | Yes | |||
S0187 | TAMOXIFEN CITRATE, ORAL, 10MG | Tamoxifen Citrate | Yes | |||
S0189 | TESTOSTERONE PELLET, 75MG | Testopel | Yes | |||
S0190 | MIFEPRISTONE, ORAL, 200 MG | Mifeprex | Yes | |||
S0191 | MISOPROSTOL, ORAL, 200 MCG | Cytotec | Yes | |||
S0197 | Prenatal vitamins, 30-day supply | Prenatal Vitamin And Mineral | Yes | |||
S4991 | Nicotine patches, non-legend | Nicoderm CQ | Yes | |||
S4993 | Contraceptive pills for birth control | Multiple | Yes | |||
S4995 | Smoking cessation gum | Nicorette | Yes | |||
S5010 | 5% dextrose and 0.45% normal saline, 1000 ml | Dextrose-sodium chloride | Yes | |||
S5550 | Insulin, rapid onset, 5 units | Apidra | Yes | |||
S5551 | Insulin, most rapid onset (lispro or aspart); 5 units | Multiple | Yes | |||
S5552 | Insulin, intermediate acting (nph or lente); 5 units | Humulin N; Novolin N | Yes | |||
S5553 | Insulin, long acting; 5 units | Multiple | Yes | |||
S5561 | Insulin delivery device, reusable pen; 3 ml size | Yes | ||||
S5566 | Insulin cartridge for use in insulin delivery device other than pump; 300 units | Yes | ||||
S5570 | Insulin delivery device, disposable pen (including insulin); 1.5 ml size | Toujeo Solostar | Yes | |||
S5571 | Insulin delivery device, disposable pen (including insulin); 3 ml size | Multiple | Yes | |||
S8490 | Insulin syringes (100 syringes, any size) | Insulin syringes (100 syringes, any size) | Yes | |||
C1052 | HEMOSTATIC AGT GASTROINTESTINAL TOP | HEMOSTATIC AGT GASTROINTESTINAL TOP | Yes | |||
J1823 | Injection, inebilizumab-cdon, 1 mg | Uplizna | Yes | |||
J7212 | Factor viia (antihemophilic factor, recombinant)- jncw (sevenfact), 1 microgram | Sevenfact | Yes | |||
J7352 | Afamelanotide implant, 1 mg | Scenesse | Yes | |||
J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | Darzalex Faspro | Yes | |||
J9223 | Injection, lurbinectedin, 0.1 mg | Zepzelca | Yes | |||
J9281 | Mitomycin pyelocalyceal instillation, 1 mg | Jelmyto | Yes | |||
J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg | Phesgo | Yes | |||
J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | Trodelvy | Yes | |||
M0243 | IV INFUSION CASIRIVIMAB & IMDEVIMAB MONITORING | IV INFUSION CASIRIVIMAB & IMDEVIMAB MONITORING | Yes | |||
Q0239 | INJECTION BAMLANIVIMAB-XXXX 700 MG | INJECTION BAMLANIVIMAB-XXXX 700 MG | Yes | |||
Q0243 | INJ CASIRIVIMAB & IMDEVIMAB 2400 MG | INJ CASIRIVIMAB & IMDEVIMAB 2400 MG | Yes | |||
Q5122 | Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg | Nyvepria | Yes | |||
S0013 | Esketamine, nasal spray, 1 mg | Spravato | Yes | |||
M0245 | IV INF Bamlanivimab and etesevimab, monitoring | IV INF Bamlanivimab and etesevimab, monitoring | Yes | |||
Q0245 | INJ Bamlanivimab and etesevimab | Bamlanivimab and etesevimab | Yes | |||
J1427 | Injection, viltolarsen, 10 mg | Viltepso | Yes | |||
J1554 | Injection, immune globulin (Asceniv), 500 mg | Asceniv | Yes | |||
J9037 | Injection, belantamab mafodontin-blmf, 0.5 mg | Blenrep | Yes | |||
J9349 | Injection, tafasitamab-cxix, 2 mg | Monjuvi | Yes | |||
Q2053 | Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Tecartus | Yes | |||
J7402 | Mometasone furoate sinus implant, (Sinuva), 10 mcg | Sinuva | Yes | |||
S1091 | Stent, non-coronary, temporary, with delivery system(propel) | Propel | Yes | |||
M0244 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence | n/a | Yes | |||
M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence | n/a | Yes | |||
J0224 | INJECTION LUMASIRAN 0.5 MG | Oxlumo | Yes | |||
J1951 | INJ LEU AC FOR DEP SUSP 0.25 MG | Fensolvi | Yes | |||
J7168 | PRT CMPLX CONC KCNTRA PR IU FIX ACT | Kecentra | Yes | |||
J9348 | INJECTION NAXITAMAB-GQGK 1 MG | Danyelza | Yes | |||
J9353 | INJECTION MARGETUXIMAB-CMKB 5 MG | Margenza | Yes | |||
Q5123 | INJ RITUXIMAB-ARRX BIOSIMILAR 10 MG | Riabni | Yes | |||
Q0247 | injection, sotrovimab 500mg | n/a | Yes | |||
M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | n/a | Yes | |||
Q0244 | injection, casirivimab and imdevimab, 1200mg | n/a | Yes | |||
Q0249 | INJ TOCILIZUMAB HP PT 2 YRS & > COVID-19 1 MG | n/a | Yes | |||
M0249 | IV TCZ HP PT 2 & > COVID-19 INC INF & PA MON FD | n/a | Yes | |||
M0250 | IV TCZ HP 2 & > COVID-19 INC INF & PA MON 2ND D | n/a | Yes | |||
Q0240 | Injection, casirivimab and imdevimab, 600 mg | casirivimab and imdevimab | Yes | |||
M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses | n/a | Yes | |||
M0241 | ntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence | n/a | Yes | |||
J1305 | Injection, evinacumab-dgnb, 5mg | Evkeeza | Yes | |||
J1426 | Injection, casimersen, 10 mg | Amondys 45 | Yes | |||
J1448 | Injection, trilaciclib, 1mg | Cosela | Yes | |||
J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | n/a | Yes | |||
J9319 | Injection, romidepsin, lyophilized, 0.1 mg | Istodax | Yes | |||
Q2054 | Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Breyanzi | Yes | |||
J0699 | Injection, cefiderocol, 10 mg | Fetroja | Yes | |||
J0741 | Injection, cabotegravir and rilpivirine, 2mg/3mg | Cabenuva | Yes | |||
J1445 | Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron | Triferic AVNU | Yes | |||
J2406 | Injection, oritavancin (kimyrsa), 10 mg | Kimyrsa | Yes | |||
J7294 | Segesterone acetate and ethinyl estradiol 0.15 mg, 0.013 mg per 24 hours; yearly vaginal system, each | Annovera | Yes | |||
J7295 | Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each | Nuvaring | Yes | |||
J1952 | Leuprolide injectable, camcevi, 1 mg | Camcevi | Yes | |||
J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | Neulasta | Yes | |||
J9021 | Injection, asparaginase, recombinant, (Rylaze), 0.1 mg | Rylaze | Yes | |||
J9061 | Injection, amivantamab-vmjw, 2 mg | Rybrevant | Yes | |||
J9272 | Injection, dostarlimab-gxly, 10 mg | Jemperli | Yes | |||
Q2055 | Idecabtagene vicleucel, up to 460 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Abecma | Yes | |||
C9088 | Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg | Zynrelef | Yes | |||
C9089 | Bupivacaine, collagen-matrix implant, 1 mg | Xaracoll | Yes | |||
J0172 | Injection, aducanumab-avwa, 2 mg | Aduhelm | Yes | |||
Q0220 | tixagevimab and cilgavimab | Evusheld | Yes | |||
M0220 | tixagevimab and cilgavimab administration code | Evusheld (administration code) | Yes | |||
M0221 | tixagevimab and cilgavimab home administration code | Evusheld ( home administration code) | Yes | |||
J0248 | injection, remdesivir | Veklury | Yes | |||
Q0222 | injection, bebtelovimab, 175mg | bebtelovimab | yes | |||
M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | yes | |||
J0219 | Injection, avalglucosidase alfa-ngpt, 4 mg | Nexviazyme | Yes | |||
J0491 | Injection, anifrolumab-fnia, 1 mg | Saphnelo | Yes | |||
J0879 | Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) | Korsuva | Yes | |||
J9273 | Injection, tisotumab vedotin-tftv, 1 mg | Tivdak | Yes | |||
J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | Zynlonta | Yes | |||
Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | Byooviz | Yes | |||
J9071 | Injection, cyclophosphamide, (auromedics), 5 mg | cyclophosphamide | Yes | |||
Q0221 | Injection, tixagevimab and cilgavimab, for pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg | Evusheld | Yes | |||
J2998 | Injection, plasminogen, human-tvmh, 1 mg | Ryplazim | Yes | |||
J9331 | Injection, sirolimus protein-bound particles, 1 mg | Fyarro | Yes | |||
J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | Xipere | Yes | |||
J2779 | Injection, ranibizumab, via sustained release intravitreal implant | Susvimo | Yes | |||
J0739 | Injection, cabotegravir, 1 mg | Apretude | Yes | |||
J1306 | Injection, inclisiran, 1 mg | Leqvio | Yes | |||
J1551 | Injection, immune globulin (cutaquig), 100 mg | Cutaquig | Yes | |||
J2356 | Injection, tezepelumab-ekko, 1 mg | Tezspire | Yes | |||
J9332 | Injection, efgartigimod alfa-fcab, 2 mg | Vyvgart | Yes | |||
Q2017 | injection, teniposide, 50mg | Vumon | Yes | |||
J9999 | not otherwise classified, antineoplastic drugs | n/a | Yes | |||
J7599 | immunosuppressive drugs, not otherwise classified, | Yes | ||||
C9399 | unclassified drugs or biologicals | Yes | ||||
C9101 | Injection, oliceridine, 0.1 mg | Olinvyk | Yes | |||
J1302 | Injection, sutimlimab-jome, 10 mg | Enjaymo | Yes | |||
J1932 | Injection, lanreotide, (Cipla), 1 mg | Cipla | Yes | |||
J2777 | Injection, faricimab-svoa, 0.1 mg | Vabysmo | Yes | |||
J9274 | Injection, tebentafusp-tebn, 1 mcg | kimmtrak | Yes | |||
J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | Opdualag | Yes | |||
Q2056 | Ciltacabtagene autoleucel, up to 100 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Carvykti | Yes | |||
Q5125 | Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg | Releuko | Yes | |||
A9607 | Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie | Pluvicto | Yes | |||
C9143 | Cocaine hydrochloride nasal solution (numbrino), 1 mg | Numbrino | Yes | |||
C9144 | Injection, bupivacaine (posimir), 1 mg | Posimir | Yes | |||
J0134 | Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to J0131, 10mg | Fresenius Kabi 505(b)2 | Yes | |||
J0136 | Injection, acetaminophen (b braun) not therapeutically equivalent to J0131, 10mg | B. Braun 505(b)2 | Yes | |||
J0173 | Injection, epinephrine (belcher) not therapeutically equivalent to J0171, 0.1mg | Belcher/Bpi lanbs 505(b)(2) | Yes | |||
J0225 | Injection, vutrisiran, 1 mg | Amvuttra | Yes | |||
J0283 | Injection, amiodarone hydrochloride (nexterone), 30 mg | Nexterone 505(b)(2) | Yes | |||
J0611 | Injection, calcium gluconate (wg critical care), per 10 ml | WG Critical Care 505(b)(2) | Yes | |||
J0689 | Injection, cefazolin sodium (baxter), not therapeutically equivalent to J0690, 500mg | Baxter 505(b)(2) | Yes | |||
J0701 | Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500mg | Baxter 505(b)(2) | Yes | |||
J0703 | Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500mg | B.Braun 505(b)(2) | Yes | |||
J0877 | Injection, daptomycin (hospira), not therapeutically equivalent to J0878, 1 mg | Hospira 505(b)(2) | Yes | |||
J0891 | Injection, argatroban (accord), not therapeutically equivalent to J0883, 1 mg(for non-esrd use) | Accord 505(b)(2) | Yes | |||
J0892 | Injection, argatroban (accord), not therapeutically equivalent to J0884, 1mg (for esrd on dialysis) | Accord 505(b)(2) | Yes | |||
J0893 | Injection, decitabine (sun pharma) not therapeutically equivalent to J0894, 1mg | Sun Pharma 505(b)(2) | Yes | |||
J0898 | Injection, argatroban (auromedics), not therapeutically equivalent to J0883, 1mg (for non-esrd use) | Auromedics/Eugia 505(b)(2) | Yes | |||
J0899 | Injection, argatroban (auromedics), not therapeutically equivalent to J0884, 1mg (for esrd on dialysis) | Auromedics/Eugia 505(b)(2) | Yes | |||
J1456 | Injection, fosaprepitant (teva), not therapeutically equivalent to J1453, 1mg | Teva/Actavis 505(b)(2) | Yes | |||
J1574 | Injection, ganciclovir sodium (exela) not therapeutically equivalent to J1570, 500mg | Exela 505(b)(2) | Yes | |||
J1611 | Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to J1610, per 1mg | Fresenius Kabi 505(b)(2) | Yes | |||
J1643 | Injection, heparin sodium (pfizer), not therapeutically equivalent to J1644, per 1000 units | Pfizer 505 (b)(2) | Yes | |||
J1954 | Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg | Lutrate | Yes | |||
J2021 | Injection, linezolid (hospira) not therapeutically equivalent to J2020, 200 mg | Hospira 505(b)(2) | Yes | |||
J2184 | Injection, meropenem (b. braun) not therapeutically equivalent to J2185, 100mg | B.Braun 505(b)(2) | Yes | |||
J2247 | Injection, micafungin sodium (par pharm) not therapeutically equivalent to J2248, 1mg | Par 505(b)(2) | Yes | |||
J2251 | Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to J2250, 1mg | WG Critical Care 505(b)(2) | Yes | |||
J2272 | Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to J2270, up to 10mg | Fresenius Kabi 505(b)(2) | Yes | |||
J2281 | Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to J2280, 100mg | Fresenius Kabi 505(b)(2) | Yes | |||
J2311 | Injection, naloxone hydrochloride (zimhi), 1 mg | Zimhi | Yes | |||
J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | Skyrizi | Yes | |||
J2401 | Injection, chloroprocaine hydrochloride, per 1 mg | Nesacaine | Yes | |||
J2402 | Injection, chloroprocaine hydrochloride, per 1 mg | Clorotekal | Yes | |||
J3244 | Injection, tigecycline (accord) not therapeutically equivalent to J3243, 1mg | Accord 505(b)(2) | Yes | |||
J3371 | Injection, vancomycin hcl (mylan) not therapeutically equivalent to J3370, 500mg | Mylan 505(b)(2) | Yes | |||
J3372 | Injection, vancomycin hcl (xellia) not therapeutically equivalent to J3370, 500mg | Xellia 505(b)(2) | Yes | |||
J9046 | Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to J9041, 0.1mg | Dr. Reddy's 505(b)(2) | Yes | |||
J9048 | Injection, bortezomib (fresenius kabi), not therapeutically equivalent to J9041, 0.1mg | Fresenius Kabi 505(b)(2) | Yes | |||
J9049 | Injection, bortezomib (hospira), not therapeutically equivalent to J9041, 0.1mg | Hospira 505(b)(2) | Yes | |||
J9314 | Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10mg | Teva 505(b)(2) | Yes | |||
J9393 | Injection, fulvestrant (teva) not therapeutically equivalent to J9395, 25mg | Teva/Actavis 505(b)(2) | Yes | |||
J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to J9395, 25mg | Fresenius Kabi 505(b)(2) | Yes | |||
Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | Alymsys | Yes |
HCPCS CODE | HCPCS CODE DESCRIPTION | DRUG NAME | INTEGRITY - Authorization Required | INTEGRITY - COVERED (No PA Required) | INTEGRITY-Not Covered | Auth Required if Prescribed for an Oncology/Hematology Related Indication |
---|---|---|---|---|---|---|
90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use | Synagis | Yes | |||
A9513 | Lutetium lu 177, dotatate, therapeutic, 1 millicurie | Lutathera | Yes | |||
A9517 | Iodine- i-131 sodium iodide capsule(s), therapeutic, per millicurie | Hicon | Yes | |||
A9543 | Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries | Zevalin Y-90 | Yes | |||
A9590 | Iodine i-131, iobenguane, 1 millicurie | Azedra | Yes | |||
A9600 | Strontium sr-89 chloride, therapeutic, per millicurie | Metastron | Yes | |||
A9604 | Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries | Quadramet | Yes | |||
A9606 | Radium ra-223 dichloride, therapeutic, per microcurie | Xofigo | Yes | |||
C9046 | COCAINE HCL NASAL SOLUTION | Goprelto | Yes | |||
C9047 | Injection, caplacizumab-yhdp, 1 mg (Cablivi) | Cablivi | Yes | |||
C9113 | INJECTION, PANTOPRAZOLE SODIUM, PER VIAL | Protonix | Yes | |||
C9248 | Inj, clevidipine butyrate | Cleviprex | Yes | |||
C9250 | Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml | Artiss | Yes | |||
C9254 | Injection, lacosamide | Vimpat | Yes | |||
C9257 | Bevacizumab injection | Avastin | Yes | |||
C9285 | Patch, lidocaine/tetracaine | Synera | Yes | |||
C9290 | INJ, BUPIVACAINE LIPOSOME | Exparel | Yes | |||
C9293 | INJECTION, GLUCARPIDASE | Voraxaze | Yes | |||
C9460 | INJECTION, CANGRELOR | Kengreal | Yes | |||
C9462 | INJECTION, DELAFLOXACIN | Baxdela | Yes | |||
C9482 | SOTALOL HYDROCHLORIDE IV | Sotalol Hcl | Yes | |||
C9488 | CONIVAPTAN HCL | Vaprisol | Yes | |||
J0121 | Injection, omadacycline, 1 mg | Nuzyra | Yes | |||
J0122 | Injection, eravacycline, 1 mg | Xerava | Yes | |||
J0129 | INJECTION ABATACEPT 10 MG | Orencia Clickject | Yes | |||
J0130 | INJECTION ABCIXIMAB, 10 MG | Reopro | Yes | |||
J0131 | Acetaminophen injection, not otherwise specified, 10mg | Ofirmev | Yes | |||
J0132 | INJECTION, ACETYLCYSTEINE, 100 MG | Acetadote | Yes | |||
J0133 | INJECTION, ACYCLOVIR, 5 MG | Acyclovir Sodium | Yes | |||
J0135 | INJECTION, ADALIMUMAB, 20 MG | Humira Pen | Yes | |||
J0153 | ADENOSINE INJ 1MG | Adenoscan | Yes | |||
J0171 | Adrenalin epinephrine inject | Epinephrine Pf | Yes | |||
J0178 | Injection, aflibercept, 1 mg | Eylea | Yes | |||
J0179 | Injection, brolucizumab-dbll, 1 mg | Beovu | Yes | |||
J0180 | INJECTION, AGALSIDASE BETA, 1 MG | Fabrazyme | Yes | |||
J0185 | INJ., APREPITANT, 1 MG | Cinvanti | Yes | |||
J0202 | INJECTION, ALEMTUZUMAB | Lemtrada | Yes | |||
J0207 | INJECTION, AMIFOSTINE, 500 MG | Ethyol | Yes | |||
J0210 | INJECTION, METHYLDOPATE HCL, UP TO 250 MG | Methyldopate Hcl | Yes | |||
J0221 | Injection, alglucosidase alfa, 10 mg | Lumizyme | Yes | |||
J0222 | Injection, patisiran, 0.1 mg | Onpattro | Yes | |||
J0223 | Injection, givosiran, 0.5 mg | Givlaari | Yes | |||
J0256 | INJECTION, ALPHA 1 - PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG | Prolastin-c | Yes | |||
J0257 | INJECTION, ALPHA 1 - PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG | Glassia | Yes | |||
J0270 | ALPROSTADIL, PER 1.25MCG | Caverject | Yes | |||
J0275 | ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRU | Muse | Yes | |||
J0278 | INJECTION, AMIKACIN SULFATE, 100 MG | Amikacin Sulfate | Yes | |||
J0280 | INJECTION, AMINOPHYLLIN, UP TO 250 MG | Aminophylline | Yes | |||
J0282 | INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG | Amiodarone Hcl | Yes | |||
J0285 | INJECTION, AMPHOTERICIN B, 50 MG | Amphotericin B | Yes | |||
J0287 | INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG | Abelcet | Yes | |||
J0289 | INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG | Ambisome | Yes | |||
J0290 | INJECTION, AMPICILLIN SODIUM, UP TO 500MG | Ampicillin Sodium | Yes | |||
J0291 | Injection, plazomicin, 5 mg | Zemdri | Yes | |||
J0295 | INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM | Unasyn | Yes | |||
J0300 | INJECTION, AMOBARBITAL, UP TO 125 MG | Amytal Sodium | Yes | |||
J0330 | INJECTION, SUCCINYCHOLINE CHLORIDE, UP TO 20 MG | Quelicin | Yes | |||
J0348 | INJECTION, ANIDULAFUNGIN, 1 MG | Eraxis | Yes | |||
J0360 | INJECTION, HYDRALAZINE HCL, UP TO 20 MG | Hydralazine Hcl | Yes | |||
J0364 | INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG | Apokyn | Yes | |||
J0401 | INJ ARIPIPRAZOLE EXT REL 1MG | Abilify Maintena | Yes | |||
J0456 | INJECTION, AZITHROMYCIN, 500 MG | Zithromax | Yes | |||
J0461 | Atropine sulfate injection | Atropine Sulfate | Yes | |||
J0470 | INJECTION, DIMECAPROL, UP TO 100 MG | Bal In Oil | Yes | |||
J0475 | INJECTION, BACLOFEN, 10 MG | Baclofen | Yes | |||
J0476 | INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL | Lioresal | Yes | |||
J0480 | INJECTION, BASILIXIMAB, 20 MG | Simulect | Yes | |||
J0485 | BELATACEPT INJECTION | Nulojix | Yes | |||
J0490 | Belimumab injection | Benlysta | Yes | |||
J0500 | INJECTION, DICYCLOMINE, UP TO 20 MG | Bentyl | Yes | |||
J0515 | INJECTION, BENZTROPINE | Cogentin | Yes | |||
J0517 | INJ., BENRALIZUMAB, 1 MG | Fasenra | Yes | |||
J0558 | PenG benzathine/procaine inj | Bicillin C-R | Yes | |||
J0561 | Penicillin g benzathine inj | Bicillin L-A | Yes | |||
J0565 | INJ, BEZLOTOXUMAB, 10 MG | Zinplava | Yes | |||
J0567 | INJ., CERLIPONASE ALFA 1 MG | Brineura | Yes | |||
J0570 | BUPRENORPHINE IMPLANT, 74.2 MG | Probuphine Implant Kit | Yes | |||
J0571 | BUPRENORPHINE ORAL 1MG | Subutex | Yes | |||
J0572 | BUPRENORPHIN/NALOX UP TO 3MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0573 | BUPRENORPH/NALOX 3.1 TO 6MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0574 | BUPRENORPH/NALOX 6.1 TO 10MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0575 | BUPRENORPH/NALOX OVER 10MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0583 | INJECTION, BIVALIRUDIN, 1 MG | Angiomax | Yes | |||
J0584 | INJECTION, BUROSUMAB-TWZA 1M | Crysvita | Yes | |||
J0585 | BOTULINUM TOXIN TYPE A, PER UNIT | Botox | Yes | |||
J0586 | AbobotulinumtoxinA | Dysport | Yes | |||
J0587 | RimabotulinumtoxinB | Myobloc | Yes | |||
J0588 | IncobotulinumtoxinA | Xeomin | Yes | |||
J0591 | Injection, deoxycholic acid, 1 mg | Kybella | Yes | |||
J0592 | INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG | Buprenex | Yes | |||
J0593 | Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) | Takhzyro | Yes | |||
J0594 | INJECTION BUSULFAN 1 MG | Busulfex | Yes | |||
J0595 | INJECTION, BUTORPHANOL TARTRATE, 1 MG | Butorphanol Tartrate | Yes | |||
J0596 | Injection, C1 esterase inhibitor (recombinant), ruconest, 10 units | Ruconest | Yes | |||
J0597 | Injection, c-1 esterase inhibitor (human), berinert, 10 units | Berinert | Yes | |||
J0598 | Injection, c-1 esterase inhibitor (human), cinryze, 10 units | Cinryze | Yes | |||
J0599 | Injection, c-1 esterase inhibitor (human), haegarda, 10 units | Haegarda | Yes | |||
J0600 | INJECTION, EDETATE CALCIUM DISODIUM, UP TO 200 MG | Calcium Disodium Versenate | Yes | |||
J0604 | CINACALCET, ORAL, ESRD ON DIALYSIS | Sensipar | Yes | |||
J0606 | INJ, ETELCALCETIDE, 0.1 MG | Parsabiv | Yes | |||
J0610 | INJECTION, CALCIUM GLUCONATE(fresenius kabi), PER 10 ML | Calcium Gluconate | Yes | |||
J0630 | INJECTION, CALCITONIN SALMON, UP TO 400 UNITS | Miacalcin | Yes | |||
J0636 | INJECTION, CALCITRIOL, 0.1 MCG | Calcitriol | Yes | |||
J0637 | INJECTION, CASPOFUNGIN ACETATE, 5 MG | Cancidas | Yes | |||
J0638 | Canakinumab injection | Ilaris | Yes | |||
J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG | Leucovorin Calcium | Yes | |||
J0641 | Levoleucovorin injection | Levoleucovorin Calcium Pf | Yes | |||
J0642 | Injection, levoleucovorin (Khapzory), 0.5 mg | Khapzory | Yes | |||
J0670 | INJECTION, MEPIVACAINE | Polocaine-mpf | Yes | |||
J0690 | INJECTION, CEFAZOLIN SODIUM, UP TO 500 MG | Cefazolin Sodium | Yes | |||
J0691 | Injection, lefamulin, 1 mg | Xenleta | Yes | |||
J0692 | INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG | Cefepime Hcl | Yes | |||
J0694 | INJECTION, CEFOXITIN SODIUM, 1 GM | Cefoxitin Sodium | Yes | |||
J0695 | INJ CEFTOLOZANE AND TAZOBACTAM | Zerbaxa | Yes | |||
J0696 | INJECTION, CEFTRIAXONE SODIUM, PER 250 MG (ROCEPHIN) | Ceftriaxone Sodium | Yes | |||
J0697 | INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG | Zinacef | Yes | |||
J0698 | CEFOTAXIME SODIUM, PER GM | Cefotaxime Sodium | Yes | |||
J0702 | INJECTION; BETAMETHASONE ACETATE & SODIUM PHOSPHATE | Betamethasone Sod Phos & Acet | Yes | |||
J0706 | INJECTION, CAFFEINE CITRATE, 5MG | Caffeine Citrate | Yes | |||
J0712 | Ceftaroline fosamil inj | Teflaro | Yes | |||
J0713 | INJ CEFTAZIDIME PER 500 MG | Ceftazidime | Yes | |||
J0714 | CEFTAZIDIME AND AVIBACTAM | Avycaz | Yes | |||
J0716 | CENTRUROIDES IMMUNE F(AB) | Anascorp | Yes | |||
J0717 | CERTOLIZUMAB PEGOL INJ 1MG | Cimzia Starter Kit | Yes | |||
J0720 | INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM | Chloramphenicol Sod Succinate | Yes | |||
J0725 | INJECTION, CHORIONIC GONADOTROPIN | Novarel | Yes | |||
J0735 | INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG | Duraclon | Yes | |||
J0740 | INJECTION, CIDOFOVIR, 375 MG | Cidofovir | Yes | |||
J0742 | Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg | Recarbrio | Yes | |||
J0743 | INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG | Primaxin | Yes | |||
J0744 | INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG | Cipro IV | Yes | |||
J0770 | INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG | Coly-Mycin M | Yes | |||
J0775 | Collagenase, clost hist inj | Xiaflex | Yes | |||
J0780 | INJECTION, PROCHLORPERAZINE, UP TO 10 MG | Prochlorperazine Edisylate | Yes | |||
J0791 | Injection, crizanlizumab-tmca, 5 mg | Adakveo | Yes | |||
J0795 | INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM | Acthrel | Yes | |||
J0800 | INJECTION, CORTICOTROPIN, UP TO 40 UNITS | Acthar | Yes | |||
J0834 | Cosyntropin cortrosyn inj | Cosyntropin | Yes | |||
J0840 | Crotalidae poly immune fab | Crofab | Yes | |||
J0841 | INJ CROTALIDAE IM F(AB')2 EQ | Anavip | Yes | |||
J0850 | Injection, cytomegalovirus immune globulin IV | Cytogam | Yes | |||
J0875 | INJECTION, DALBAVANCIN | Dalvance | Yes | |||
J0878 | INJECTION, DAPTOMYCIN, 1 MG | Cubicin | Yes | |||
J0881 | INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE) | Aranesp | Yes | |||
J0882 | INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS) | Aranesp | Yes | |||
J0883 | ARGATROBAN NONESRD USE 1MG | Argatroban | Yes | |||
J0884 | ARGATROBAN ESRD DIALYSIS 1MG | Argatroban | Yes | |||
J0885 | INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS | Epogen, Procrit | Yes | |||
J0887 | EPOETIN BETA ESRD USE | Mircera | Yes | |||
J0888 | EPOETIN BETA NON ESRD | Mircera | Yes | |||
J0894 | INJECTION DECITABINE 1 MG | Decitabine | Yes | |||
J0895 | INJECTION, DEFEROXAMINE MESYLATE, 500 MG PER 5 CC | Desferal | Yes | |||
J0896 | Injection, luspatercept-aamt, 0.25 mg | Reblozyl | Yes | |||
J0897 | Denosumab injection | Prolia, Xgeva | Yes | |||
J1000 | INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG | Depo-estradiol | Yes | |||
J1020 | INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG | Depo-medrol | Yes | |||
J1030 | INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG | Methylprednisolone Acetate | Yes | |||
J1040 | INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG | Methylprednisolone Acetate | Yes | |||
J1050 | INJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG(DEPO PROVERA) | Depo-provera | Yes | |||
J1071 | INJ TESTOSTERONE CYPIONATE | Testosterone Cypionate | Yes | |||
J1095 | INJECTION, DEXAMETHASONE 9 PERCENT, INTRAOCULAR, 1 | Dexycu | Yes | |||
J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | Dextenza | Yes | |||
J1097 | Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | Omidria | Yes | |||
J1100 | INJECTION, DEXAMETHOSONE SODIUM PHOSPHATE, UP TO 4MG/ML | Dexamethasone Sodium Phosphate | Yes | |||
J1110 | INJECTION, DEHYDROERGOTAMINE, UP TO 1 MG | Dihydroergotamine Mesylate | Yes | |||
J1120 | INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG | Acetazolamide Sodium | Yes | |||
J1130 | INJ DICLOFENAC SODIUM 0.5MG | Dyloject | Yes | |||
J1160 | INJECTION, DIGOXIN, UP TO 0.5 MG | Lanoxin | Yes | |||
J1162 | INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL | Digifab | Yes | |||
J1165 | INJECTION, PHENYTOIN SODIUM | Phenytoin Sodium | Yes | |||
J1170 | INJECTION, HYDROMORPHONE, UP TO 4 MG | Dilaudid | Yes | |||
J1190 | INJECTION, DEXRAZOXANE HCL, PER 250 MG | Dexrazoxane Hcl | Yes | |||
J1200 | INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG | Diphenhydramine Hcl | Yes | |||
J1201 | Injection, cetirizine hydrochloride, 0.5 mg | Quzyttir | Yes | |||
J1205 | INJECTION, CHLOROTHIAZIDE SODIUM | Diuril | Yes | |||
J1212 | INJECTION, DMSO, DIMETHYL SULFOXIDE | Rimso-50 | Yes | |||
J1230 | INJECTION, METHADONE HCL, UP TO 10 MG | Methadone Hcl | Yes | |||
J1240 | INJECTION, DIMENHYDRINATE, UP TO 50 MG | Dimenhydrinate | Yes | |||
J1245 | INJECTION, DIPYRIDAMOLE, PER 10 MG | Dipyridamole | Yes | |||
J1250 | INJ DOBUTAMINE HCL/250 MG | Dobutamine Hcl | Yes | |||
J1260 | INJECTION, DOLASETRON MESYLATE, 10 MG | Anzemet | Yes | |||
J1265 | INJECTION, DOPAMINE HCL, 40 MG | Dopamine Hcl | Yes | |||
J1267 | Doripenem injection | Doribax | Yes | |||
J1270 | INJECTION, DOXERCALCIFEROL, 1 MCG | Hectorol | Yes | |||
J1290 | Ecallantide injection | Kalbitor | Yes | |||
J1300 | Eculizumab injection | Soliris | Yes | |||
J1301 | INJECTION, EDARAVONE, 1 MG | Radicava | Yes | |||
J1303 | Injection, ravulizumab-cwvz, 10 mg | Ultomiris | Yes | |||
J1322 | ELOSULFASE ALFA, INJECTION | Vimizim | Yes | |||
J1324 | Enfuvirtide injection | Fuzeon | Yes | |||
J1325 | INJECTION, EPOPROSTENOL, 0.5 MG | Flolan, Veletri | Yes | |||
J1327 | INJECTION, EPTIFIBATIDE, 5 MG | Integrilin | Yes | |||
J1335 | INJECTION, ERTAPENEM SODIUM, 500 MG | Invanz | Yes | |||
J1364 | INJECTION; ERYTHROMYCIN LACTOBIONA | Erythrocin Lactobionate | Yes | |||
J1380 | INJECTION, ESTRADIOL VALERATE, UP TO 10 MG | Estradiol Valerate | Yes | |||
J1410 | INJECTION, ESTROGEN CONJUGATED, UP TO 2 MG OR 20,000 UNITS | Premarin | Yes | |||
J1428 | INJ, ETEPLIRSEN, 10 MG | Exondys 51 | Yes | |||
J1429 | Injection, golodirsen, 10 mg | Vyondys 53 | Yes | |||
J1430 | INJECTION, ETHANOLAMINE OLEATE, 100 MG | Ethamolin | Yes | |||
J1437 | Injection, ferric derisomaltose, 10 mg | Monoferric | Yes | |||
J1438 | INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | Enbrel | Yes | |||
J1439 | INJ FERRIC CARBOXYMALTOSE 1MG | Injectafer | Yes | |||
J1442 | INJ, FILGRASTIM G-CSF 1MCG | Neupogen | Yes | |||
J1443 | Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron | Triferic | Yes | |||
J1444 | Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron | Triferic | Yes | |||
J1447 | INJ TBO FILGRASTIM 1 MICROG | Granix | Yes | |||
J1450 | INJECTION FLUCONAZOLE, 200 MG | Fluconazole In Sodium Chloride | Yes | |||
J1451 | INJECTION, FOMEPIZOLE, 15 MG | Fomepizole | Yes | |||
J1453 | Fosaprepitant injection | Emend | Yes | |||
J1454 | INJ FOSNETUPITANT AND PALONOSETRON | Akynzeo | Yes | |||
J1455 | INJECTION, FOSCARNET SODIUM, PER 1000 MG | Foscavir | Yes | |||
J1458 | INJECTION GALSULFASE 1 MG | Naglazyme | Yes | |||
J1459 | Inj IVIG privigen 500 mg | Privigen | Yes | |||
J1460 | INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC | Gamastan | Yes | |||
J1555 | INJ, IMMUNE GLOBULIN, CUVITRU, 100 MG | Cuvitru | Yes | |||
J1556 | INJ, IMM GLOB BIVIGAM, 500MG | Bivigam | Yes | |||
J1557 | Inj, immune globulin, Gammaplex, 500 mg | Gammaplex | Yes | |||
J1558 | Injection, immune globulin (xembify), 100 mg | Xembify | Yes | |||
J1559 | Inj, immune globulin, Hizentra, 100 mg | Hizentra | Yes | |||
J1560 | INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC | Gamastan | Yes | |||
J1561 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, PER 500 MG. | Gammaked, Gamunex-C | Yes | |||
J1566 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P | Carimune Nf | Yes | |||
J1568 | Octagam injection | Octagam | Yes | |||
J1569 | Gammagard liquid injection | Gammagard Liquid | Yes | |||
J1570 | INJECTION, GANCICLOVIR SODIUM, 500 MG | Ganciclovir Sodium | Yes | |||
J1571 | HepaGam B IM injection | Hepagam B | Yes | |||
J1572 | Flebogamma injection | Flebogamma Dif | Yes | |||
J1573 | Hepagam B intravenous, inj | Hepagam B | Yes | |||
J1575 | HYQVIA 100MG IMMUNEGLOBULIN | Hyqvia | Yes | |||
J1580 | INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG | Gentamicin Sulfate | Yes | |||
J1595 | INJECTION, GLATIRAMER ACETATE, 20 MG | Copaxone | Yes | |||
J1599 | Ivig non-lyophilized, NOS | Panzyga, Asceniv | Yes | |||
J1602 | GOLIMUMAB FOR IV USE 1MG | Simponi Aria | Yes | |||
J1610 | INJECTION; GLUCAGON HYDROCHLORIDE | Glucagon Emergency | Yes | |||
J1626 | INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG | Granisetron Hcl | Yes | |||
J1627 | INJ, GRANISETRON, XR, 0.1 MG | Sustol | Yes | |||
J1628 | INJ., GUSELKUMAB, 1 MG | Tremfya | Yes | |||
J1630 | INJECTION, HALOPERIDOL, UP TO 5 MG | Haldol Lactate | Yes | |||
J1631 | INJECTION, HALOPERIDOL DECANOATE, PER 50 MG | Haldol Decanoate | Yes | |||
J1632 | Injection, brexanolone, 1 mg | Zulresso | Yes | |||
J1640 | INJECTION, HEMIN, 1 MG | Panhematin | Yes | |||
J1642 | HEPARIN SODIUM PER 10 UNITS | Heparin Lock Flush | Yes | |||
J1644 | INJECTION, HEPARIN SODIUM, PER 1000 units | Heparin Sodium (porcine) | Yes | |||
J1645 | INJECTION, DALTEPARIN SODIUM, PER 2500 IU | Fragmin | Yes | |||
J1650 | INJ ENOXAPARIN SODIUM 30 MG | Lovenox | Yes | |||
J1652 | INJECTION, FONDAPARINUX SODIUM, 0.5 MG | Arixtra | Yes | |||
J1670 | INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS | Hypertet S/D | Yes | |||
J1675 | INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS | Vantas | Yes | |||
J1720 | INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG | Solu-cortef | Yes | |||
J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | Makena | Yes | |||
J1729 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | Hydroxyprogesterone Caproate | Yes | |||
J1730 | INJECTION, DIAZOXIDE, UP TO 300 MG | Yes | ||||
J1738 | Injection, meloxicam, 1 mg | Anjeso | Yes | |||
J1740 | INJECTION IBANDRONATE SODIUM 1 MG | Boniva | Yes | |||
J1741 | INJECTION, IBUPROFEN, 100 MG | Caldolor | Yes | |||
J1742 | INJECTION, IBUTILIDE FUMARATE, 1 MG | Corvert | Yes | |||
J1743 | Idursulfase injection | Elaprase | Yes | |||
J1744 | ICATIBANT INJECTION | Firazyr | Yes | |||
J1745 | INJECTION INFLIXIMAB, 10 MG | Remicade | Yes | |||
J1746 | INJ., IBALIZUMAB-UIYK, 10 MG | Trogarzo | Yes | |||
J1750 | INJECTION, IRON DEXTRAN, 50 MG | Infed | Yes | |||
J1756 | INJECTION, IRON SUCROSE, 1 MG | Venofer | Yes | |||
J1786 | Injection, imiglucerase, 10 units | Cerezyme | Yes | |||
J1790 | INJECTION, DROPERIDOL, UP TO 5 MG | Droperidol | Yes | |||
J1800 | INJECTION, PROPRANOLOL HCL, UP TO 1 MG | Propranolol Hcl | Yes | |||
J1815 | INJECTION, INSULIN, PER 5 UNITS | Multiple | Yes | |||
J1817 | INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS | Multiple | Yes | |||
J1826 | Interferon Beta-1A inj | Avonex Pen | Yes | |||
J1830 | INJECTION; INTERFERON BETA-1B | Betaseron | Yes | |||
J1833 | INJECTION, ISAVUCONAZONIUM | Cresemba | Yes | |||
J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | Toradol | Yes | |||
J1930 | Injection, lanreotide, 1 mg | Somatuline Depot | Yes | |||
J1931 | INJECTION, LARONIDASE, 0.1 MG | Aldurazyme | Yes | |||
J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | Lasix | Yes | |||
J1943 | Injection, aripiprazole lauroxil, (Aristada Initio), 1 mg | Aristada Initio | Yes | |||
J1944 | Injection, aripiprazole lauroxil, (Aristada), 1 mg | Aristada | Yes | |||
J1950 | Injection, leuprolide acetate, per 3.75mg | Lupron Depot | Yes | |||
J1953 | Levetiracetam injection | Keppra | Yes | |||
J1955 | INJ LEVOCARNITINE PER 1 GM | Carnitor | Yes | |||
J1956 | INJECTION, LEVOFLOXACIN, 250 MG | Levaquin | Yes | |||
J1980 | INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG | Levsin | Yes | |||
J2001 | INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG | Xylocaine | Yes | |||
J2010 | INJECTION, LINCOMYCIN HCL, UP TO 300 MG | Lincocin | Yes | |||
J2020 | INJECTION, LINEZOLID, 200MG | Zyvox | Yes | |||
J2060 | INJECTION, LORAZEPAM, 2 MG | Ativan | Yes | |||
J2062 | LOXAPINE FOR INHALATION 1 MG | Adasuve | Yes | |||
J2150 | INJECTION, MANNITOL, 25% IN 50 ML | Osmitrol | Yes | |||
J2170 | Mecasermin injection | Increlex | Yes | |||
J2175 | INJECTION, MEPERIDINE; PER 100MG | Demerol | Yes | |||
J2182 | INJECTION, MEPOLIZUMAB, 1MG | Nucala | Yes | |||
J2185 | INJECTION, MEROPENEM, 100 MG | Merrem | Yes | |||
J2186 | INJECTION, MEROPENEM AND VABORBACTAM, 10MG/10MG, (20 MG) | Vabomere | Yes | |||
J2210 | INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG | Methergine | Yes | |||
J2212 | METHYLNALTREXONE INJECTION | Relistor | Yes | |||
J2248 | INJECTION MICAFUNGIN SODIUM 1 MG | Mycamine | Yes | |||
J2250 | INJ MIDAZOLAM HYDROCHLORIDE (VERSED) | Versed | Yes | |||
J2260 | INJECTION; MILRIONONE LACTATE | Milrinone Lactate | Yes | |||
J2265 | Minocycline hydrochloride | Minocin | Yes | |||
J2270 | INJECTION, MORPHINE SULFATE, UP TO 10 MG | Morphine Sulfate | Yes | |||
J2274 | IN MORPHINE PRESERVATIV FREE | Morphine Sulfate (pf) | Yes | |||
J2278 | INJECTION, ZICONOTIDE, 1 MICROGRAM | Prialt | Yes | |||
J2280 | INJECTION, MOXIFLOXACIN, 100 MG | Avelox | Yes | |||
J2300 | INJ NALBUPHINE HYDROCHLORIDE | Nalbuphine Hcl | Yes | |||
J2310 | INJ NALOXONE HYDROCHLORIDE | Narcan | Yes | |||
J2315 | INJECTION NALTREXONE DEPOT FORM 1 MG | Vivitrol | Yes | |||
J2323 | Natalizumab injection | Tysabri | Yes | |||
J2325 | INJECTION, NESIRITIDE, 0.1 MG | Natrecor | Yes | |||
J2326 | INJ, NUSINERSEN, 0.1MG | Spinraza | Yes | |||
J2350 | Injection, ocrelizumab, 1 mg | Ocrevus | Yes | |||
J2353 | INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG | Sandostatin LAR Depot | Yes | |||
J2354 | INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJ, 25 MCG | Sandostatin | Yes | |||
J2357 | INJECTION, OMALIZUMAB, 5 MG | Xolair | Yes | |||
J2358 | Olanzapine long-acting inj | Zyprexa Relprevv | Yes | |||
J2360 | INJECTION, ORPHENADRINE, UP TO 60 MG | Orphenate | Yes | |||
J2370 | INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML | Phenylephrine Hcl | Yes | |||
J2405 | INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG | Zofran | Yes | |||
J2407 | INJECTION, ORITAVANCIN | Orbactiv | Yes | |||
J2410 | INJECTION, OXYMORPHONE HCL, UP TO 1 MG | Opana | Yes | |||
J2425 | INJECTION, PALIFERMIN, 50 MICROGRAMS | Kepivance | Yes | |||
J2426 | Inj, paliperidone palmitate extended release, 1 mg | Invega Sustenna, Invega Trinza | Yes | |||
J2430 | INJECTION; PAMIDRONATE DISODIUM | Aredia | Yes | |||
J2440 | INJECTION, PAPAVERINE HCL, UP TO 60 MG | Papaverine Hcl | Yes | |||
J2469 | INJECTION, PALONOSETRON HCL, 25 MCG | Aloxi | Yes | |||
J2501 | INJECTION, PARICALCITOL, 1 MCG | Zemplar | Yes | |||
J2502 | INJ, PASIREOTIDE LONG ACTING | Signifor LAR | Yes | |||
J2503 | INJECTION, PEGAPTANIB SODIUM, 0.3 MG | Macugen | Yes | |||
J2504 | INJECTION, PEGADEMASE BOVINE, 25 IU | Adagen | Yes | |||
J2507 | Pegloticase injection | Krystexxa | Yes | |||
J2510 | INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS | Penicillin G Procaine | Yes | |||
J2515 | INJECTION, PENTOBARBITAL SODIUM | Nembutal | Yes | |||
J2540 | INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS | Pfizerpen | Yes | |||
J2543 | INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS) | Zosyn | Yes | |||
J2545 | Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg | Nebupent | Yes | |||
J2547 | INJECTION, PERAMIVIR | Rapivab | Yes | |||
J2550 | INJECTION, PROMETHAZINE HCL, UP TO 50 MG | Phenergan | Yes | |||
J2560 | INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG | Phenobarbital Sodium | Yes | |||
J2562 | Plerixafor injection | Mozobil | Yes | |||
J2590 | INJECTION, OXYTOCIN, UP TO 10 UNITS | Pitocin | Yes | |||
J2597 | INJECTION DESMOPRESSIN ACETATE, PER 1 MCG | DDAVP | Yes | |||
J2675 | INJECTION, PROGESTERONE, PER 50MG | Progesterone in Oil | Yes | |||
J2680 | INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG | Prolixin Decanoate | Yes | |||
J2690 | INJECTION, PROCAINAMIDE HCL, UP TO 1 GM | Pronestyl | Yes | |||
J2700 | INJECTION, OXACILLIN SODIUM, UP TO 250 MG | Bactocill | Yes | |||
J2704 | INJ, PROPOFOL, 10 MG | Diprivan | Yes | |||
J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | Bloxiverz | Yes | |||
J2720 | INJECTION, PROTAMINE SULFATE, UP TO 5 ML | Protamine Sulfate | Yes | |||
J2724 | Injection, protein c concentrate, intravenous, human, 10 iu | Ceprotin | Yes | |||
J2730 | INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM | Protopam | Yes | |||
J2760 | INJECTION, PHENTOLAINE MESYLATE, UP TO 5 MG(REGITINE) | Phentolamine Mesylate | Yes | |||
J2765 | INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG | Reglan | Yes | |||
J2770 | INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350) | Synercid | Yes | |||
J2778 | Ranibizumab injection | Lucentis | Yes | |||
J2780 | INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG | Zantac | Yes | |||
J2783 | INJECTION, RASBURICASE, 0.5 MG | Elitek | Yes | |||
J2785 | Regadenoson injection | Lexiscan | Yes | |||
J2786 | INJECTION, RESLIZUMAB, 1MG | Cinqair | Yes | |||
J2787 | Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml | Photrexa Viscous | Yes | |||
J2788 | Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) | HyperRHO S/D | Yes | |||
J2790 | Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) | HyperRHO S/D, Rhogam Ultra-filtered Plus | Yes | |||
J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | Rhophylac | Yes | |||
J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | WinRho SDF | Yes | |||
J2793 | Rilonacept injection | Arcalyst | Yes | |||
J2794 | Injection, risperidone (Risperdal CONSTA), 0.5 mg | Risperdal Consta | Yes | |||
J2795 | INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG | Naropin | Yes | |||
J2796 | Romiplostim injection | Nplate | Yes | |||
J2797 | INJ., ROLAPITANT, 0.5 MG | Varubi | Yes | |||
J2798 | Injection, risperidone, (Perseris), 0.5 mg | Perseris | Yes | |||
J2800 | INJECTION, METHOCARBAMOL, UP TO 10 ML | Robaxin | Yes | |||
J2805 | INJECTION, SINCALIDE, 5 MICROGRAMS | Kinevac | Yes | |||
J2810 | INJECTION, THEOPHYLLINE, UP TO 2 ML | Theophylline | Yes | |||
J2820 | INJECTION, SARGRAMOSTIM (CM-CSF), 50 MCG | Leukine | Yes | |||
J2840 | INJECTION, SEBELIPASE ALFA, 1 MG | Kanuma | Yes | |||
J2850 | INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM | ChiRhoStim | Yes | |||
J2860 | INJECTION, SILTUXIMAB | Sylvant | Yes | |||
J2916 | INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG | Ferrlecit | Yes | |||
J2920 | INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG | Solu-medrol | Yes | |||
J2930 | INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG | Solu-medrol | Yes | |||
J2941 | INJECTION, SOMATROPIN, 1 MG | Serostim, Humatrope, Genotropin,Norditropin,Nutropin,Omnitrope,Saizen,Zomacton,Zorbtive | Yes | |||
J2993 | INJECTION, RETEPLASE, 18.1 MG | Retavase | Yes | |||
J2997 | INJECTION, ALTEPLASE RECOMBINANT, 1 MG | Activase | Yes | |||
J3000 | INJECTION, STREPTOMYCIN, UP TO 1 GM | Streptomycin Sulfate | Yes | |||
J3010 | INJECTION, FENTANYL CITRATE, 0.1 MG | Sublimaze | Yes | |||
J3030 | INJECTION; SUMATRIPTAN SUCCINATE; 6MG | Imitrex, Sumavel | Yes | |||
J3031 | Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered) | Ajovy | Yes | |||
J3032 | Injection, eptinezumab-jjmr, 1 mg | Vyepti | Yes | |||
J3060 | Injection, taliglucerase alfa, 10 units | Elelyso | Yes | |||
J3070 | INJECTION, PENTAZOCINE HCL, UP TO 30 MG | Talwin | Yes | |||
J3090 | INJ TEDIZOLID PHOSPHATE | Sivextro | Yes | |||
J3095 | Televancin injection | Vibativ | Yes | |||
J3101 | Tenecteplase injection | TNKase | Yes | |||
J3105 | INJECTION, TERBUTALINE SULFATE, UP TO 1 MG | Terbutaline Sulfate | Yes | |||
J3110 | INJECTION, TERIPARATIDE, 10 MCG | Forteo | Yes | |||
J3111 | Injection, romosozumab-aqqg, 1 mg | Evenity | Yes | |||
J3121 | INJ TESTOSTERO ENANTHATE 1MG | Delatestryl | Yes | |||
J3145 | TESTOSTERONE UNDECANOATE 1MG | Aveed | Yes | |||
J3230 | INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG | Thorazine | Yes | |||
J3240 | INJECTION, THYROTROPIN, UP TO 10 I.U. | Thyrogen | Yes | |||
J3241 | Injection, teprotumumab-trbw, 10 mg | Tepezza | Yes | |||
J3243 | INJECTION TIGECYCLINE 1 MG | Tygacil | Yes | |||
J3245 | INJ., TILDRAKIZUMAB, 1 MG | Ilumya | Yes | |||
J3246 | INJECTION, TIROFIBAN HCL, 0.25MG | Aggrastat | Yes | |||
J3250 | INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG | Tigan | Yes | |||
J3260 | INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG | Nebcin | Yes | |||
J3262 | Tocilizumab injection | Actemra | Yes | |||
J3285 | INJECTION, TREPROSTINIL, 1 MG | Remodulin | Yes | |||
J3300 | Triamcinolone A inj PRS-free | Triesence | Yes | |||
J3301 | INJECTION TRIAMCINOLONE ACETONIDE, PER 10MG | Kenalog | Yes | |||
J3303 | INJECTION TRIAMCINOLONE HEXACETONIDE, PER 5MG | Aristospan | Yes | |||
J3304 | INJ TRIAMCINOLONE ACE XR 1MG | Zilretta | Yes | |||
J3315 | INJECTION, TRIPTORELIN PAMOATE, 3.75 MG | Trelstar | Yes | |||
J3316 | INJ., TRIPTORELIN XR 3.75 MG | Triptodur | Yes | |||
J3355 | INJECTION, UROFOLLITROPIN, 75 IU | Bravelle | Yes | |||
J3357 | Ustekinumab, for subcutaneous injection, 1 mg | Stelara | Yes | |||
J3358 | Ustekinumab, for intravenous injection, 1 mg | Stelara | Yes | |||
J3360 | INJECTION, DIAZEPAM, UP TO 5 MG | Valium | Yes | |||
J3370 | INJECTION, VANCOMYCIN HCL, UP TO 500 MG | Vancocin | Yes | |||
J3380 | INJECTION, VEDOLIZUMAB | Entyvio | Yes | |||
J3385 | Velaglucerase alfa | Vpriv | Yes | |||
J3396 | INJECTION, VERTEPORFIN, 0.1 MG | Visudyne | Yes | |||
J3397 | INJ., VESTRONIDASE ALFA-VJBK | Mepsevii | Yes | |||
J3398 | Injection, voretigene neparvovec-rzyl, 1 billion vector genomes | Luxturna | Yes | |||
J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes | Zolgensma | Yes | |||
J3410 | INJECTION, HYDROXYZINE HCL, UP TO 25 MG | Vistaril | Yes | |||
J3411 | INJECTION, THIAMINE HCL, 100 MG | Thiamine Hcl | Yes | |||
J3415 | INJECTION, PYRIDOXINE HCL, 100 MG | Pyridoxine Hcl | Yes | |||
J3420 | INJECTION, VITAMIN B- 12 CYANOCOBALAMIN, UP TO 1000 MCG | Cyanocobalamin | Yes | |||
J3430 | Injection, phytonadione (vitamin k), per 1 mg | Aqua-Mephyton | Yes | |||
J3465 | INJECTION, VORICONAZOLE, 10 MG | Vfend IV | Yes | |||
J3470 | INJECTION, HYALURONIDASE, UP TO 150 UNITS | Amphadase | Yes | |||
J3471 | INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 US | Vitrase | Yes | |||
J3473 | INJECTION HYALURONIDASE RECOMBINANT 1 USP UNIT | Hylenex | Yes | |||
J3475 | INJ MAGNESIUM SULFATE | Magnesium Sulfate | Yes | |||
J3480 | INJ POTASSIUM CHLORIDE-2 MEQ | Potassium Chloride | Yes | |||
J3485 | INJECTION, ZIDOVUDINE, 10 MG | Retrovir | Yes | |||
J3486 | INJECTION, ZIPRASIDONE MESYLATE, 10 MG | Geodon | Yes | |||
J3489 | ZOLEDRONIC ACID 1MG | Reclast, Zometa | Yes | |||
J3490 | Unclassified drugs | Unclassified drugs | Yes | |||
J3590 | Unclassified biologics | Unclassified biologics | Yes | |||
J7030 | INFUSION, NORMAL SALINE SOLUTION , 1000 CC | Sodium Chloride | Yes | |||
J7040 | INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) | Sodium Chloride | Yes | |||
J7042 | 5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT) | Dextrose 5%-0.9% NaCl | Yes | |||
J7050 | INFUSION, NORMAL SALINE SOLUTION , 250 CC | Sodium Chloride | Yes | |||
J7060 | 5% DEXTROSE/WATER (500 ML = 1 UNIT) | Dextrose in water | Yes | |||
J7070 | INFUSION, D5W, 1000 CC | Dextrose in water | Yes | |||
J7100 | INFUSION, DEXTRAN 40, 500 ML | LMD | Yes | |||
J7120 | RINGERS LACTATE INFUSION, UP TO 1000 CC | Lactated Ringers | Yes | |||
J7121 | 5% DEXTROSE IN LAC RINGERS | Dextrose In Lactated Ringers | Yes | |||
J7169 | Injection, coagulation Factor Xa (recombinant), inactivated-zhzo (Andexxa), 10 mg | Andexxa | Yes | |||
J7170 | INJ., EMICIZUMAB-KXWH 0.5 MG | Hemlibra | Yes | |||
J7175 | INJ, FACTOR X, (HUMAN), 1IU | Coagadex | Yes | |||
J7177 | Injection, human fibrinogen concentrate (fibryga), 1 mg | Fibryga | Yes | |||
J7178 | HUMAN FIBRINOGEN CONC INJ | Riastap | Yes | |||
J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco | Vonvendi | Yes | |||
J7180 | Factor XIII anti-hem factor | Corifact | Yes | |||
J7181 | FACTOR XIII RECOMB A-SUBUNIT | Tretten | Yes | |||
J7182 | FACTOR VIII RECOMB NOVOEIGHT | Novoeight | Yes | |||
J7183 | Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco | Wilate | Yes | |||
J7185 | Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. | Xyntha | Yes | |||
J7186 | Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. | Alphanate/VWF Complex/Human | Yes | |||
J7187 | INJECTION VON WILLEBRAND FACTOR COMPLEX HUMAN RISTOCETIN COFACTOR PER IV | Humate-p | Yes | |||
J7188 | FACTOR VIII RECOMB OBIZUR | Obizur | Yes | |||
J7189 | Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram | NovoSeven RT | Yes | |||
J7190 | FACTOR VIII, (ANTI-HEMOPHILIC FACTOR (HUMAN)), PER I.U. | Hemofil M, Koate | Yes | |||
J7192 | FACTOR VIII (ANTIHEMOPHILIC FACTOR (RECOMBINANT)), PER I.U. | Recombinate, Advate, Kogenate, Helixate FS | Yes | |||
J7193 | FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U. | Mononine, Alphanine | Yes | |||
J7194 | FACTOR IX, COMPLEX, PER I.U. | Profilnine SD | Yes | |||
J7195 | FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U. | Ixinity, BeneFIX | Yes | |||
J7196 | Antithrombin recombinant | Atryn | Yes | |||
J7197 | ANTITHROMBIN III (HUMAN), PER I.U. | Thrombate III | Yes | |||
J7198 | ANTI-INHIBITOR, PER I.U. | Feiba NF | Yes | |||
J7200 | FACTOR IX RECOMBINAN RIXUBIS | Rixubis | Yes | |||
J7201 | FACTOR IX FC FUSION RECOMB | Alprolix | Yes | |||
J7202 | FACTOR IX IDELVION INJ | Idelvion | Yes | |||
J7203 | FACTOR IX RECOMB GLY REBINYN | Rebinyn | Yes | |||
J7204 | Injection, Factor VIII, antihemophilic factor (recombinant), (Esperoct), glycopegylated-exei, per IU | Esperoct | Yes | |||
J7205 | FACTOR VIII FC FUSION RECOMB | Eloctate | Yes | |||
J7207 | FACTOR VIII PEGYLATED RECOMB | Adynovate | Yes | |||
J7208 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. | Jivi | Yes | |||
J7209 | FACTOR VIII NUWIQ RECOMB 1IU | Nuwiq | Yes | |||
J7210 | INJ, AFSTYLA, 1 I.U. | Afstyla | Yes | |||
J7211 | INJ, KOVALTRY, 1 I.U. | Kovaltry | Yes | |||
J7296 | LEVONORGESTREL IU, KYLEENA, 19.5 MG | Kyleena | Yes | |||
J7297 | LEVONORGESTREL IU 52MG 3 YR | Liletta (52 Mg) | Yes | |||
J7298 | LEVONORGESTREL IU 52MG 5 YR | Mirena (52 Mg) | Yes | |||
J7300 | IUD COPPER | Paragard Intrauterine Copper | Yes | |||
J7301 | LEVONORGESTREL IU, SKYLA, 13.5MG | Skyla | Yes | |||
J7304 | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH | Xulane | Yes | |||
J7307 | Etonogestrel implant system | Nexplanon | Yes | |||
J7308 | AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOS | Levulan Kerastick | Yes | |||
J7311 | FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT | Retisert | Yes | |||
J7312 | Dexamethasone intravitreal implant | Ozurdex | Yes | |||
J7313 | FLUOCINOL ACET INTRAVITREAL IMPLANT | Iluvien | Yes | |||
J7314 | Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg | Yutiq | Yes | |||
J7315 | OPTHALMIC MITOMYCIN | Mitosol | Yes | |||
J7316 | INJ, OCRIPLASMIN, 0.125 MG | Jetrea | Yes | |||
J7318 | INJ, DUROLANE 1 MG | Durolane | Yes | |||
J7320 | HYALURONAN OR DERIVITIVE, GENVISC 850, FOR INTRA-ARTICULAR INJ, 1 MG | Genvisc 850 | Yes | |||
J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | Hyalgan; Supartz;Visco-3 | Yes | |||
J7322 | HYALURONAN OR DERIVATIVE, HYMOVIS, FOR INTRA-ARTICULAR INJECTION, 1 MG | Hymovis | Yes | |||
J7323 | Euflexxa inj per dose | Euflexxa | Yes | |||
J7324 | Orthovisc inj per dose | Orthovisc | Yes | |||
J7325 | Synvisc or Synvisc-One | Synvisc, Synvisc-One | Yes | |||
J7326 | Gel-one | Gel-one | Yes | |||
J7327 | MONOVISC INJ PER DOSE | Monovisc | Yes | |||
J7328 | GEL-SYN INJECTION 0.1 MG | Gelsyn-3 | Yes | |||
J7329 | INJ, TRIVISC 1 MG | Trivisc | Yes | |||
J7330 | AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT | MACI | Yes | |||
J7331 | Hyaluronan or derivative, SYNOJOYNT, for intra-articular injection, 1 mg | Synojoynt | Yes | |||
J7332 | Hyaluronan or derivative, Triluron, for intra-articular injection, 1 mg | Triluron | Yes | |||
J7336 | CAPSAICIN 8% PATCH | Qutenza | Yes | |||
J7340 | CARBIDOPA LEVODOPA ENTERAL | Duopa | Yes | |||
J7342 | Instillation, ciprofloxacin otic suspension, 6 mg | Otiprio | Yes | |||
J7345 | Aminolevulinic acid HCl for topical administration, 10% gel, 10mg | Ameluz | Yes | |||
J7351 | Injection, bimatoprost, intracameral implant, 1 mcg | Durysta | Yes | |||
J7500 | Azathioprine, oral, 50 mg | Imuran | Yes | |||
J7501 | Azathioprine, parenteral, 100 mg | Azathioprine Sodium | Yes | |||
J7502 | CYCLOSPORINE, ORAL, 100 MG | Sandimmune; Gengraf; Neoral | Yes | |||
J7503 | TACROL ENVARSUS EXT REL ORAL | Envarsus XR | Yes | |||
J7504 | LYMPHOCYTE IMMUNE GLOBULIN, ANTITYMOCYTE GLOBULIN - PARENTERAL, AMP, 5 | Atgam | Yes | |||
J7507 | TACROLIMUS, ORAL | Prograf | Yes | |||
J7508 | TACROLIMUS EXT REL ORAL 0.1MG | Astagraf XL | Yes | |||
J7509 | METHYLPREDNISOLONE ORAL | Medrol | Yes | |||
J7510 | PREDNISOLONE ORAL PER 5 MG | Prednisolone | Yes | |||
J7511 | LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, | Thymoglobulin | Yes | |||
J7512 | PREDNISONE IR OR DR ORAL 1MG | Deltasone | Yes | |||
J7513 | DACLIZUMAB, PARENTERAL, 25 MG | Zinbryta | Yes | |||
J7515 | CYCLOSPORINE, ORAL, 25 MG | Sandimmune; Gengraf, Neoral | Yes | |||
J7516 | CYCLOSPORIN, PARENTERAL, 250 MG | SandIMMUNE | Yes | |||
J7517 | MYCOPHENOLATE MOFETIL, ORAL, 250 MG | CellCept | Yes | |||
J7518 | MYCOPHENOLIC ACID, ORAL, 180 MG | Myfortic | Yes | |||
J7520 | SIROLIMUS, ORAL, 1 MG | Rapamune | Yes | |||
J7525 | TACROLIMUS, PARENTERAL, 5 MG | Prograf | Yes | |||
J7527 | ORAL EVEROLIMUS | Zortress | Yes | |||
J7605 | Arformoterol non-comp unit | Brovana | Yes | |||
J7606 | Formoterol fumarate, inh | Perforomist | Yes | |||
J7608 | ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE | Acetylcysteine | Yes | |||
J7611 | ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CO | Albuterol Sulfate | Yes | |||
J7612 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg | Xopenex | Yes | |||
J7613 | ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UN | Albuterol Sulfate | Yes | |||
J7614 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg | Xopenex | Yes | |||
J7620 | ALBUTEROL AND IPRATROPIUM INHAL.SOLUTION ADMIN. VIA DME | Ipratropium-albuterol | Yes | |||
J7626 | BUDESONIDE INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE FORM | Pulmicort Respules | Yes | |||
J7631 | CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE | Cromolyn Sodium | Yes | |||
J7639 | DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE F | Pulmozyme | Yes | |||
J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT | Atrovent | Yes | |||
J7665 | Mannitol for inhaler | Aridol | Yes | |||
J7674 | METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION TH | Provocholine | Yes | |||
J7677 | revefenacin inhalation solution | Yupelri | Yes | |||
J7682 | TOBRAMYCIN, UNIT DOSE FORM, 300 MG, INHALATION SOLUTION, ADMINISTERED THROUGH DME | Tobi; Bethkis; Kitabis | Yes | |||
J7686 | Treprostinil, non-comp unit | Tyvaso | Yes | |||
J8499 | Prescription drug, oral, non chemotherapeutic, nos | Prescription drug, oral, non chemotherapeutic, nos | Yes | |||
J8501 | APREPITANT, ORAL, 5 MG | Emend | Yes | |||
J8510 | BUSULFAN; ORAL, 2 MG | Myleran | Yes | |||
J8515 | CABERGOLINE, ORAL, 0.25 MG | Cabergoline | Yes | |||
J8520 | CAPECITABINE, ORAL, 150 MG | Xeloda | Yes | |||
J8521 | CAPECITABINE, ORAL, 500 MG | Xeloda | Yes | |||
J8530 | CYCLOPHOSPHAMIDE, ORAL | Cyclophosphamide | Yes | |||
J8540 | DEXAMETHASONE, ORAL, 0.25 MG | Dexamethasone | Yes | |||
J8560 | ETOPOSIDE, ORAL | VePesid | Yes | |||
J8565 | GEFITINIB, ORAL, 250 MG | Iressa | Yes | |||
J8600 | MELPHALAN | Alkeran | Yes | |||
J8610 | METHOTREXATE, ORAL | Methotrexate | Yes | |||
J8650 | Nabilone oral | Cesamet | Yes | |||
J8655 | NETUPITANT AND PALONOSETRON, ORAL | Akynzeo | Yes | |||
J8670 | ROLAPITANT, ORAL, 1MG | Varubi | Yes | |||
J8700 | TEMOZOLOMIDE, ORAL, 5 MG | Temodar | Yes | |||
J8705 | Topotecan oral | Hycamtin | Yes | |||
J8999 | Prescription drug, oral, chemotherapeutic, NOS | Prescription drug, oral, chemotherapeutic, NOS | Yes | |||
J9000 | DOXORUBICIN HCL, 10 MG | Adriamycin | Yes | |||
J9015 | ALDESLEUKIN/SINGLE USE VIAL | Proleukin | Yes | |||
J9017 | ARSENIC TRIOXIDE, 1MG | Trisenox | Yes | |||
J9019 | Injection, asparaginase (erwinaze), 1,000 iu | Erwinaze | Yes | |||
J9022 | INJ, ATEZOLIZUMAB,10 MG | Tecentriq | Yes | |||
J9023 | INJECTION, AVELUMAB, 10 MG | Bavencio | Yes | |||
J9025 | INJECTION, AZACITIDINE, 1 MG | Vidaza | Yes | |||
J9027 | INJECTION, CLOFARABINE, 1 MG | Clolar | Yes | |||
J9030 | Bcg live intravesical instillation, 1 mg | Tice BCG | Yes | |||
J9032 | INJECTION, BELINOSTAT, 10MG | Beleodaq | Yes | |||
J9033 | Bendamustine injection | Treanda | Yes | |||
J9034 | Inj., bendamustine hcl (bendeka), 1 mg | Bendeka | Yes | |||
J9035 | INJECTION, BEVACIZUMAB, 10 MG | Avastin | Yes | |||
J9036 | Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg | Belrapzo | Yes | |||
J9039 | INJECTION, BLINATUMOMAB | Blincyto | Yes | |||
J9040 | BLEOMYCIN SULFATE, 15 UNITS | Bleomycin Sulfate | Yes | |||
J9041 | INJECTION, BORTEZOMIB(VELCADE), 0.1 MG | Velcade | Yes | |||
J9042 | BRENTUXIMAB VEDOTIN INJ | Adcetris | Yes | |||
J9043 | Cabazitaxel injection | Jevtana | Yes | |||
J9045 | CARBOPLATIN, 50 MG | Paraplatin | Yes | |||
J9047 | INJECTION, CARFILZOMIB, 1 MG | Kyprolis | Yes | |||
J9050 | CARMUSTINE, 100 MG | BiCNU | Yes | |||
J9055 | INJECTION, CETUXIMAB, 10 MG | Erbitux | Yes | |||
J9057 | INJ., COPANLISIB, 1 MG | Aliqopa | Yes | |||
J9060 | CISPLATIN, POWDER OR S0LUTION, PER 10 MG | Platinol AQ | Yes | |||
J9065 | INJECTION; CLADRIBINE | Leustatin | Yes | |||
J9070 | CYCLOPHOSPHAMIDE, 100 MG | Cytoxan | Yes | |||
J9098 | CYTARABINE LIPOSOME, 10 MG | Depocyt | Yes | |||
J9100 | CYTARABINE 100 MG | Cytarabine (pf) | Yes | |||
J9118 | Injection, calaspargase pegol-mknl, 10 units | Asparlas | Yes | |||
J9119 | Injection, cemiplimab-rwlc, 1 mg | Libtayo | Yes | |||
J9120 | DACTINOMYCIN, 0.5 MG | Cosmegen | Yes | |||
J9130 | DACARBAZINE, 100 MG | DTIC-DOME IV | Yes | |||
J9145 | INJECTION, DARATUMUMAB 10 MG | Darzalex | Yes | |||
J9150 | DAUNORUBICIN HYDROCHLORIDE, 10 MG | Cerubidine | Yes | |||
J9151 | DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG | Daunoxome | Yes | |||
J9153 | INJ, LIPOSOMAL, DAUNORUBICIN AND CYTARABINE | Vyxeos | Yes | |||
J9155 | Degarelix injection | Firmagon | Yes | |||
J9171 | Docetaxel injection | Taxotere | Yes | |||
J9173 | INJ., DURVALUMAB, 10 MG | Imfinzi | Yes | |||
J9175 | INJECTION, ELLIOTTS' B SOLUTION, 1 ML | Elliotts B | Yes | |||
J9176 | INJECTION, ELOTUZUMAB, 1MG | Empliciti | Yes | |||
J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | Padcev | Yes | |||
J9178 | INJECTION, EPIRUBICIN HCL, 2 MG | Ellence | Yes | |||
J9179 | Eribulin mesylate injection | Halaven | Yes | |||
J9181 | ETOPOSIDE, 10 MG | Etoposide | Yes | |||
J9185 | FLUDARABINE PHOSPHATE, 50 MG | Fludara | Yes | |||
J9190 | FLUOROURACIL, 500 MG | Adrucil | Yes | |||
J9198 | Injection, gemcitabine hydrochloride, (Infugem), 100 mg | Infugem | Yes | |||
J9200 | FLOXURIDINE, 500 MG | Floxuridine | Yes | |||
J9201 | GEMCITABINE HCL, 200 MG | Gemzar | Yes | |||
J9202 | GOSERELIN ACETATE IMPLANT, PER 3.6 MG | Zoladex | Yes | |||
J9203 | GEMTUZUMAB OZOGAMICIN 0.1 MG | Mylotarg | Yes | |||
J9204 | Injection, mogamulizumab-kpkc, 1 mg | Poteligeo | Yes | |||
J9205 | INJ IRINOTECAN LIPOSOME 1 MG | Onivyde | Yes | |||
J9206 | IRINOTECAN, 20 MG | Camptosar | Yes | |||
J9207 | Ixabepilone injection | Ixempra Kit | Yes | |||
J9208 | IFOSFAMIDE, 1 GM | Ifex | Yes | |||
J9209 | MESNA, 200 MG | Mesnex | Yes | |||
J9210 | Injection, emapalumab-lzsg, 1 mg | Gamifant | Yes | |||
J9211 | IDARUBICIN HYDROCHLORIDE, 5 MG | Idamycin PFS | Yes | |||
J9214 | INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS | Intron A | Yes | |||
J9215 | INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU | Alferon N | Yes | |||
J9216 | INTERFERON, GAMMA 1-B, 3 MILLION UNITS | Actimmune | Yes | |||
J9217 | LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG | Eligard, Lupron Depot | Yes | |||
J9218 | LEUPROLIDE ACETATE, PER 1 MG | Leuprolide Acetate | Yes | |||
J9225 | HISTRELIN IMPLANT, 50 MG | Vantas | Yes | |||
J9226 | Supprelin LA implant | Supprelin LA | Yes | |||
J9227 | Injection, isatuximab-irfc, 10 mg | Sarclisa | Yes | |||
J9228 | Ipilimumab injection | Yervoy | Yes | |||
J9229 | INJ INOTUZUMAB OZOGAM 0.1 MG | Besponsa | Yes | |||
J9230 | MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG | Mustargen | Yes | |||
J9245 | INJECTION; MELPHALAN HCL | Alkeran | Yes | |||
J9246 | Injection, melphalan (Evomela), 1 mg | Evomela | Yes | |||
J9250 | METHOTREXATE SODIUM, 5 MG | Methotrexate Sodium | Yes | |||
J9260 | METHOTREXATE SODIUM, 50 MG | Methotrexate Sodium | Yes | |||
J9261 | INJECTION NELARABINE 50 MG | Arranon | Yes | |||
J9262 | INJ, OMACETAXINE MEP, 0.01MG | Synribo | Yes | |||
J9263 | INJECTION, OXALIPLATIN, 0.5 MG | Eloxatin | Yes | |||
J9264 | INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG | Abraxane | Yes | |||
J9266 | PEGASPARGASE/SINGL DOSE VIAL | Oncaspar | Yes | |||
J9267 | PACLITAXEL INJECTION | Taxol | Yes | |||
J9268 | PENTOSTATIN, PER 10 MG (NIPENT) | Nipent | Yes | |||
J9269 | Injection, tagraxofusp-erzs, 10 mcg | Elzonris | Yes | |||
J9271 | INJ PEMBROLIZUMAB | Keytruda | Yes | |||
J9280 | MITOMYCIN, 5 MG | Mutamycin | Yes | |||
J9285 | INJ, OLARATUMAB, 10 MG | Lartruvo | Yes | |||
J9293 | MITOXANTRONE HYDROCHLORIDE, 20 MG-1994,1995=5MG | Novantrone | Yes | |||
J9295 | INJECTION, NECITUMUMAB, 1 MG | Portrazza | Yes | |||
J9299 | INJECTION, NIVOLUMAB | Opdivo | Yes | |||
J9301 | OBINUTUZUMAB INJ | Gazyva | Yes | |||
J9302 | Ofatumumab injection | Arzerra | Yes | |||
J9303 | Panitumumab injection | Vectibix | Yes | |||
J9304 | Injection, pemetrexed (Pemfexy), 10 mg | Pemfexy | Yes | |||
J9305 | INJECTION, PEMETREXED, not otherwise specified, 10 MG | Alimta | Yes | |||
J9306 | INJECTION, PERTUZUMAB, 1 MG | Perjeta | Yes | |||
J9307 | Pralatrexate injection | Folotyn | Yes | |||
J9308 | INJECTION, RAMUCIRUMAB | Cyramza | Yes | |||
J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | Polivy | Yes | |||
J9311 | INJ RITUXIMAB, HYALURONIDASE | Rituxan Hycela | Yes | |||
J9312 | INJ., RITUXIMAB, 10 MG | Rituxan | Yes | |||
J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | Lumoxiti | Yes | |||
J9320 | STREPTOZOCIN, 1 GM | Zanosar | Yes | |||
J9325 | INJ TALIMOGENE LAHERPAREPVEC | Imlygic | Yes | |||
J9328 | Temozolomide injection | Temodar | Yes | |||
J9330 | Temsirolimus injection | Torisel | Yes | |||
J9340 | THIOTEPA, 15 MG | Tepadina | Yes | |||
J9351 | Topotecan injection | Hycamtin | Yes | |||
J9352 | INJECTION TRABECTEDIN 0.1MG | Yondelis | Yes | |||
J9354 | INJ, ADO-TRASTUZUMAB EMT 1MG | Kadcyla | Yes | |||
J9355 | TRASTUZUMAB, 10 MG | Herceptin | Yes | |||
J9356 | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk | Herceptin Hylecta | Yes | |||
J9357 | VALRUBICIN, INTRAVESICAL, 200 MG | Valstar | Yes | |||
J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | Enhertu | Yes | |||
J9360 | VINBLASTINE SULFATE, 1 MG | Vinblastine Sulfate | Yes | |||
J9370 | VINCRISTINE SULFATE, 1 MG | Vincasar PFS | Yes | |||
J9371 | INJ, VINCRISTINE SUL LIP 1MG | Marqibo | Yes | |||
J9390 | VINORELBINE TARTRATE/10 MG | Navelbine | Yes | |||
J9395 | INJECTION, FULVESTRANT, 25 MG | Faslodex | Yes | |||
J9400 | INJ, ZIV-AFLIBERCEPT, 1MG | Zaltrap | Yes | |||
J9600 | PORFIMER SODIUM, 75 MG | Photofrin | Yes | |||
P9045 | INFUSION, ALBUMIN (HUMAN), 5%, 250 ML | Plasbumin-5 | Yes | |||
P9046 | INFUSION, ALBUMIN (HUMAN), 25%, 20 ML | Albutein | Yes | |||
P9047 | INFUSION, ALBUMIN (HUMAN), 25%, 50 ML | Albuminar-25 | Yes | |||
Q0138 | Ferumoxytol, non-esrd | Feraheme | Yes | |||
Q0139 | Ferumoxytol, esrd use | Feraheme | Yes | |||
Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | Zithromax | Yes | |||
Q0162 | Ondansetron oral | Zofran | Yes | |||
Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION AN | Benadryl | Yes | |||
Q0164 | PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EM | Compazine | Yes | |||
Q0166 | GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EM | Kytril | Yes | |||
Q0167 | DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE | Marinol | Yes | |||
Q0169 | PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANT | Phenergan | Yes | |||
Q0175 | PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE | Perphenazine | Yes | |||
Q0177 | HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, | Vistaril | Yes | |||
Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml | Renacidin | Yes | |||
Q2009 | INJECTION, FOSPHENYTOIN, 50 MG | Cerebyx | Yes | |||
Q2028 | INJ, SCULPTRA, 0.5MG | Sculptra | Yes | |||
Q2041 | Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Yescarta | Yes | |||
Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Kymriah | Yes | |||
Q2043 | Sipuleucel-T auto CD54+ | Provenge | Yes | |||
Q2050 | Inj, doxorubicin, liposomal, not otherwise specified, 10 mg | Doxil | Yes | |||
Q3027 | INJ BETA INTERFERON IM 1 MCG | Avonex | Yes | |||
Q3028 | INJ BETA INTERFERON SQ 1 MCG | Rebif | Yes | |||
Q4074 | Iloprost non-comp unit dose | Ventavis | Yes | |||
Q4081 | INJECTION EPOETIN ALFA 100 UNITS (FOR ESRD ON DIALYSIS) | Epogen, Procrit | Yes | |||
Q5101 | INJ FILGRASTIM G-CSF BIOSIM | Zarxio | Yes | |||
Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | Inflectra | Yes | |||
Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | Renflexis | Yes | |||
Q5105 | Inj, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Retacrit | Yes | |||
Q5106 | Inj, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Retacrit | Yes | |||
Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | Mvasi | Yes | |||
Q5108 | Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg | Fulphila | Yes | |||
Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg | Ixifi | Yes | |||
Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 mcg | Nivestym | Yes | |||
Q5111 | Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg | Udenyca | Yes | |||
Q5112 | Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg | Ontruzant | Yes | |||
Q5113 | Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg | Herzuma | Yes | |||
Q5114 | Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg | Ogivri | Yes | |||
Q5115 | Injection, rituximab-abbs, biosimilar, 10 mg | Truxima | Yes | |||
Q5116 | Injection, trastuzumab-qyyp, biosimilar, (Trazimera), 10 mg | Trazimera | Yes | |||
Q5117 | Injection, trastuzumab-anns, biosimilar, (Kanjinti), 10 mg | Kanjinti | Yes | |||
Q5118 | Injection, bevacizumab-bvcr, biosimilar, (Zirabev), 10 mg | Zirabev | Yes | |||
Q5119 | Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg | Ruxience | Yes | |||
Q5120 | Injection, pegfilgrastim-bmez, biosimilar, (ZIEXTENZO), 0.5 mg | Ziextenzo | Yes | |||
Q5121 | Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mg | Avsola | Yes | |||
Q9991 | BUPRENORPH XR 100 MG OR LESS | Sublocade | Yes | |||
Q9992 | BUPRENORPHINE XR OVER 100 MG | Sublocade | Yes | |||
S0012 | BUTORPHANOL TARTRATE, NASAL SPRAY, 25 MG | Butorphanol Tartrate | Yes | |||
S0017 | INJECTION, AMINOCAPROIC ACID, 5 GRAMS | Aminocaproic Acid | Yes | |||
S0020 | INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML | Marcaine; Sensorcaine | Yes | |||
S0028 | INJECTION, FAMOTIDINE, 20 MG | Pepcid | Yes | |||
S0030 | INJECTION, METRONIDAZOLE, 500 MG | Flagyl | Yes | |||
S0032 | INJECTION, NAFCILLIN SODIUM, 2 GRAMS | Nafcillin Sodium | Yes | |||
S0039 | INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML | Sulfamethoxazole-trimethoprim | Yes | |||
S0073 | INJECTION, AZTREONAM, 500 MG | Azactam | Yes | |||
S0074 | INJECTION, CEFOTETAN DISODIUM, 500 MG | Cefotan | Yes | |||
S0077 | INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG | Cleocin Phosphate | Yes | |||
S0078 | INJECTION, FOSPHENYTOIN SODIUM, 750 MG | Cerebyx | Yes | |||
S0080 | INJECTION, PENTAMIDINE ISETHIONATE, 300 MG | Pentam | Yes | |||
S0088 | Imatinib, 100 mg | Gleevec | Yes | |||
S0090 | SILDENAFIL CITRATE, 25 MG | Viagra | Yes | |||
S0091 | Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166) | Kytril | Yes | |||
S0092 | Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) | Dilaudid | Yes | |||
S0093 | INJECTION, MORPHINE SULFATE, 500 MG (LOADING DOSE FOR INFUSION PUMP) | Morphine Sulfate | Yes | |||
S0104 | ZIDOVUDINE, ORAL, 100 MG | Retrovir | Yes | |||
S0106 | BUPROPION HCL SUSTAINED RELEASE TABLET, 150 MG, PER BOTTLE OF 60 TABLETS | Wellbutrin SR | Yes | |||
S0108 | MERCAPTOPURINE, ORAL, 50 MG | Purixan | Yes | |||
S0109 | METHADONE, ORAL, 5MG | Dolophine; Methadose | Yes | |||
S0117 | TRETINOIN, TOPICAL, 5 GRAMS | Retin-A; Altreno | Yes | |||
S0119 | Ondansetron 4 mg | Zofran | Yes | |||
S0122 | INJECTION, MENOTROPINS, 75 IU | Menopur | Yes | |||
S0126 | INJECTION, FOLLITROPIN ALFA, 75 IU | Gonal-f Rff | Yes | |||
S0128 | INJECTION, FOLLITROPIN BETA, 75 IU | Follistim AQ | Yes | |||
S0132 | INJECTION, GANIRELIX ACETATE, 250 MCG | Ganirelix Acetate | Yes | |||
S0136 | CLOZAPINE, 25 MG | Clozaril | Yes | |||
S0137 | DIDANOSINE (DDI), 25 MG | Videx; Videx EC | Yes | |||
S0138 | FINASTERIDE, 5 MG | Proscar | Yes | |||
S0139 | MINOXIDIL, 10 MG | Minoxidil | Yes | |||
S0140 | SAQUINAVIR, 200 MG | Invirase | Yes | |||
S0145 | INJECTION, PEGYLATED INTERFERON ALFA-2A, 180 MCG PER ML | Pegasys | Yes | |||
S0148 | Peg interferon alfa-2b, 10 mcg | PegIntron; Sylatron | Yes | |||
S0155 | STERILE DILUTANT FOR EPOPROSTENOL, 50ML | Diluent For Epoprostenol | Yes | |||
S0156 | EXEMESTANE, 25 MG | Aromasin | Yes | |||
S0157 | BECAPLERMIN GEL 0.01%, 0.5 GM | Regranex | Yes | |||
S0160 | DEXTROAMPHETAMINE SULFATE, 5 MG | Dexedrine | Yes | |||
S0164 | INJECTION, PANTOPRAZOLE SODIUM, 40 MG | Protonix | Yes | |||
S0166 | INJECTION, OLANZAPINE, 2.5 MG | Zyprexa | Yes | |||
S0169 | Calcitrol, 0.25 mcg | Rocaltrol | Yes | |||
S0170 | ANASTROZOLE, ORAL, 1MG | Arimidex | Yes | |||
S0171 | INJECTION, BUMETANIDE, 0.5MG | Bumex | Yes | |||
S0172 | CHLORAMBUCIL, ORAL, 2MG | Leukeran | Yes | |||
S0174 | DOLASETRON MESYLATE, ORAL 50MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDI | Anzemet | Yes | |||
S0175 | FLUTAMIDE, ORAL, 125MG | Eulexin | Yes | |||
S0176 | HYDROXYUREA, ORAL, 500MG | Hydrea | Yes | |||
S0178 | LOMUSTINE, ORAL, 10MG | Gleostine | Yes | |||
S0179 | MEGESTROL ACETATE, ORAL, 20MG | Megace ES | Yes | |||
S0182 | PROCARBAZINE HYDROCHLORIDE, ORAL, 50MG | Matulane | Yes | |||
S0183 | PROCHLORPERAZINE MALEATE, ORAL, 5MG (FOR CIRCUMSTANCES FALLING UNDER THE | Compazine | Yes | |||
S0187 | TAMOXIFEN CITRATE, ORAL, 10MG | Tamoxifen Citrate | Yes | |||
S0189 | TESTOSTERONE PELLET, 75MG | Testopel | Yes | |||
S0190 | MIFEPRISTONE, ORAL, 200 MG | Mifeprex | Yes | |||
S0191 | MISOPROSTOL, ORAL, 200 MCG | Cytotec | Yes | |||
S0197 | Prenatal vitamins, 30-day supply | Prenatal Vitamin And Mineral | Yes | |||
S4991 | Nicotine patches, non-legend | Nicoderm CQ | Yes | |||
S4993 | Contraceptive pills for birth control | Multiple | Yes | |||
S4995 | Smoking cessation gum | Nicorette | Yes | |||
S5010 | 5% dextrose and 0.45% normal saline, 1000 ml | Dextrose-sodium chloride | Yes | |||
S5550 | Insulin, rapid onset, 5 units | Apidra | Yes | |||
S5551 | Insulin, most rapid onset (lispro or aspart); 5 units | Multiple | Yes | |||
S5552 | Insulin, intermediate acting (nph or lente); 5 units | Humulin N; Novolin N | Yes | |||
S5553 | Insulin, long acting; 5 units | Multiple | Yes | |||
S5561 | Insulin delivery device, reusable pen; 3 ml size | Yes | ||||
S5566 | Insulin cartridge for use in insulin delivery device other than pump; 300 units | Yes | ||||
S5570 | Insulin delivery device, disposable pen (including insulin); 1.5 ml size | Toujeo Solostar | Yes | |||
S5571 | Insulin delivery device, disposable pen (including insulin); 3 ml size | Multiple | Yes | |||
S8490 | Insulin syringes (100 syringes, any size) | Insulin syringes (100 syringes, any size) | Yes | |||
C1052 | HEMOSTATIC AGT GASTROINTESTINAL TOP | HEMOSTATIC AGT GASTROINTESTINAL TOP | Yes | |||
J1823 | Injection, inebilizumab-cdon, 1 mg | Uplizna | Yes | |||
J7212 | Factor viia (antihemophilic factor, recombinant)- jncw (sevenfact), 1 microgram | Sevenfact | Yes | |||
J7352 | Afamelanotide implant, 1 mg | Scenesse | Yes | |||
J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | Darzalex Faspro | Yes | |||
J9223 | Injection, lurbinectedin, 0.1 mg | Zepzelca | Yes | |||
J9281 | Mitomycin pyelocalyceal instillation, 1 mg | Jelmyto | Yes | |||
J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg | Phesgo | Yes | |||
J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | Trodelvy | Yes | |||
M0243 | IV INFUSION CASIRIVIMAB & IMDEVIMAB MONITORING | IV INFUSION CASIRIVIMAB & IMDEVIMAB MONITORING | Yes | |||
Q0239 | INJECTION BAMLANIVIMAB-XXXX 700 MG | INJECTION BAMLANIVIMAB-XXXX 700 MG | Yes | |||
Q0243 | INJ CASIRIVIMAB & IMDEVIMAB 2400 MG | INJ CASIRIVIMAB & IMDEVIMAB 2400 MG | Yes | |||
Q5122 | Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg | Nyvepria | Yes | |||
S0013 | Esketamine, nasal spray, 1 mg | Spravato | Yes | |||
M0245 | IV INF Bamlanivimab and etesevimab, monitoring | IV INF Bamlanivimab and etesevimab, monitoring | Yes | |||
Q0245 | INJ Bamlanivimab and etesevimab | Bamlanivimab and etesevimab | Yes | |||
J1427 | Injection, viltolarsen, 10 mg | Viltepso | Yes | |||
J1554 | Injection, immune globulin (Asceniv), 500 mg | Asceniv | Yes | |||
J9037 | Injection, belantamab mafodontin-blmf, 0.5 mg | Blenrep | Yes | |||
J9349 | Injection, tafasitamab-cxix, 2 mg | Monjuvi | Yes | |||
Q2053 | Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Tecartus | Yes | |||
J7402 | Mometasone furoate sinus implant, (Sinuva), 10 mcg | Sinuva | Yes | |||
S1091 | Stent, non-coronary, temporary, with delivery system(propel) | Propel | Yes | |||
M0244 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence | n/a | Yes | |||
M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence | n/a | Yes | |||
J0224 | INJECTION LUMASIRAN 0.5 MG | Oxlumo | Yes | |||
J1951 | INJ LEU AC FOR DEP SUSP 0.25 MG | Fensolvi | Yes | |||
J7168 | PRT CMPLX CONC KCNTRA PR IU FIX ACT | Kecentra | Yes | |||
J9348 | INJECTION NAXITAMAB-GQGK 1 MG | Danyelza | Yes | |||
J9353 | INJECTION MARGETUXIMAB-CMKB 5 MG | Margenza | Yes | |||
Q5123 | INJ RITUXIMAB-ARRX BIOSIMILAR 10 MG | Riabni | Yes | |||
Q0247 | injection, sotrovimab 500mg | n/a | Yes | |||
M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | n/a | Yes | |||
Q0244 | injection, casirivimab and imdevimab, 1200mg | n/a | Yes | |||
Q0249 | INJ TOCILIZUMAB HP PT 2 YRS & > COVID-19 1 MG | n/a | Yes | |||
M0249 | IV TCZ HP PT 2 & > COVID-19 INC INF & PA MON FD | n/a | Yes | |||
M0250 | IV TCZ HP 2 & > COVID-19 INC INF & PA MON 2ND D | n/a | Yes | |||
Q0240 | Injection, casirivimab and imdevimab, 600 mg | casirivimab and imdevimab | Yes | |||
M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses | n/a | Yes | |||
M0241 | ntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence | n/a | Yes | |||
J1305 | Injection, evinacumab-dgnb, 5mg | Evkeeza | Yes | |||
J1426 | Injection, casimersen, 10 mg | Amondys 45 | Yes | |||
J1448 | Injection, trilaciclib, 1mg | Cosela | Yes | |||
J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | n/a | Yes | |||
J9319 | Injection, romidepsin, lyophilized, 0.1 mg | Istodax | Yes | |||
Q2054 | Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Breyanzi | Yes | |||
J0699 | Injection, cefiderocol, 10 mg | Fetroja | Yes | |||
J0741 | Injection, cabotegravir and rilpivirine, 2mg/3mg | Cabenuva | Yes | |||
J1445 | Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron | Triferic AVNU | Yes | |||
J2406 | Injection, oritavancin (kimyrsa), 10 mg | Kimyrsa | Yes | |||
J7294 | Segesterone acetate and ethinyl estradiol 0.15 mg, 0.013 mg per 24 hours; yearly vaginal system, each | Annovera | Yes | |||
J7295 | Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each | Nuvaring | Yes | |||
J1952 | Leuprolide injectable, camcevi, 1 mg | Camcevi | Yes | |||
J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | Neulasta | Yes | |||
J9021 | Injection, asparaginase, recombinant, (Rylaze), 0.1 mg | Rylaze | Yes | |||
J9061 | Injection, amivantamab-vmjw, 2 mg | Rybrevant | Yes | |||
J9272 | Injection, dostarlimab-gxly, 10 mg | Jemperli | Yes | |||
Q2055 | Idecabtagene vicleucel, up to 460 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Abecma | Yes | |||
C9088 | Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg | Zynrelef | Yes | |||
C9089 | Bupivacaine, collagen-matrix implant, 1 mg | Xaracoll | Yes | |||
J0172 | Injection, aducanumab-avwa, 2 mg | Aduhelm | Yes | |||
Q0220 | tixagevimab and cilgavimab | Evusheld | Yes | |||
M0220 | tixagevimab and cilgavimab administration code | Evusheld (administration code) | Yes | |||
M0221 | tixagevimab and cilgavimab home administration code | Evusheld ( home administration code) | Yes | |||
J0248 | injection, remdesivir | Veklury | Yes | |||
Q0222 | injection, bebtelovimab, 175mg | bebtelovimab | Yes | |||
M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | Yes | |||
J0219 | Injection, avalglucosidase alfa-ngpt, 4 mg | Nexviazyme | Yes | |||
J0491 | Injection, anifrolumab-fnia, 1 mg | Saphnelo | Yes | |||
J0879 | Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) | Korsuva | Yes | |||
J9273 | Injection, tisotumab vedotin-tftv, 1 mg | Tivdak | Yes | |||
J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | Zynlonta | Yes | |||
Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | Byooviz | Yes | |||
J9071 | Injection, cyclophosphamide, (auromedics), 5 mg | cyclophosphamide | Yes | |||
Q0221 | Injection, tixagevimab and cilgavimab, for pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg | Evusheld | Yes | |||
J2998 | Injection, plasminogen, human-tvmh, 1 mg | Ryplazim | Yes | |||
J9331 | Injection, sirolimus protein-bound particles, 1 mg | Fyarro | Yes | |||
J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | Xipere | Yes | |||
J2779 | Injection, ranibizumab, via sustained release intravitreal implant | Susvimo | Yes | |||
J0739 | Injection, cabotegravir, 1 mg | Apretude | Yes | |||
J1306 | Injection, inclisiran, 1 mg | Leqvio | Yes | |||
J1551 | Injection, immune globulin (cutaquig), 100 mg | Cutaquig | Yes | |||
J2356 | Injection, tezepelumab-ekko, 1 mg | Tezspire | Yes | |||
J9332 | Injection, efgartigimod alfa-fcab, 2 mg | Vyvgart | Yes | |||
Q2017 | injection, teniposide, 50mg | Vumon | Yes | |||
J9999 | not otherwise classified, antineoplastic drugs | n/a | Yes | |||
J7599 | immunosuppressive drugs, not otherwise classified, | Yes | ||||
C9399 | unclassified drugs or biologicals | Yes | ||||
C9101 | Injection, oliceridine, 0.1 mg | Olinvyk | Yes | |||
J1302 | Injection, sutimlimab-jome, 10 mg | Enjaymo | Yes | |||
J1932 | Injection, lanreotide, (Cipla), 1 mg | Cipla | Yes | |||
J2777 | Injection, faricimab-svoa, 0.1 mg | Vabysmo | Yes | |||
J9274 | Injection, tebentafusp-tebn, 1 mcg | kimmtrak | Yes | |||
J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | Opdualag | Yes | |||
Q2056 | Ciltacabtagene autoleucel, up to 100 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Carvykti | Yes | |||
Q5125 | Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg | Releuko | Yes | |||
A9607 | Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie | Pluvicto | Yes | |||
C9143 | Cocaine hydrochloride nasal solution (numbrino), 1 mg | Numbrino | Yes | |||
C9144 | Injection, bupivacaine (posimir), 1 mg | Posimir | Yes | |||
J0134 | Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to J0131, 10mg | Fresenius Kabi 505(b)2 | Yes | |||
J0136 | Injection, acetaminophen (b braun) not therapeutically equivalent to J0131, 10mg | B. Braun 505(b)2 | Yes | |||
J0173 | Injection, epinephrine (belcher) not therapeutically equivalent to J0171, 0.1mg | Belcher/Bpi lanbs 505(b)(2) | Yes | |||
J0225 | Injection, vutrisiran, 1 mg | Amvuttra | Yes | |||
J0283 | Injection, amiodarone hydrochloride (nexterone), 30 mg | Nexterone 505(b)(2) | Yes | |||
J0611 | Injection, calcium gluconate (wg critical care), per 10 ml | WG Critical Care 505(b)(2) | Yes | |||
J0689 | Injection, cefazolin sodium (baxter), not therapeutically equivalent to J0690, 500mg | Baxter 505(b)(2) | Yes | |||
J0701 | Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500mg | Baxter 505(b)(2) | Yes | |||
J0703 | Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500mg | B.Braun 505(b)(2) | Yes | |||
J0877 | Injection, daptomycin (hospira), not therapeutically equivalent to J0878, 1 mg | Hospira 505(b)(2) | Yes | |||
J0891 | Injection, argatroban (accord), not therapeutically equivalent to J0883, 1 mg(for non-esrd use) | Accord 505(b)(2) | Yes | |||
J0892 | Injection, argatroban (accord), not therapeutically equivalent to J0884, 1mg (for esrd on dialysis) | Accord 505(b)(2) | Yes | |||
J0893 | Injection, decitabine (sun pharma) not therapeutically equivalent to J0894, 1mg | Sun Pharma 505(b)(2) | Yes | |||
J0898 | Injection, argatroban (auromedics), not therapeutically equivalent to J0883, 1mg (for non-esrd use) | Auromedics/Eugia 505(b)(2) | Yes | |||
J0899 | Injection, argatroban (auromedics), not therapeutically equivalent to J0884, 1mg (for esrd on dialysis) | Auromedics/Eugia 505(b)(2) | Yes | |||
J1456 | Injection, fosaprepitant (teva), not therapeutically equivalent to J1453, 1mg | Teva/Actavis 505(b)(2) | Yes | |||
J1574 | Injection, ganciclovir sodium (exela) not therapeutically equivalent to J1570, 500mg | Exela 505(b)(2) | Yes | |||
J1611 | Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to J1610, per 1mg | Fresenius Kabi 505(b)(2) | Yes | |||
J1643 | Injection, heparin sodium (pfizer), not therapeutically equivalent to J1644, per 1000 units | Pfizer 505 (b)(2) | Yes | |||
J1954 | Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg | Lutrate | Yes | |||
J2021 | Injection, linezolid (hospira) not therapeutically equivalent to J2020, 200 mg | Hospira 505(b)(2) | Yes | |||
J2184 | Injection, meropenem (b. braun) not therapeutically equivalent to J2185, 100mg | B.Braun 505(b)(2) | Yes | |||
J2247 | Injection, micafungin sodium (par pharm) not therapeutically equivalent to J2248, 1mg | Par 505(b)(2) | Yes | |||
J2251 | Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to J2250, 1mg | WG Critical Care 505(b)(2) | Yes | |||
J2272 | Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to J2270, up to 10mg | Fresenius Kabi 505(b)(2) | Yes | |||
J2281 | Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to J2280, 100mg | Fresenius Kabi 505(b)(2) | Yes | |||
J2311 | Injection, naloxone hydrochloride (zimhi), 1 mg | Zimhi | Yes | |||
J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | Skyrizi | Yes | |||
J2401 | Injection, chloroprocaine hydrochloride, per 1 mg | Nesacaine | Yes | |||
J2402 | Injection, chloroprocaine hydrochloride, per 1 mg | Clorotekal | Yes | |||
J3244 | Injection, tigecycline (accord) not therapeutically equivalent to J3243, 1mg | Accord 505(b)(2) | Yes | |||
J3371 | Injection, vancomycin hcl (mylan) not therapeutically equivalent to J3370, 500mg | Mylan 505(b)(2) | Yes | |||
J3372 | Injection, vancomycin hcl (xellia) not therapeutically equivalent to J3370, 500mg | Xellia 505(b)(2) | Yes | |||
J9046 | Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to J9041, 0.1mg | Dr. Reddy's 505(b)(2) | Yes | |||
J9048 | Injection, bortezomib (fresenius kabi), not therapeutically equivalent to J9041, 0.1mg | Fresenius Kabi 505(b)(2) | Yes | |||
J9049 | Injection, bortezomib (hospira), not therapeutically equivalent to J9041, 0.1mg | Hospira 505(b)(2) | Yes | |||
J9314 | Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10mg | Teva 505(b)(2) | Yes | |||
J9393 | Injection, fulvestrant (teva) not therapeutically equivalent to J9395, 25mg | Teva/Actavis 505(b)(2) | Yes | |||
J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to J9395, 25mg | Fresenius Kabi 505(b)(2) | Yes | |||
Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | Alymsys | Yes |
HCPCS CODE | HCPCS CODE DESCRIPTION | DRUG NAME | Commercial - Authorization Required | Commercial - COVERED (No PA Required) | Commercial - Not Covered | Auth Required if Prescribed for an Oncology/Hematology Related Indication |
---|---|---|---|---|---|---|
90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use | Synagis | Yes | |||
A9513 | Lutetium lu 177, dotatate, therapeutic, 1 millicurie | Lutathera | Yes | |||
A9517 | Iodine- i-131 sodium iodide capsule(s), therapeutic, per millicurie | Hicon | Yes | |||
A9543 | Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries | Zevalin Y-90 | Yes | |||
A9590 | Iodine i-131, iobenguane, 1 millicurie | Azedra | Yes | |||
A9600 | Strontium sr-89 chloride, therapeutic, per millicurie | Metastron | Yes | |||
A9604 | Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries | Quadramet | Yes | |||
A9606 | Radium ra-223 dichloride, therapeutic, per microcurie | Xofigo | Yes | |||
C9046 | COCAINE HCL NASAL SOLUTION | Goprelto | Yes | |||
C9047 | Injection, caplacizumab-yhdp, 1 mg (Cablivi) | Cablivi | Yes | |||
C9113 | INJECTION, PANTOPRAZOLE SODIUM, PER VIAL | Protonix | Yes | |||
C9248 | Inj, clevidipine butyrate | Cleviprex | Yes | |||
C9250 | Human plasma fibrin sealant, vapor-heated, solvent-detergent (artiss), 2 ml | Artiss | Yes | |||
C9254 | Injection, lacosamide | Vimpat | Yes | |||
C9257 | Bevacizumab injection | Avastin | Yes | |||
C9285 | Patch, lidocaine/tetracaine | Synera | Yes | |||
C9290 | INJ, BUPIVACAINE LIPOSOME | Exparel | Yes | |||
C9293 | INJECTION, GLUCARPIDASE | Voraxaze | Yes | |||
C9460 | INJECTION, CANGRELOR | Kengreal | Yes | |||
C9462 | INJECTION, DELAFLOXACIN | Baxdela | Yes | |||
C9482 | SOTALOL HYDROCHLORIDE IV | Sotalol Hcl | Yes | |||
C9488 | CONIVAPTAN HCL | Vaprisol | Yes | |||
J0121 | Injection, omadacycline, 1 mg | Nuzyra | Yes | |||
J0122 | Injection, eravacycline, 1 mg | Xerava | Yes | |||
J0129 | INJECTION ABATACEPT 10 MG | Orencia Clickject | Yes | |||
J0130 | INJECTION ABCIXIMAB, 10 MG | Reopro | Yes | |||
J0131 | Acetaminophen injection, not otherwise specified, 10mg | Ofirmev | Yes | |||
J0132 | INJECTION, ACETYLCYSTEINE, 100 MG | Acetadote | Yes | |||
J0133 | INJECTION, ACYCLOVIR, 5 MG | Acyclovir Sodium | Yes | |||
J0135 | INJECTION, ADALIMUMAB, 20 MG | Humira Pen | Yes | |||
J0153 | ADENOSINE INJ 1MG | Adenoscan | Yes | |||
J0171 | Adrenalin epinephrine inject | Epinephrine Pf | Yes | |||
J0178 | Injection, aflibercept, 1 mg | Eylea | Yes | |||
J0179 | Injection, brolucizumab-dbll, 1 mg | Beovu | Yes | |||
J0180 | INJECTION, AGALSIDASE BETA, 1 MG | Fabrazyme | Yes | |||
J0185 | INJ., APREPITANT, 1 MG | Cinvanti | Yes | |||
J0202 | INJECTION, ALEMTUZUMAB | Lemtrada | Yes | |||
J0207 | INJECTION, AMIFOSTINE, 500 MG | Ethyol | Yes | |||
J0210 | INJECTION, METHYLDOPATE HCL, UP TO 250 MG | Methyldopate Hcl | Yes | |||
J0221 | Injection, alglucosidase alfa, 10 mg | Lumizyme | Yes | |||
J0222 | Injection, patisiran, 0.1 mg | Onpattro | Yes | |||
J0223 | Injection, givosiran, 0.5 mg | Givlaari | Yes | |||
J0256 | INJECTION, ALPHA 1 - PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG | Prolastin-c | Yes | |||
J0257 | INJECTION, ALPHA 1 - PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG | Glassia | Yes | |||
J0270 | ALPROSTADIL, PER 1.25MCG | Caverject | Yes | |||
J0275 | ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRU | Muse | Yes | |||
J0278 | INJECTION, AMIKACIN SULFATE, 100 MG | Amikacin Sulfate | Yes | |||
J0280 | INJECTION, AMINOPHYLLIN, UP TO 250 MG | Aminophylline | Yes | |||
J0282 | INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG | Amiodarone Hcl | Yes | |||
J0285 | INJECTION, AMPHOTERICIN B, 50 MG | Amphotericin B | Yes | |||
J0287 | INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG | Abelcet | Yes | |||
J0289 | INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG | Ambisome | Yes | |||
J0290 | INJECTION, AMPICILLIN SODIUM, UP TO 500MG | Ampicillin Sodium | Yes | |||
J0291 | Injection, plazomicin, 5 mg | Zemdri | Yes | |||
J0295 | INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM | Unasyn | Yes | |||
J0300 | INJECTION, AMOBARBITAL, UP TO 125 MG | Amytal Sodium | Yes | |||
J0330 | INJECTION, SUCCINYCHOLINE CHLORIDE, UP TO 20 MG | Quelicin | Yes | |||
J0348 | INJECTION, ANIDULAFUNGIN, 1 MG | Eraxis | Yes | |||
J0360 | INJECTION, HYDRALAZINE HCL, UP TO 20 MG | Hydralazine Hcl | Yes | |||
J0364 | INJECTION, APOMORPHINE HYDROCHLORIDE, 1 MG | Apokyn | Yes | |||
J0401 | INJ ARIPIPRAZOLE EXT REL 1MG | Abilify Maintena | Yes | |||
J0456 | INJECTION, AZITHROMYCIN, 500 MG | Zithromax | Yes | |||
J0461 | Atropine sulfate injection | Atropine Sulfate | Yes | |||
J0470 | INJECTION, DIMECAPROL, UP TO 100 MG | Bal In Oil | Yes | |||
J0475 | INJECTION, BACLOFEN, 10 MG | Baclofen | Yes | |||
J0476 | INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL | Lioresal | Yes | |||
J0480 | INJECTION, BASILIXIMAB, 20 MG | Simulect | Yes | |||
J0485 | BELATACEPT INJECTION | Nulojix | Yes | |||
J0490 | Belimumab injection | Benlysta | Yes | |||
J0500 | INJECTION, DICYCLOMINE, UP TO 20 MG | Bentyl | Yes | |||
J0515 | INJECTION, BENZTROPINE | Cogentin | Yes | |||
J0517 | INJ., BENRALIZUMAB, 1 MG | Fasenra | Yes | |||
J0558 | PenG benzathine/procaine inj | Bicillin C-R | Yes | |||
J0561 | Penicillin g benzathine inj | Bicillin L-A | Yes | |||
J0565 | INJ, BEZLOTOXUMAB, 10 MG | Zinplava | Yes | |||
J0567 | INJ., CERLIPONASE ALFA 1 MG | Brineura | Yes | |||
J0570 | BUPRENORPHINE IMPLANT, 74.2 MG | Probuphine Implant Kit | Yes | |||
J0571 | BUPRENORPHINE ORAL 1MG | Subutex | Yes | |||
J0572 | BUPRENORPHIN/NALOX UP TO 3MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0573 | BUPRENORPH/NALOX 3.1 TO 6MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0574 | BUPRENORPH/NALOX 6.1 TO 10MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0575 | BUPRENORPH/NALOX OVER 10MG | Suboxone, Bunavail, Zubsolv | Yes | |||
J0583 | INJECTION, BIVALIRUDIN, 1 MG | Angiomax | Yes | |||
J0584 | INJECTION, BUROSUMAB-TWZA 1M | Crysvita | Yes | |||
J0585 | BOTULINUM TOXIN TYPE A, PER UNIT | Botox | Yes | |||
J0586 | AbobotulinumtoxinA | Dysport | Yes | |||
J0587 | RimabotulinumtoxinB | Myobloc | Yes | |||
J0588 | IncobotulinumtoxinA | Xeomin | Yes | |||
J0591 | Injection, deoxycholic acid, 1 mg | Kybella | Yes | |||
J0592 | INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG | Buprenex | Yes | |||
J0593 | Injection, lanadelumab-flyo, 1 mg (code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) | Takhzyro | Yes | |||
J0594 | INJECTION BUSULFAN 1 MG | Busulfex | Yes | |||
J0595 | INJECTION, BUTORPHANOL TARTRATE, 1 MG | Butorphanol Tartrate | Yes | |||
J0596 | Injection, C1 esterase inhibitor (recombinant), ruconest, 10 units | Ruconest | Yes | |||
J0597 | Injection, c-1 esterase inhibitor (human), berinert, 10 units | Berinert | Yes | |||
J0598 | Injection, c-1 esterase inhibitor (human), cinryze, 10 units | Cinryze | Yes | |||
J0599 | Injection, c-1 esterase inhibitor (human), haegarda, 10 units | Haegarda | Yes | |||
J0600 | INJECTION, EDETATE CALCIUM DISODIUM, UP TO 200 MG | Calcium Disodium Versenate | Yes | |||
J0604 | CINACALCET, ORAL, ESRD ON DIALYSIS | Sensipar | Yes | |||
J0606 | INJ, ETELCALCETIDE, 0.1 MG | Parsabiv | Yes | |||
J0610 | INJECTION, CALCIUM GLUCONATE(fresenius kabi), PER 10 ML | Calcium Gluconate | Yes | |||
J0630 | INJECTION, CALCITONIN SALMON, UP TO 400 UNITS | Miacalcin | Yes | |||
J0636 | INJECTION, CALCITRIOL, 0.1 MCG | Calcitriol | Yes | |||
J0637 | INJECTION, CASPOFUNGIN ACETATE, 5 MG | Cancidas | Yes | |||
J0638 | Canakinumab injection | Ilaris | Yes | |||
J0640 | INJECTION, LEUCOVORIN CALCIUM, PER 50 MG | Leucovorin Calcium | Yes | |||
J0641 | Levoleucovorin injection | Levoleucovorin Calcium Pf | Yes | |||
J0642 | Injection, levoleucovorin (Khapzory), 0.5 mg | Khapzory | Yes | |||
J0670 | INJECTION, MEPIVACAINE | Polocaine-mpf | Yes | |||
J0690 | INJECTION, CEFAZOLIN SODIUM, UP TO 500 MG | Cefazolin Sodium | Yes | |||
J0691 | Injection, lefamulin, 1 mg | Xenleta | Yes | |||
J0692 | INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG | Cefepime Hcl | Yes | |||
J0694 | INJECTION, CEFOXITIN SODIUM, 1 GM | Cefoxitin Sodium | Yes | |||
J0695 | INJ CEFTOLOZANE AND TAZOBACTAM | Zerbaxa | Yes | |||
J0696 | INJECTION, CEFTRIAXONE SODIUM, PER 250 MG (ROCEPHIN) | Ceftriaxone Sodium | Yes | |||
J0697 | INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG | Zinacef | Yes | |||
J0698 | CEFOTAXIME SODIUM, PER GM | Cefotaxime Sodium | Yes | |||
J0702 | INJECTION; BETAMETHASONE ACETATE & SODIUM PHOSPHATE | Betamethasone Sod Phos & Acet | Yes | |||
J0706 | INJECTION, CAFFEINE CITRATE, 5MG | Caffeine Citrate | Yes | |||
J0712 | Ceftaroline fosamil inj | Teflaro | Yes | |||
J0713 | INJ CEFTAZIDIME PER 500 MG | Ceftazidime | Yes | |||
J0714 | CEFTAZIDIME AND AVIBACTAM | Avycaz | Yes | |||
J0716 | CENTRUROIDES IMMUNE F(AB) | Anascorp | Yes | |||
J0717 | CERTOLIZUMAB PEGOL INJ 1MG | Cimzia Starter Kit | Yes | |||
J0720 | INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM | Chloramphenicol Sod Succinate | Yes | |||
J0725 | INJECTION, CHORIONIC GONADOTROPIN | Novarel | Yes | |||
J0735 | INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG | Duraclon | Yes | |||
J0740 | INJECTION, CIDOFOVIR, 375 MG | Cidofovir | Yes | |||
J0742 | Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg | Recarbrio | Yes | |||
J0743 | INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG | Primaxin | Yes | |||
J0744 | INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG | Cipro IV | Yes | |||
J0770 | INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG | Coly-Mycin M | Yes | |||
J0775 | Collagenase, clost hist inj | Xiaflex | Yes | |||
J0780 | INJECTION, PROCHLORPERAZINE, UP TO 10 MG | Prochlorperazine Edisylate | Yes | |||
J0791 | Injection, crizanlizumab-tmca, 5 mg | Adakveo | Yes | |||
J0795 | INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM | Acthrel | Yes | |||
J0800 | INJECTION, CORTICOTROPIN, UP TO 40 UNITS | Acthar | Yes | |||
J0834 | Cosyntropin cortrosyn inj | Cosyntropin | Yes | |||
J0840 | Crotalidae poly immune fab | Crofab | Yes | |||
J0841 | INJ CROTALIDAE IM F(AB')2 EQ | Anavip | Yes | |||
J0850 | Injection, cytomegalovirus immune globulin IV | Cytogam | Yes | |||
J0875 | INJECTION, DALBAVANCIN | Dalvance | Yes | |||
J0878 | INJECTION, DAPTOMYCIN, 1 MG | Cubicin | Yes | |||
J0881 | INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE) | Aranesp | Yes | |||
J0882 | INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS) | Aranesp | Yes | |||
J0883 | ARGATROBAN NONESRD USE 1MG | Argatroban | Yes | |||
J0884 | ARGATROBAN ESRD DIALYSIS 1MG | Argatroban | Yes | |||
J0885 | INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS | Epogen, Procrit | Yes | |||
J0887 | EPOETIN BETA ESRD USE | Mircera | Yes | |||
J0888 | EPOETIN BETA NON ESRD | Mircera | Yes | |||
J0894 | INJECTION DECITABINE 1 MG | Decitabine | Yes | |||
J0895 | INJECTION, DEFEROXAMINE MESYLATE, 500 MG PER 5 CC | Desferal | Yes | |||
J0896 | Injection, luspatercept-aamt, 0.25 mg | Reblozyl | Yes | |||
J0897 | Denosumab injection | Prolia, Xgeva | Yes | |||
J1000 | INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG | Depo-estradiol | Yes | |||
J1020 | INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG | Depo-medrol | Yes | |||
J1030 | INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG | Methylprednisolone Acetate | Yes | |||
J1040 | INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG | Methylprednisolone Acetate | Yes | |||
J1050 | INJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG(DEPO PROVERA) | Depo-provera | Yes | |||
J1071 | INJ TESTOSTERONE CYPIONATE | Testosterone Cypionate | Yes | |||
J1095 | INJECTION, DEXAMETHASONE 9 PERCENT, INTRAOCULAR, 1 | Dexycu | Yes | |||
J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg | Dextenza | Yes | |||
J1097 | Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | Omidria | Yes | |||
J1100 | INJECTION, DEXAMETHOSONE SODIUM PHOSPHATE, UP TO 4MG/ML | Dexamethasone Sodium Phosphate | Yes | |||
J1110 | INJECTION, DEHYDROERGOTAMINE, UP TO 1 MG | Dihydroergotamine Mesylate | Yes | |||
J1120 | INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG | Acetazolamide Sodium | Yes | |||
J1130 | INJ DICLOFENAC SODIUM 0.5MG | Dyloject | Yes | |||
J1160 | INJECTION, DIGOXIN, UP TO 0.5 MG | Lanoxin | Yes | |||
J1162 | INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL | Digifab | Yes | |||
J1165 | INJECTION, PHENYTOIN SODIUM | Phenytoin Sodium | Yes | |||
J1170 | INJECTION, HYDROMORPHONE, UP TO 4 MG | Dilaudid | Yes | |||
J1190 | INJECTION, DEXRAZOXANE HCL, PER 250 MG | Dexrazoxane Hcl | Yes | |||
J1200 | INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG | Diphenhydramine Hcl | Yes | |||
J1201 | Injection, cetirizine hydrochloride, 0.5 mg | Quzyttir | Yes | |||
J1205 | INJECTION, CHLOROTHIAZIDE SODIUM | Diuril | Yes | |||
J1212 | INJECTION, DMSO, DIMETHYL SULFOXIDE | Rimso-50 | Yes | |||
J1230 | INJECTION, METHADONE HCL, UP TO 10 MG | Methadone Hcl | Yes | |||
J1240 | INJECTION, DIMENHYDRINATE, UP TO 50 MG | Dimenhydrinate | Yes | |||
J1245 | INJECTION, DIPYRIDAMOLE, PER 10 MG | Dipyridamole | Yes | |||
J1250 | INJ DOBUTAMINE HCL/250 MG | Dobutamine Hcl | Yes | |||
J1260 | INJECTION, DOLASETRON MESYLATE, 10 MG | Anzemet | Yes | |||
J1265 | INJECTION, DOPAMINE HCL, 40 MG | Dopamine Hcl | Yes | |||
J1267 | Doripenem injection | Doribax | Yes | |||
J1270 | INJECTION, DOXERCALCIFEROL, 1 MCG | Hectorol | Yes | |||
J1290 | Ecallantide injection | Kalbitor | Yes | |||
J1300 | Eculizumab injection | Soliris | Yes | |||
J1301 | INJECTION, EDARAVONE, 1 MG | Radicava | Yes | |||
J1303 | Injection, ravulizumab-cwvz, 10 mg | Ultomiris | Yes | |||
J1322 | ELOSULFASE ALFA, INJECTION | Vimizim | Yes | |||
J1324 | Enfuvirtide injection | Fuzeon | Yes | |||
J1325 | INJECTION, EPOPROSTENOL, 0.5 MG | Flolan, Veletri | Yes | |||
J1327 | INJECTION, EPTIFIBATIDE, 5 MG | Integrilin | Yes | |||
J1335 | INJECTION, ERTAPENEM SODIUM, 500 MG | Invanz | Yes | |||
J1364 | INJECTION; ERYTHROMYCIN LACTOBIONA | Erythrocin Lactobionate | Yes | |||
J1380 | INJECTION, ESTRADIOL VALERATE, UP TO 10 MG | Estradiol Valerate | Yes | |||
J1410 | INJECTION, ESTROGEN CONJUGATED, UP TO 2 MG OR 20,000 UNITS | Premarin | Yes | |||
J1428 | INJ, ETEPLIRSEN, 10 MG | Exondys 51 | Yes | |||
J1429 | Injection, golodirsen, 10 mg | Vyondys 53 | Yes | |||
J1430 | INJECTION, ETHANOLAMINE OLEATE, 100 MG | Ethamolin | Yes | |||
J1437 | Injection, ferric derisomaltose, 10 mg | Monoferric | Yes | |||
J1438 | INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) | Enbrel | Yes | |||
J1439 | INJ FERRIC CARBOXYMALTOSE 1MG | Injectafer | Yes | |||
J1442 | INJ, FILGRASTIM G-CSF 1MCG | Neupogen | Yes | |||
J1443 | Injection, ferric pyrophosphate citrate solution, 0.1 mg of iron | Triferic | Yes | |||
J1444 | Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron | Triferic | Yes | |||
J1447 | INJ TBO FILGRASTIM 1 MICROG | Granix | Yes | |||
J1450 | INJECTION FLUCONAZOLE, 200 MG | Fluconazole In Sodium Chloride | Yes | |||
J1451 | INJECTION, FOMEPIZOLE, 15 MG | Fomepizole | Yes | |||
J1453 | Fosaprepitant injection | Emend | Yes | |||
J1454 | INJ FOSNETUPITANT AND PALONOSETRON | Akynzeo | Yes | |||
J1455 | INJECTION, FOSCARNET SODIUM, PER 1000 MG | Foscavir | Yes | |||
J1458 | INJECTION GALSULFASE 1 MG | Naglazyme | Yes | |||
J1459 | Inj IVIG privigen 500 mg | Privigen | Yes | |||
J1460 | INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC | Gamastan | Yes | |||
J1555 | INJ, IMMUNE GLOBULIN, CUVITRU, 100 MG | Cuvitru | Yes | |||
J1556 | INJ, IMM GLOB BIVIGAM, 500MG | Bivigam | Yes | |||
J1557 | Inj, immune globulin, Gammaplex, 500 mg | Gammaplex | Yes | |||
J1558 | Injection, immune globulin (xembify), 100 mg | Xembify | Yes | |||
J1559 | Inj, immune globulin, Hizentra, 100 mg | Hizentra | Yes | |||
J1560 | INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC | Gamastan | Yes | |||
J1561 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, PER 500 MG. | Gammaked, Gamunex-C | Yes | |||
J1566 | INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. P | Carimune Nf | Yes | |||
J1568 | Octagam injection | Octagam | Yes | |||
J1569 | Gammagard liquid injection | Gammagard Liquid | Yes | |||
J1570 | INJECTION, GANCICLOVIR SODIUM, 500 MG | Ganciclovir Sodium | Yes | |||
J1571 | HepaGam B IM injection | Hepagam B | Yes | |||
J1572 | Flebogamma injection | Flebogamma Dif | Yes | |||
J1573 | Hepagam B intravenous, inj | Hepagam B | Yes | |||
J1575 | HYQVIA 100MG IMMUNEGLOBULIN | Hyqvia | Yes | |||
J1580 | INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG | Gentamicin Sulfate | Yes | |||
J1595 | INJECTION, GLATIRAMER ACETATE, 20 MG | Copaxone | Yes | |||
J1599 | Ivig non-lyophilized, NOS | Panzyga, Asceniv | Yes | |||
J1602 | GOLIMUMAB FOR IV USE 1MG | Simponi Aria | Yes | |||
J1610 | INJECTION; GLUCAGON HYDROCHLORIDE | Glucagon Emergency | Yes | |||
J1626 | INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG | Granisetron Hcl | Yes | |||
J1627 | INJ, GRANISETRON, XR, 0.1 MG | Sustol | Yes | |||
J1628 | INJ., GUSELKUMAB, 1 MG | Tremfya | Yes | |||
J1630 | INJECTION, HALOPERIDOL, UP TO 5 MG | Haldol Lactate | Yes | |||
J1631 | INJECTION, HALOPERIDOL DECANOATE, PER 50 MG | Haldol Decanoate | Yes | |||
J1632 | Injection, brexanolone, 1 mg | Zulresso | Yes | |||
J1640 | INJECTION, HEMIN, 1 MG | Panhematin | Yes | |||
J1642 | HEPARIN SODIUM PER 10 UNITS | Heparin Lock Flush | Yes | |||
J1644 | INJECTION, HEPARIN SODIUM, PER 1000 units | Heparin Sodium (porcine) | Yes | |||
J1645 | INJECTION, DALTEPARIN SODIUM, PER 2500 IU | Fragmin | Yes | |||
J1650 | INJ ENOXAPARIN SODIUM 30 MG | Lovenox | Yes | |||
J1652 | INJECTION, FONDAPARINUX SODIUM, 0.5 MG | Arixtra | Yes | |||
J1670 | INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS | Hypertet S/D | Yes | |||
J1675 | INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS | Vantas | Yes | |||
J1720 | INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG | Solu-cortef | Yes | |||
J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg | Makena | Yes | |||
J1729 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg | Hydroxyprogesterone Caproate | Yes | |||
J1730 | INJECTION, DIAZOXIDE, UP TO 300 MG | Yes | ||||
J1738 | Injection, meloxicam, 1 mg | Anjeso | Yes | |||
J1740 | INJECTION IBANDRONATE SODIUM 1 MG | Boniva | Yes | |||
J1741 | INJECTION, IBUPROFEN, 100 MG | Caldolor | Yes | |||
J1742 | INJECTION, IBUTILIDE FUMARATE, 1 MG | Corvert | Yes | |||
J1743 | Idursulfase injection | Elaprase | Yes | |||
J1744 | ICATIBANT INJECTION | Firazyr | Yes | |||
J1745 | INJECTION INFLIXIMAB, 10 MG | Remicade | Yes | |||
J1746 | INJ., IBALIZUMAB-UIYK, 10 MG | Trogarzo | Yes | |||
J1750 | INJECTION, IRON DEXTRAN, 50 MG | Infed | Yes | |||
J1756 | INJECTION, IRON SUCROSE, 1 MG | Venofer | Yes | |||
J1786 | Injection, imiglucerase, 10 units | Cerezyme | Yes | |||
J1790 | INJECTION, DROPERIDOL, UP TO 5 MG | Droperidol | Yes | |||
J1800 | INJECTION, PROPRANOLOL HCL, UP TO 1 MG | Propranolol Hcl | Yes | |||
J1815 | INJECTION, INSULIN, PER 5 UNITS | Multiple | Yes | |||
J1817 | INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS | Multiple | Yes | |||
J1826 | Interferon Beta-1A inj | Avonex Pen | Yes | |||
J1830 | INJECTION; INTERFERON BETA-1B | Betaseron | Yes | |||
J1833 | INJECTION, ISAVUCONAZONIUM | Cresemba | Yes | |||
J1885 | INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG | Toradol | Yes | |||
J1930 | Injection, lanreotide, 1 mg | Somatuline Depot | Yes | |||
J1931 | INJECTION, LARONIDASE, 0.1 MG | Aldurazyme | Yes | |||
J1940 | INJECTION, FUROSEMIDE, UP TO 20 MG | Lasix | Yes | |||
J1943 | Injection, aripiprazole lauroxil, (Aristada Initio), 1 mg | Aristada Initio | Yes | |||
J1944 | Injection, aripiprazole lauroxil, (Aristada), 1 mg | Aristada | Yes | |||
J1950 | Injection, leuprolide acetate, per 3.75mg | Lupron Depot | Yes | |||
J1953 | Levetiracetam injection | Keppra | Yes | |||
J1955 | INJ LEVOCARNITINE PER 1 GM | Carnitor | Yes | |||
J1956 | INJECTION, LEVOFLOXACIN, 250 MG | Levaquin | Yes | |||
J1980 | INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG | Levsin | Yes | |||
J2001 | INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG | Xylocaine | Yes | |||
J2010 | INJECTION, LINCOMYCIN HCL, UP TO 300 MG | Lincocin | Yes | |||
J2020 | INJECTION, LINEZOLID, 200MG | Zyvox | Yes | |||
J2060 | INJECTION, LORAZEPAM, 2 MG | Ativan | Yes | |||
J2062 | LOXAPINE FOR INHALATION 1 MG | Adasuve | Yes | |||
J2150 | INJECTION, MANNITOL, 25% IN 50 ML | Osmitrol | Yes | |||
J2170 | Mecasermin injection | Increlex | Yes | |||
J2175 | INJECTION, MEPERIDINE; PER 100MG | Demerol | Yes | |||
J2182 | INJECTION, MEPOLIZUMAB, 1MG | Nucala | Yes | |||
J2185 | INJECTION, MEROPENEM, 100 MG | Merrem | Yes | |||
J2186 | INJECTION, MEROPENEM AND VABORBACTAM, 10MG/10MG, (20 MG) | Vabomere | Yes | |||
J2210 | INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG | Methergine | Yes | |||
J2212 | METHYLNALTREXONE INJECTION | Relistor | Yes | |||
J2248 | INJECTION MICAFUNGIN SODIUM 1 MG | Mycamine | Yes | |||
J2250 | INJ MIDAZOLAM HYDROCHLORIDE (VERSED) | Versed | Yes | |||
J2260 | INJECTION; MILRIONONE LACTATE | Milrinone Lactate | Yes | |||
J2265 | Minocycline hydrochloride | Minocin | Yes | |||
J2270 | INJECTION, MORPHINE SULFATE, UP TO 10 MG | Morphine Sulfate | Yes | |||
J2274 | IN MORPHINE PRESERVATIV FREE | Morphine Sulfate (pf) | Yes | |||
J2278 | INJECTION, ZICONOTIDE, 1 MICROGRAM | Prialt | Yes | |||
J2280 | INJECTION, MOXIFLOXACIN, 100 MG | Avelox | Yes | |||
J2300 | INJ NALBUPHINE HYDROCHLORIDE | Nalbuphine Hcl | Yes | |||
J2310 | INJ NALOXONE HYDROCHLORIDE | Narcan | Yes | |||
J2315 | INJECTION NALTREXONE DEPOT FORM 1 MG | Vivitrol | Yes | |||
J2323 | Natalizumab injection | Tysabri | Yes | |||
J2325 | INJECTION, NESIRITIDE, 0.1 MG | Natrecor | Yes | |||
J2326 | INJ, NUSINERSEN, 0.1MG | Spinraza | Yes | |||
J2350 | Injection, ocrelizumab, 1 mg | Ocrevus | Yes | |||
J2353 | INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG | Sandostatin LAR Depot | Yes | |||
J2354 | INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJ, 25 MCG | Sandostatin | Yes | |||
J2357 | INJECTION, OMALIZUMAB, 5 MG | Xolair | Yes | |||
J2358 | Olanzapine long-acting inj | Zyprexa Relprevv | Yes | |||
J2360 | INJECTION, ORPHENADRINE, UP TO 60 MG | Orphenate | Yes | |||
J2370 | INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML | Phenylephrine Hcl | Yes | |||
J2405 | INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG | Zofran | Yes | |||
J2407 | INJECTION, ORITAVANCIN | Orbactiv | Yes | |||
J2410 | INJECTION, OXYMORPHONE HCL, UP TO 1 MG | Opana | Yes | |||
J2425 | INJECTION, PALIFERMIN, 50 MICROGRAMS | Kepivance | Yes | |||
J2426 | Inj, paliperidone palmitate extended release, 1 mg | Invega Sustenna, Invega Trinza | Yes | |||
J2430 | INJECTION; PAMIDRONATE DISODIUM | Aredia | Yes | |||
J2440 | INJECTION, PAPAVERINE HCL, UP TO 60 MG | Papaverine Hcl | Yes | |||
J2469 | INJECTION, PALONOSETRON HCL, 25 MCG | Aloxi | Yes | |||
J2501 | INJECTION, PARICALCITOL, 1 MCG | Zemplar | Yes | |||
J2502 | INJ, PASIREOTIDE LONG ACTING | Signifor LAR | Yes | |||
J2503 | INJECTION, PEGAPTANIB SODIUM, 0.3 MG | Macugen | Yes | |||
J2504 | INJECTION, PEGADEMASE BOVINE, 25 IU | Adagen | Yes | |||
J2507 | Pegloticase injection | Krystexxa | Yes | |||
J2510 | INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS | Penicillin G Procaine | Yes | |||
J2515 | INJECTION, PENTOBARBITAL SODIUM | Nembutal | Yes | |||
J2540 | INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS | Pfizerpen | Yes | |||
J2543 | INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS) | Zosyn | Yes | |||
J2545 | Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg | Nebupent | Yes | |||
J2547 | INJECTION, PERAMIVIR | Rapivab | Yes | |||
J2550 | INJECTION, PROMETHAZINE HCL, UP TO 50 MG | Phenergan | Yes | |||
J2560 | INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG | Phenobarbital Sodium | Yes | |||
J2562 | Plerixafor injection | Mozobil | Yes | |||
J2590 | INJECTION, OXYTOCIN, UP TO 10 UNITS | Pitocin | Yes | |||
J2597 | INJECTION DESMOPRESSIN ACETATE, PER 1 MCG | DDAVP | Yes | |||
J2675 | INJECTION, PROGESTERONE, PER 50MG | Progesterone in Oil | Yes | |||
J2680 | INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG | Prolixin Decanoate | Yes | |||
J2690 | INJECTION, PROCAINAMIDE HCL, UP TO 1 GM | Pronestyl | Yes | |||
J2700 | INJECTION, OXACILLIN SODIUM, UP TO 250 MG | Bactocill | Yes | |||
J2704 | INJ, PROPOFOL, 10 MG | Diprivan | Yes | |||
J2710 | INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG | Bloxiverz | Yes | |||
J2720 | INJECTION, PROTAMINE SULFATE, UP TO 5 ML | Protamine Sulfate | Yes | |||
J2724 | Injection, protein c concentrate, intravenous, human, 10 iu | Ceprotin | Yes | |||
J2730 | INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM | Protopam | Yes | |||
J2760 | INJECTION, PHENTOLAINE MESYLATE, UP TO 5 MG(REGITINE) | Phentolamine Mesylate | Yes | |||
J2765 | INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG | Reglan | Yes | |||
J2770 | INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350) | Synercid | Yes | |||
J2778 | Ranibizumab injection | Lucentis | Yes | |||
J2780 | INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG | Zantac | Yes | |||
J2783 | INJECTION, RASBURICASE, 0.5 MG | Elitek | Yes | |||
J2785 | Regadenoson injection | Lexiscan | Yes | |||
J2786 | INJECTION, RESLIZUMAB, 1MG | Cinqair | Yes | |||
J2787 | Riboflavin 5'-phosphate, ophthalmic solution, up to 3 ml | Photrexa Viscous | Yes | |||
J2788 | Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) | HyperRHO S/D | Yes | |||
J2790 | Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) | HyperRHO S/D, Rhogam Ultra-filtered Plus | Yes | |||
J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | Rhophylac | Yes | |||
J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | WinRho SDF | Yes | |||
J2793 | Rilonacept injection | Arcalyst | Yes | |||
J2794 | Injection, risperidone (Risperdal CONSTA), 0.5 mg | Risperdal Consta | Yes | |||
J2795 | INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG | Naropin | Yes | |||
J2796 | Romiplostim injection | Nplate | Yes | |||
J2797 | INJ., ROLAPITANT, 0.5 MG | Varubi | Yes | |||
J2798 | Injection, risperidone, (Perseris), 0.5 mg | Perseris | Yes | |||
J2800 | INJECTION, METHOCARBAMOL, UP TO 10 ML | Robaxin | Yes | |||
J2805 | INJECTION, SINCALIDE, 5 MICROGRAMS | Kinevac | Yes | |||
J2810 | INJECTION, THEOPHYLLINE, UP TO 2 ML | Theophylline | Yes | |||
J2820 | INJECTION, SARGRAMOSTIM (CM-CSF), 50 MCG | Leukine | Yes | |||
J2840 | INJECTION, SEBELIPASE ALFA, 1 MG | Kanuma | Yes | |||
J2850 | INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM | ChiRhoStim | Yes | |||
J2860 | INJECTION, SILTUXIMAB | Sylvant | Yes | |||
J2916 | INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG | Ferrlecit | Yes | |||
J2920 | INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG | Solu-medrol | Yes | |||
J2930 | INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG | Solu-medrol | Yes | |||
J2941 | INJECTION, SOMATROPIN, 1 MG | Serostim, Humatrope, Genotropin,Norditropin,Nutropin,Omnitrope,Saizen,Zomacton,Zorbtive | Yes | |||
J2993 | INJECTION, RETEPLASE, 18.1 MG | Retavase | Yes | |||
J2997 | INJECTION, ALTEPLASE RECOMBINANT, 1 MG | Activase | Yes | |||
J3000 | INJECTION, STREPTOMYCIN, UP TO 1 GM | Streptomycin Sulfate | Yes | |||
J3010 | INJECTION, FENTANYL CITRATE, 0.1 MG | Sublimaze | Yes | |||
J3030 | INJECTION; SUMATRIPTAN SUCCINATE; 6MG | Imitrex, Sumavel | Yes | |||
J3031 | Injection, fremanezumab-vfrm, 1 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered) | Ajovy | Yes | |||
J3032 | Injection, eptinezumab-jjmr, 1 mg | Vyepti | Yes | |||
J3060 | Injection, taliglucerase alfa, 10 units | Elelyso | Yes | |||
J3070 | INJECTION, PENTAZOCINE HCL, UP TO 30 MG | Talwin | Yes | |||
J3090 | INJ TEDIZOLID PHOSPHATE | Sivextro | Yes | |||
J3095 | Televancin injection | Vibativ | Yes | |||
J3101 | Tenecteplase injection | TNKase | Yes | |||
J3105 | INJECTION, TERBUTALINE SULFATE, UP TO 1 MG | Terbutaline Sulfate | Yes | |||
J3110 | INJECTION, TERIPARATIDE, 10 MCG | Forteo | Yes | |||
J3111 | Injection, romosozumab-aqqg, 1 mg | Evenity | Yes | |||
J3121 | INJ TESTOSTERO ENANTHATE 1MG | Delatestryl | Yes | |||
J3145 | TESTOSTERONE UNDECANOATE 1MG | Aveed | Yes | |||
J3230 | INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG | Thorazine | Yes | |||
J3240 | INJECTION, THYROTROPIN, UP TO 10 I.U. | Thyrogen | Yes | |||
J3241 | Injection, teprotumumab-trbw, 10 mg | Tepezza | Yes | |||
J3243 | INJECTION TIGECYCLINE 1 MG | Tygacil | Yes | |||
J3245 | INJ., TILDRAKIZUMAB, 1 MG | Ilumya | Yes | |||
J3246 | INJECTION, TIROFIBAN HCL, 0.25MG | Aggrastat | Yes | |||
J3250 | INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG | Tigan | Yes | |||
J3260 | INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG | Nebcin | Yes | |||
J3262 | Tocilizumab injection | Actemra | Yes | |||
J3285 | INJECTION, TREPROSTINIL, 1 MG | Remodulin | Yes | |||
J3300 | Triamcinolone A inj PRS-free | Triesence | Yes | |||
J3301 | INJECTION TRIAMCINOLONE ACETONIDE, PER 10MG | Kenalog | Yes | |||
J3303 | INJECTION TRIAMCINOLONE HEXACETONIDE, PER 5MG | Aristospan | Yes | |||
J3304 | INJ TRIAMCINOLONE ACE XR 1MG | Zilretta | Yes | |||
J3315 | INJECTION, TRIPTORELIN PAMOATE, 3.75 MG | Trelstar | Yes | |||
J3316 | INJ., TRIPTORELIN XR 3.75 MG | Triptodur | Yes | |||
J3355 | INJECTION, UROFOLLITROPIN, 75 IU | Bravelle | Yes | |||
J3357 | Ustekinumab, for subcutaneous injection, 1 mg | Stelara | Yes | |||
J3358 | Ustekinumab, for intravenous injection, 1 mg | Stelara | Yes | |||
J3360 | INJECTION, DIAZEPAM, UP TO 5 MG | Valium | Yes | |||
J3370 | INJECTION, VANCOMYCIN HCL, UP TO 500 MG | Vancocin | Yes | |||
J3380 | INJECTION, VEDOLIZUMAB | Entyvio | Yes | |||
J3385 | Velaglucerase alfa | Vpriv | Yes | |||
J3396 | INJECTION, VERTEPORFIN, 0.1 MG | Visudyne | Yes | |||
J3397 | INJ., VESTRONIDASE ALFA-VJBK | Mepsevii | Yes | |||
J3398 | Injection, voretigene neparvovec-rzyl, 1 billion vector genomes | Luxturna | Yes | |||
J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes | Zolgensma | Yes | |||
J3410 | INJECTION, HYDROXYZINE HCL, UP TO 25 MG | Vistaril | Yes | |||
J3411 | INJECTION, THIAMINE HCL, 100 MG | Thiamine Hcl | Yes | |||
J3415 | INJECTION, PYRIDOXINE HCL, 100 MG | Pyridoxine Hcl | Yes | |||
J3420 | INJECTION, VITAMIN B- 12 CYANOCOBALAMIN, UP TO 1000 MCG | Cyanocobalamin | Yes | |||
J3430 | Injection, phytonadione (vitamin k), per 1 mg | Aqua-Mephyton | Yes | |||
J3465 | INJECTION, VORICONAZOLE, 10 MG | Vfend IV | Yes | |||
J3470 | INJECTION, HYALURONIDASE, UP TO 150 UNITS | Amphadase | Yes | |||
J3471 | INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 US | Vitrase | Yes | |||
J3473 | INJECTION HYALURONIDASE RECOMBINANT 1 USP UNIT | Hylenex | Yes | |||
J3475 | INJ MAGNESIUM SULFATE | Magnesium Sulfate | Yes | |||
J3480 | INJ POTASSIUM CHLORIDE-2 MEQ | Potassium Chloride | Yes | |||
J3485 | INJECTION, ZIDOVUDINE, 10 MG | Retrovir | Yes | |||
J3486 | INJECTION, ZIPRASIDONE MESYLATE, 10 MG | Geodon | Yes | |||
J3489 | ZOLEDRONIC ACID 1MG | Reclast, Zometa | Yes | |||
J3490 | Unclassified drugs | Unclassified drugs | Yes | |||
J3590 | Unclassified biologics | Unclassified biologics | Yes | |||
J7030 | INFUSION, NORMAL SALINE SOLUTION , 1000 CC | Sodium Chloride | Yes | |||
J7040 | INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) | Sodium Chloride | Yes | |||
J7042 | 5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT) | Dextrose 5%-0.9% NaCl | Yes | |||
J7050 | INFUSION, NORMAL SALINE SOLUTION , 250 CC | Sodium Chloride | Yes | |||
J7060 | 5% DEXTROSE/WATER (500 ML = 1 UNIT) | Dextrose in water | Yes | |||
J7070 | INFUSION, D5W, 1000 CC | Dextrose in water | Yes | |||
J7100 | INFUSION, DEXTRAN 40, 500 ML | LMD | Yes | |||
J7120 | RINGERS LACTATE INFUSION, UP TO 1000 CC | Lactated Ringers | Yes | |||
J7121 | 5% DEXTROSE IN LAC RINGERS | Dextrose In Lactated Ringers | Yes | |||
J7169 | Injection, coagulation Factor Xa (recombinant), inactivated-zhzo (Andexxa), 10 mg | Andexxa | Yes | |||
J7170 | INJ., EMICIZUMAB-KXWH 0.5 MG | Hemlibra | Yes | |||
J7175 | INJ, FACTOR X, (HUMAN), 1IU | Coagadex | Yes | |||
J7177 | Injection, human fibrinogen concentrate (fibryga), 1 mg | Fibryga | Yes | |||
J7178 | HUMAN FIBRINOGEN CONC INJ | Riastap | Yes | |||
J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco | Vonvendi | Yes | |||
J7180 | Factor XIII anti-hem factor | Corifact | Yes | |||
J7181 | FACTOR XIII RECOMB A-SUBUNIT | Tretten | Yes | |||
J7182 | FACTOR VIII RECOMB NOVOEIGHT | Novoeight | Yes | |||
J7183 | Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco | Wilate | Yes | |||
J7185 | Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. | Xyntha | Yes | |||
J7186 | Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. | Alphanate/VWF Complex/Human | Yes | |||
J7187 | INJECTION VON WILLEBRAND FACTOR COMPLEX HUMAN RISTOCETIN COFACTOR PER IV | Humate-p | Yes | |||
J7188 | FACTOR VIII RECOMB OBIZUR | Obizur | Yes | |||
J7189 | Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram | NovoSeven RT | Yes | |||
J7190 | FACTOR VIII, (ANTI-HEMOPHILIC FACTOR (HUMAN)), PER I.U. | Hemofil M, Koate | Yes | |||
J7192 | FACTOR VIII (ANTIHEMOPHILIC FACTOR (RECOMBINANT)), PER I.U. | Recombinate, Advate, Kogenate, Helixate FS | Yes | |||
J7193 | FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U. | Mononine, Alphanine | Yes | |||
J7194 | FACTOR IX, COMPLEX, PER I.U. | Profilnine SD | Yes | |||
J7195 | FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U. | Ixinity, BeneFIX | Yes | |||
J7196 | Antithrombin recombinant | Atryn | Yes | |||
J7197 | ANTITHROMBIN III (HUMAN), PER I.U. | Thrombate III | Yes | |||
J7198 | ANTI-INHIBITOR, PER I.U. | Feiba NF | Yes | |||
J7200 | FACTOR IX RECOMBINAN RIXUBIS | Rixubis | Yes | |||
J7201 | FACTOR IX FC FUSION RECOMB | Alprolix | Yes | |||
J7202 | FACTOR IX IDELVION INJ | Idelvion | Yes | |||
J7203 | FACTOR IX RECOMB GLY REBINYN | Rebinyn | Yes | |||
J7204 | Injection, Factor VIII, antihemophilic factor (recombinant), (Esperoct), glycopegylated-exei, per IU | Esperoct | Yes | |||
J7205 | FACTOR VIII FC FUSION RECOMB | Eloctate | Yes | |||
J7207 | FACTOR VIII PEGYLATED RECOMB | Adynovate | Yes | |||
J7208 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. | Jivi | Yes | |||
J7209 | FACTOR VIII NUWIQ RECOMB 1IU | Nuwiq | Yes | |||
J7210 | INJ, AFSTYLA, 1 I.U. | Afstyla | Yes | |||
J7211 | INJ, KOVALTRY, 1 I.U. | Kovaltry | Yes | |||
J7296 | LEVONORGESTREL IU, KYLEENA, 19.5 MG | Kyleena | Yes | |||
J7297 | LEVONORGESTREL IU 52MG 3 YR | Liletta (52 Mg) | Yes | |||
J7298 | LEVONORGESTREL IU 52MG 5 YR | Mirena (52 Mg) | Yes | |||
J7300 | IUD COPPER | Paragard Intrauterine Copper | Yes | |||
J7301 | LEVONORGESTREL IU, SKYLA, 13.5MG | Skyla | Yes | |||
J7304 | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH | Xulane | Yes | |||
J7307 | Etonogestrel implant system | Nexplanon | Yes | |||
J7308 | AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOS | Levulan Kerastick | Yes | |||
J7311 | FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT | Retisert | Yes | |||
J7312 | Dexamethasone intravitreal implant | Ozurdex | Yes | |||
J7313 | FLUOCINOL ACET INTRAVITREAL IMPLANT | Iluvien | Yes | |||
J7314 | Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg | Yutiq | Yes | |||
J7315 | OPTHALMIC MITOMYCIN | Mitosol | Yes | |||
J7316 | INJ, OCRIPLASMIN, 0.125 MG | Jetrea | Yes | |||
J7318 | INJ, DUROLANE 1 MG | Durolane | Yes | |||
J7320 | HYALURONAN OR DERIVITIVE, GENVISC 850, FOR INTRA-ARTICULAR INJ, 1 MG | Genvisc 850 | Yes | |||
J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | Hyalgan; Supartz;Visco-3 | Yes | |||
J7322 | HYALURONAN OR DERIVATIVE, HYMOVIS, FOR INTRA-ARTICULAR INJECTION, 1 MG | Hymovis | Yes | |||
J7323 | Euflexxa inj per dose | Euflexxa | Yes | |||
J7324 | Orthovisc inj per dose | Orthovisc | Yes | |||
J7325 | Synvisc or Synvisc-One | Synvisc, Synvisc-One | Yes | |||
J7326 | Gel-one | Gel-one | Yes | |||
J7327 | MONOVISC INJ PER DOSE | Monovisc | Yes | |||
J7328 | GEL-SYN INJECTION 0.1 MG | Gelsyn-3 | Yes | |||
J7329 | INJ, TRIVISC 1 MG | Trivisc | Yes | |||
J7330 | AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT | MACI | Yes | |||
J7331 | Hyaluronan or derivative, SYNOJOYNT, for intra-articular injection, 1 mg | Synojoynt | Yes | |||
J7332 | Hyaluronan or derivative, Triluron, for intra-articular injection, 1 mg | Triluron | Yes | |||
J7336 | CAPSAICIN 8% PATCH | Qutenza | Yes | |||
J7340 | CARBIDOPA LEVODOPA ENTERAL | Duopa | Yes | |||
J7342 | Instillation, ciprofloxacin otic suspension, 6 mg | Otiprio | Yes | |||
J7345 | Aminolevulinic acid HCl for topical administration, 10% gel, 10mg | Ameluz | Yes | |||
J7351 | Injection, bimatoprost, intracameral implant, 1 mcg | Durysta | Yes | |||
J7500 | Azathioprine, oral, 50 mg | Imuran | Yes | |||
J7501 | Azathioprine, parenteral, 100 mg | Azathioprine Sodium | Yes | |||
J7502 | CYCLOSPORINE, ORAL, 100 MG | Sandimmune; Gengraf; Neoral | Yes | |||
J7503 | TACROL ENVARSUS EXT REL ORAL | Envarsus XR | Yes | |||
J7504 | LYMPHOCYTE IMMUNE GLOBULIN, ANTITYMOCYTE GLOBULIN - PARENTERAL, AMP, 5 | Atgam | Yes | |||
J7507 | TACROLIMUS, ORAL | Prograf | Yes | |||
J7508 | TACROLIMUS EXT REL ORAL 0.1MG | Astagraf XL | Yes | |||
J7509 | METHYLPREDNISOLONE ORAL | Medrol | Yes | |||
J7510 | PREDNISOLONE ORAL PER 5 MG | Prednisolone | Yes | |||
J7511 | LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, | Thymoglobulin | Yes | |||
J7512 | PREDNISONE IR OR DR ORAL 1MG | Deltasone | Yes | |||
J7513 | DACLIZUMAB, PARENTERAL, 25 MG | Zinbryta | Yes | |||
J7515 | CYCLOSPORINE, ORAL, 25 MG | Sandimmune; Gengraf, Neoral | Yes | |||
J7516 | CYCLOSPORIN, PARENTERAL, 250 MG | SandIMMUNE | Yes | |||
J7517 | MYCOPHENOLATE MOFETIL, ORAL, 250 MG | CellCept | Yes | |||
J7518 | MYCOPHENOLIC ACID, ORAL, 180 MG | Myfortic | Yes | |||
J7520 | SIROLIMUS, ORAL, 1 MG | Rapamune | Yes | |||
J7525 | TACROLIMUS, PARENTERAL, 5 MG | Prograf | Yes | |||
J7527 | ORAL EVEROLIMUS | Zortress | Yes | |||
J7605 | Arformoterol non-comp unit | Brovana | Yes | |||
J7606 | Formoterol fumarate, inh | Perforomist | Yes | |||
J7608 | ACETYLCYSTEINE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE | Acetylcysteine | Yes | |||
J7611 | ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, CO | Albuterol Sulfate | Yes | |||
J7612 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg | Xopenex | Yes | |||
J7613 | ALBUTEROL, INHALATION SOLUTION, ADMINISTERED THROUGH DME, UN | Albuterol Sulfate | Yes | |||
J7614 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg | Xopenex | Yes | |||
J7620 | ALBUTEROL AND IPRATROPIUM INHAL.SOLUTION ADMIN. VIA DME | Ipratropium-albuterol | Yes | |||
J7626 | BUDESONIDE INHALATION SOLUTION, ADMINISTERED THROUGH DME, UNIT DOSE FORM | Pulmicort Respules | Yes | |||
J7631 | CROMOLYN SODIUM, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE | Cromolyn Sodium | Yes | |||
J7639 | DORNASE ALPHA, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE F | Pulmozyme | Yes | |||
J7644 | IPRATROPIUM BROMIDE, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT | Atrovent | Yes | |||
J7665 | Mannitol for inhaler | Aridol | Yes | |||
J7674 | METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION TH | Provocholine | Yes | |||
J7677 | revefenacin inhalation solution | Yupelri | Yes | |||
J7682 | TOBRAMYCIN, UNIT DOSE FORM, 300 MG, INHALATION SOLUTION, ADMINISTERED THROUGH DME | Tobi; Bethkis; Kitabis | Yes | |||
J7686 | Treprostinil, non-comp unit | Tyvaso | Yes | |||
J8499 | Prescription drug, oral, non chemotherapeutic, nos | Prescription drug, oral, non chemotherapeutic, nos | Yes | |||
J8501 | APREPITANT, ORAL, 5 MG | Emend | Yes | |||
J8510 | BUSULFAN; ORAL, 2 MG | Myleran | Yes | |||
J8515 | CABERGOLINE, ORAL, 0.25 MG | Cabergoline | Yes | |||
J8520 | CAPECITABINE, ORAL, 150 MG | Xeloda | Yes | |||
J8521 | CAPECITABINE, ORAL, 500 MG | Xeloda | Yes | |||
J8530 | CYCLOPHOSPHAMIDE, ORAL | Cyclophosphamide | Yes | |||
J8540 | DEXAMETHASONE, ORAL, 0.25 MG | Dexamethasone | Yes | |||
J8560 | ETOPOSIDE, ORAL | VePesid | Yes | |||
J8565 | GEFITINIB, ORAL, 250 MG | Iressa | Yes | |||
J8600 | MELPHALAN | Alkeran | Yes | |||
J8610 | METHOTREXATE, ORAL | Methotrexate | Yes | |||
J8650 | Nabilone oral | Cesamet | Yes | |||
J8655 | NETUPITANT AND PALONOSETRON, ORAL | Akynzeo | Yes | |||
J8670 | ROLAPITANT, ORAL, 1MG | Varubi | Yes | |||
J8700 | TEMOZOLOMIDE, ORAL, 5 MG | Temodar | Yes | |||
J8705 | Topotecan oral | Hycamtin | Yes | |||
J8999 | Prescription drug, oral, chemotherapeutic, NOS | Prescription drug, oral, chemotherapeutic, NOS | Yes | |||
J9000 | DOXORUBICIN HCL, 10 MG | Adriamycin | Yes | |||
J9015 | ALDESLEUKIN/SINGLE USE VIAL | Proleukin | Yes | |||
J9017 | ARSENIC TRIOXIDE, 1MG | Trisenox | Yes | |||
J9019 | Injection, asparaginase (erwinaze), 1,000 iu | Erwinaze | Yes | |||
J9022 | INJ, ATEZOLIZUMAB,10 MG | Tecentriq | Yes | |||
J9023 | INJECTION, AVELUMAB, 10 MG | Bavencio | Yes | |||
J9025 | INJECTION, AZACITIDINE, 1 MG | Vidaza | Yes | |||
J9027 | INJECTION, CLOFARABINE, 1 MG | Clolar | Yes | |||
J9030 | Bcg live intravesical instillation, 1 mg | Tice BCG | Yes | |||
J9032 | INJECTION, BELINOSTAT, 10MG | Beleodaq | Yes | |||
J9033 | Bendamustine injection | Treanda | Yes | |||
J9034 | Inj., bendamustine hcl (bendeka), 1 mg | Bendeka | Yes | |||
J9035 | INJECTION, BEVACIZUMAB, 10 MG | Avastin | Yes | |||
J9036 | Injection, bendamustine hydrochloride, (Belrapzo/bendamustine), 1 mg | Belrapzo | Yes | |||
J9039 | INJECTION, BLINATUMOMAB | Blincyto | Yes | |||
J9040 | BLEOMYCIN SULFATE, 15 UNITS | Bleomycin Sulfate | Yes | |||
J9041 | INJECTION, BORTEZOMIB(VELCADE), 0.1 MG | Velcade | Yes | |||
J9042 | BRENTUXIMAB VEDOTIN INJ | Adcetris | Yes | |||
J9043 | Cabazitaxel injection | Jevtana | Yes | |||
J9045 | CARBOPLATIN, 50 MG | Paraplatin | Yes | |||
J9047 | INJECTION, CARFILZOMIB, 1 MG | Kyprolis | Yes | |||
J9050 | CARMUSTINE, 100 MG | BiCNU | Yes | |||
J9055 | INJECTION, CETUXIMAB, 10 MG | Erbitux | Yes | |||
J9057 | INJ., COPANLISIB, 1 MG | Aliqopa | Yes | |||
J9060 | CISPLATIN, POWDER OR S0LUTION, PER 10 MG | Platinol AQ | Yes | |||
J9065 | INJECTION; CLADRIBINE | Leustatin | Yes | |||
J9070 | CYCLOPHOSPHAMIDE, 100 MG | Cytoxan | Yes | |||
J9098 | CYTARABINE LIPOSOME, 10 MG | Depocyt | Yes | |||
J9100 | CYTARABINE 100 MG | Cytarabine (pf) | Yes | |||
J9118 | Injection, calaspargase pegol-mknl, 10 units | Asparlas | Yes | |||
J9119 | Injection, cemiplimab-rwlc, 1 mg | Libtayo | Yes | |||
J9120 | DACTINOMYCIN, 0.5 MG | Cosmegen | Yes | |||
J9130 | DACARBAZINE, 100 MG | DTIC-DOME IV | Yes | |||
J9145 | INJECTION, DARATUMUMAB 10 MG | Darzalex | Yes | |||
J9150 | DAUNORUBICIN HYDROCHLORIDE, 10 MG | Cerubidine | Yes | |||
J9151 | DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG | Daunoxome | Yes | |||
J9153 | INJ, LIPOSOMAL, DAUNORUBICIN AND CYTARABINE | Vyxeos | Yes | |||
J9155 | Degarelix injection | Firmagon | Yes | |||
J9171 | Docetaxel injection | Taxotere | Yes | |||
J9173 | INJ., DURVALUMAB, 10 MG | Imfinzi | Yes | |||
J9175 | INJECTION, ELLIOTTS' B SOLUTION, 1 ML | Elliotts B | Yes | |||
J9176 | INJECTION, ELOTUZUMAB, 1MG | Empliciti | Yes | |||
J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | Padcev | Yes | |||
J9178 | INJECTION, EPIRUBICIN HCL, 2 MG | Ellence | Yes | |||
J9179 | Eribulin mesylate injection | Halaven | Yes | |||
J9181 | ETOPOSIDE, 10 MG | Etoposide | Yes | |||
J9185 | FLUDARABINE PHOSPHATE, 50 MG | Fludara | Yes | |||
J9190 | FLUOROURACIL, 500 MG | Adrucil | Yes | |||
J9198 | Injection, gemcitabine hydrochloride, (Infugem), 100 mg | Infugem | Yes | |||
J9200 | FLOXURIDINE, 500 MG | Floxuridine | Yes | |||
J9201 | GEMCITABINE HCL, 200 MG | Gemzar | Yes | |||
J9202 | GOSERELIN ACETATE IMPLANT, PER 3.6 MG | Zoladex | Yes | |||
J9203 | GEMTUZUMAB OZOGAMICIN 0.1 MG | Mylotarg | Yes | |||
J9204 | Injection, mogamulizumab-kpkc, 1 mg | Poteligeo | Yes | |||
J9205 | INJ IRINOTECAN LIPOSOME 1 MG | Onivyde | Yes | |||
J9206 | IRINOTECAN, 20 MG | Camptosar | Yes | |||
J9207 | Ixabepilone injection | Ixempra Kit | Yes | |||
J9208 | IFOSFAMIDE, 1 GM | Ifex | Yes | |||
J9209 | MESNA, 200 MG | Mesnex | Yes | |||
J9210 | Injection, emapalumab-lzsg, 1 mg | Gamifant | Yes | |||
J9211 | IDARUBICIN HYDROCHLORIDE, 5 MG | Idamycin PFS | Yes | |||
J9214 | INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS | Intron A | Yes | |||
J9215 | INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU | Alferon N | Yes | |||
J9216 | INTERFERON, GAMMA 1-B, 3 MILLION UNITS | Actimmune | Yes | |||
J9217 | LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG | Eligard, Lupron Depot | Yes | |||
J9218 | LEUPROLIDE ACETATE, PER 1 MG | Leuprolide Acetate | Yes | |||
J9225 | HISTRELIN IMPLANT, 50 MG | Vantas | Yes | |||
J9226 | Supprelin LA implant | Supprelin LA | Yes | |||
J9227 | Injection, isatuximab-irfc, 10 mg | Sarclisa | Yes | |||
J9228 | Ipilimumab injection | Yervoy | Yes | |||
J9229 | INJ INOTUZUMAB OZOGAM 0.1 MG | Besponsa | Yes | |||
J9230 | MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG | Mustargen | Yes | |||
J9245 | INJECTION; MELPHALAN HCL | Alkeran | Yes | |||
J9246 | Injection, melphalan (Evomela), 1 mg | Evomela | Yes | |||
J9250 | METHOTREXATE SODIUM, 5 MG | Methotrexate Sodium | Yes | |||
J9260 | METHOTREXATE SODIUM, 50 MG | Methotrexate Sodium | Yes | |||
J9261 | INJECTION NELARABINE 50 MG | Arranon | Yes | |||
J9262 | INJ, OMACETAXINE MEP, 0.01MG | Synribo | Yes | |||
J9263 | INJECTION, OXALIPLATIN, 0.5 MG | Eloxatin | Yes | |||
J9264 | INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG | Abraxane | Yes | |||
J9266 | PEGASPARGASE/SINGL DOSE VIAL | Oncaspar | Yes | |||
J9267 | PACLITAXEL INJECTION | Taxol | Yes | |||
J9268 | PENTOSTATIN, PER 10 MG (NIPENT) | Nipent | Yes | |||
J9269 | Injection, tagraxofusp-erzs, 10 mcg | Elzonris | Yes | |||
J9271 | INJ PEMBROLIZUMAB | Keytruda | Yes | |||
J9280 | MITOMYCIN, 5 MG | Mutamycin | Yes | |||
J9285 | INJ, OLARATUMAB, 10 MG | Lartruvo | Yes | |||
J9293 | MITOXANTRONE HYDROCHLORIDE, 20 MG-1994,1995=5MG | Novantrone | Yes | |||
J9295 | INJECTION, NECITUMUMAB, 1 MG | Portrazza | Yes | |||
J9299 | INJECTION, NIVOLUMAB | Opdivo | Yes | |||
J9301 | OBINUTUZUMAB INJ | Gazyva | Yes | |||
J9302 | Ofatumumab injection | Arzerra | Yes | |||
J9303 | Panitumumab injection | Vectibix | Yes | |||
J9304 | Injection, pemetrexed (Pemfexy), 10 mg | Pemfexy | Yes | |||
J9305 | INJECTION, PEMETREXED, not otherwise specified, 10 MG | Alimta | Yes | |||
J9306 | INJECTION, PERTUZUMAB, 1 MG | Perjeta | Yes | |||
J9307 | Pralatrexate injection | Folotyn | Yes | |||
J9308 | INJECTION, RAMUCIRUMAB | Cyramza | Yes | |||
J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | Polivy | Yes | |||
J9311 | INJ RITUXIMAB, HYALURONIDASE | Rituxan Hycela | Yes | |||
J9312 | INJ., RITUXIMAB, 10 MG | Rituxan | Yes | |||
J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | Lumoxiti | Yes | |||
J9320 | STREPTOZOCIN, 1 GM | Zanosar | Yes | |||
J9325 | INJ TALIMOGENE LAHERPAREPVEC | Imlygic | Yes | |||
J9328 | Temozolomide injection | Temodar | Yes | |||
J9330 | Temsirolimus injection | Torisel | Yes | |||
J9340 | THIOTEPA, 15 MG | Tepadina | Yes | |||
J9351 | Topotecan injection | Hycamtin | Yes | |||
J9352 | INJECTION TRABECTEDIN 0.1MG | Yondelis | Yes | |||
J9354 | INJ, ADO-TRASTUZUMAB EMT 1MG | Kadcyla | Yes | |||
J9355 | TRASTUZUMAB, 10 MG | Herceptin | Yes | |||
J9356 | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk | Herceptin Hylecta | Yes | |||
J9357 | VALRUBICIN, INTRAVESICAL, 200 MG | Valstar | Yes | |||
J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | Enhertu | Yes | |||
J9360 | VINBLASTINE SULFATE, 1 MG | Vinblastine Sulfate | Yes | |||
J9370 | VINCRISTINE SULFATE, 1 MG | Vincasar PFS | Yes | |||
J9371 | INJ, VINCRISTINE SUL LIP 1MG | Marqibo | Yes | |||
J9390 | VINORELBINE TARTRATE/10 MG | Navelbine | Yes | |||
J9395 | INJECTION, FULVESTRANT, 25 MG | Faslodex | Yes | |||
J9400 | INJ, ZIV-AFLIBERCEPT, 1MG | Zaltrap | Yes | |||
J9600 | PORFIMER SODIUM, 75 MG | Photofrin | Yes | |||
P9045 | INFUSION, ALBUMIN (HUMAN), 5%, 250 ML | Plasbumin-5 | Yes | |||
P9046 | INFUSION, ALBUMIN (HUMAN), 25%, 20 ML | Albutein | Yes | |||
P9047 | INFUSION, ALBUMIN (HUMAN), 25%, 50 ML | Albuminar-25 | Yes | |||
Q0138 | Ferumoxytol, non-esrd | Feraheme | Yes | |||
Q0139 | Ferumoxytol, esrd use | Feraheme | Yes | |||
Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM | Zithromax | Yes | |||
Q0162 | Ondansetron oral | Zofran | Yes | |||
Q0163 | DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION AN | Benadryl | Yes | |||
Q0164 | PROCHLORPERAZINE MALEATE, 5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EM | Compazine | Yes | |||
Q0166 | GRANISETRON HYDROCHLORIDE, 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EM | Kytril | Yes | |||
Q0167 | DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE | Marinol | Yes | |||
Q0169 | PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVED PRESCRIPTION ANT | Phenergan | Yes | |||
Q0175 | PERPHENAZINE, 4 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE | Perphenazine | Yes | |||
Q0177 | HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, | Vistaril | Yes | |||
Q2004 | Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml | Renacidin | Yes | |||
Q2009 | INJECTION, FOSPHENYTOIN, 50 MG | Cerebyx | Yes | |||
Q2028 | INJ, SCULPTRA, 0.5MG | Sculptra | Yes | |||
Q2041 | Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Yescarta | Yes | |||
Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Kymriah | Yes | |||
Q2043 | Sipuleucel-T auto CD54+ | Provenge | Yes | |||
Q2050 | Inj, doxorubicin, liposomal, not otherwise specified, 10 mg | Doxil | Yes | |||
Q3027 | INJ BETA INTERFERON IM 1 MCG | Avonex | Yes | |||
Q3028 | INJ BETA INTERFERON SQ 1 MCG | Rebif | Yes | |||
Q4074 | Iloprost non-comp unit dose | Ventavis | Yes | |||
Q4081 | INJECTION EPOETIN ALFA 100 UNITS (FOR ESRD ON DIALYSIS) | Epogen, Procrit | Yes | |||
Q5101 | INJ FILGRASTIM G-CSF BIOSIM | Zarxio | Yes | |||
Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | Inflectra | Yes | |||
Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | Renflexis | Yes | |||
Q5105 | Inj, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Retacrit | Yes | |||
Q5106 | Inj, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Retacrit | Yes | |||
Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | Mvasi | Yes | |||
Q5108 | Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg | Fulphila | Yes | |||
Q5109 | Injection, infliximab-qbtx, biosimilar, (ixifi), 10 mg | Ixifi | Yes | |||
Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 mcg | Nivestym | Yes | |||
Q5111 | Injection, pegfilgrastim-cbqv, biosimilar, (udenyca), 0.5 mg | Udenyca | Yes | |||
Q5112 | Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg | Ontruzant | Yes | |||
Q5113 | Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg | Herzuma | Yes | |||
Q5114 | Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg | Ogivri | Yes | |||
Q5115 | Injection, rituximab-abbs, biosimilar, 10 mg | Truxima | Yes | |||
Q5116 | Injection, trastuzumab-qyyp, biosimilar, (Trazimera), 10 mg | Trazimera | Yes | |||
Q5117 | Injection, trastuzumab-anns, biosimilar, (Kanjinti), 10 mg | Kanjinti | Yes | |||
Q5118 | Injection, bevacizumab-bvcr, biosimilar, (Zirabev), 10 mg | Zirabev | Yes | |||
Q5119 | Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg | Ruxience | Yes | |||
Q5120 | Injection, pegfilgrastim-bmez, biosimilar, (ZIEXTENZO), 0.5 mg | Ziextenzo | Yes | |||
Q5121 | Injection, infliximab-axxq, biosimilar, (AVSOLA), 10 mg | Avsola | Yes | |||
Q9991 | BUPRENORPH XR 100 MG OR LESS | Sublocade | Yes | |||
Q9992 | BUPRENORPHINE XR OVER 100 MG | Sublocade | Yes | |||
S0012 | BUTORPHANOL TARTRATE, NASAL SPRAY, 25 MG | Butorphanol Tartrate | Yes | |||
S0017 | INJECTION, AMINOCAPROIC ACID, 5 GRAMS | Aminocaproic Acid | Yes | |||
S0020 | INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML | Marcaine; Sensorcaine | Yes | |||
S0028 | INJECTION, FAMOTIDINE, 20 MG | Pepcid | Yes | |||
S0030 | INJECTION, METRONIDAZOLE, 500 MG | Flagyl | Yes | |||
S0032 | INJECTION, NAFCILLIN SODIUM, 2 GRAMS | Nafcillin Sodium | Yes | |||
S0039 | INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML | Sulfamethoxazole-trimethoprim | Yes | |||
S0073 | INJECTION, AZTREONAM, 500 MG | Azactam | Yes | |||
S0074 | INJECTION, CEFOTETAN DISODIUM, 500 MG | Cefotan | Yes | |||
S0077 | INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG | Cleocin Phosphate | Yes | |||
S0078 | INJECTION, FOSPHENYTOIN SODIUM, 750 MG | Cerebyx | Yes | |||
S0080 | INJECTION, PENTAMIDINE ISETHIONATE, 300 MG | Pentam | Yes | |||
S0088 | Imatinib, 100 mg | Gleevec | Yes | |||
S0090 | SILDENAFIL CITRATE, 25 MG | Viagra | Yes | |||
S0091 | Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166) | Kytril | Yes | |||
S0092 | Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) | Dilaudid | Yes | |||
S0093 | INJECTION, MORPHINE SULFATE, 500 MG (LOADING DOSE FOR INFUSION PUMP) | Morphine Sulfate | Yes | |||
S0104 | ZIDOVUDINE, ORAL, 100 MG | Retrovir | Yes | |||
S0106 | BUPROPION HCL SUSTAINED RELEASE TABLET, 150 MG, PER BOTTLE OF 60 TABLETS | Wellbutrin SR | Yes | |||
S0108 | MERCAPTOPURINE, ORAL, 50 MG | Purixan | Yes | |||
S0109 | METHADONE, ORAL, 5MG | Dolophine; Methadose | Yes | |||
S0117 | TRETINOIN, TOPICAL, 5 GRAMS | Retin-A; Altreno | Yes | |||
S0119 | Ondansetron 4 mg | Zofran | Yes | |||
S0122 | INJECTION, MENOTROPINS, 75 IU | Menopur | Yes | |||
S0126 | INJECTION, FOLLITROPIN ALFA, 75 IU | Gonal-f Rff | Yes | |||
S0128 | INJECTION, FOLLITROPIN BETA, 75 IU | Follistim AQ | Yes | |||
S0132 | INJECTION, GANIRELIX ACETATE, 250 MCG | Ganirelix Acetate | Yes | |||
S0136 | CLOZAPINE, 25 MG | Clozaril | Yes | |||
S0137 | DIDANOSINE (DDI), 25 MG | Videx; Videx EC | Yes | |||
S0138 | FINASTERIDE, 5 MG | Proscar | Yes | |||
S0139 | MINOXIDIL, 10 MG | Minoxidil | Yes | |||
S0140 | SAQUINAVIR, 200 MG | Invirase | Yes | |||
S0145 | INJECTION, PEGYLATED INTERFERON ALFA-2A, 180 MCG PER ML | Pegasys | Yes | |||
S0148 | Peg interferon alfa-2b, 10 mcg | PegIntron; Sylatron | Yes | |||
S0155 | STERILE DILUTANT FOR EPOPROSTENOL, 50ML | Diluent For Epoprostenol | Yes | |||
S0156 | EXEMESTANE, 25 MG | Aromasin | Yes | |||
S0157 | BECAPLERMIN GEL 0.01%, 0.5 GM | Regranex | Yes | |||
S0160 | DEXTROAMPHETAMINE SULFATE, 5 MG | Dexedrine | Yes | |||
S0164 | INJECTION, PANTOPRAZOLE SODIUM, 40 MG | Protonix | Yes | |||
S0166 | INJECTION, OLANZAPINE, 2.5 MG | Zyprexa | Yes | |||
S0169 | Calcitrol, 0.25 mcg | Rocaltrol | Yes | |||
S0170 | ANASTROZOLE, ORAL, 1MG | Arimidex | Yes | |||
S0171 | INJECTION, BUMETANIDE, 0.5MG | Bumex | Yes | |||
S0172 | CHLORAMBUCIL, ORAL, 2MG | Leukeran | Yes | |||
S0174 | DOLASETRON MESYLATE, ORAL 50MG (FOR CIRCUMSTANCES FALLING UNDER THE MEDI | Anzemet | Yes | |||
S0175 | FLUTAMIDE, ORAL, 125MG | Eulexin | Yes | |||
S0176 | HYDROXYUREA, ORAL, 500MG | Hydrea | Yes | |||
S0178 | LOMUSTINE, ORAL, 10MG | Gleostine | Yes | |||
S0179 | MEGESTROL ACETATE, ORAL, 20MG | Megace ES | Yes | |||
S0182 | PROCARBAZINE HYDROCHLORIDE, ORAL, 50MG | Matulane | Yes | |||
S0183 | PROCHLORPERAZINE MALEATE, ORAL, 5MG (FOR CIRCUMSTANCES FALLING UNDER THE | Compazine | Yes | |||
S0187 | TAMOXIFEN CITRATE, ORAL, 10MG | Tamoxifen Citrate | Yes | |||
S0189 | TESTOSTERONE PELLET, 75MG | Testopel | Yes | |||
S0190 | MIFEPRISTONE, ORAL, 200 MG | Mifeprex | Yes | |||
S0191 | MISOPROSTOL, ORAL, 200 MCG | Cytotec | Yes | |||
S0197 | Prenatal vitamins, 30-day supply | Prenatal Vitamin And Mineral | Yes | |||
S4991 | Nicotine patches, non-legend | Nicoderm CQ | Yes | |||
S4993 | Contraceptive pills for birth control | Multiple | Yes | |||
S4995 | Smoking cessation gum | Nicorette | Yes | |||
S5010 | 5% dextrose and 0.45% normal saline, 1000 ml | Dextrose-sodium chloride | Yes | |||
S5550 | Insulin, rapid onset, 5 units | Apidra | Yes | |||
S5551 | Insulin, most rapid onset (lispro or aspart); 5 units | Multiple | Yes | |||
S5552 | Insulin, intermediate acting (nph or lente); 5 units | Humulin N; Novolin N | Yes | |||
S5553 | Insulin, long acting; 5 units | Multiple | Yes | |||
S5561 | Insulin delivery device, reusable pen; 3 ml size | Yes | ||||
S5566 | Insulin cartridge for use in insulin delivery device other than pump; 300 units | Yes | ||||
S5570 | Insulin delivery device, disposable pen (including insulin); 1.5 ml size | Toujeo Solostar | Yes | |||
S5571 | Insulin delivery device, disposable pen (including insulin); 3 ml size | Multiple | Yes | |||
S8490 | Insulin syringes (100 syringes, any size) | Insulin syringes (100 syringes, any size) | Yes | |||
C1052 | HEMOSTATIC AGT GASTROINTESTINAL TOP | HEMOSTATIC AGT GASTROINTESTINAL TOP | Yes | |||
J1823 | Injection, inebilizumab-cdon, 1 mg | Uplizna | Yes | |||
J7212 | Factor viia (antihemophilic factor, recombinant)- jncw (sevenfact), 1 microgram | Sevenfact | Yes | |||
J7352 | Afamelanotide implant, 1 mg | Scenesse | Yes | |||
J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | Darzalex Faspro | Yes | |||
J9223 | Injection, lurbinectedin, 0.1 mg | Zepzelca | Yes | |||
J9281 | Mitomycin pyelocalyceal instillation, 1 mg | Jelmyto | Yes | |||
J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg | Phesgo | Yes | |||
J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | Trodelvy | Yes | |||
M0243 | IV INFUSION CASIRIVIMAB & IMDEVIMAB MONITORING | IV INFUSION CASIRIVIMAB & IMDEVIMAB MONITORING | Yes | |||
Q0239 | INJECTION BAMLANIVIMAB-XXXX 700 MG | INJECTION BAMLANIVIMAB-XXXX 700 MG | Yes | |||
Q0243 | INJ CASIRIVIMAB & IMDEVIMAB 2400 MG | INJ CASIRIVIMAB & IMDEVIMAB 2400 MG | Yes | |||
Q5122 | Injection, pegfilgrastim-apgf, biosimilar, (nyvepria), 0.5 mg | Nyvepria | Yes | |||
S0013 | Esketamine, nasal spray, 1 mg | Spravato | Yes | |||
M0245 | IV INF Bamlanivimab and etesevimab, monitoring | IV INF Bamlanivimab and etesevimab, monitoring | Yes | |||
Q0245 | INJ Bamlanivimab and etesevimab | Bamlanivimab and etesevimab | Yes | |||
J1427 | Injection, viltolarsen, 10 mg | Viltepso | Yes | |||
J1554 | Injection, immune globulin (Asceniv), 500 mg | Asceniv | Yes | |||
J9037 | Injection, belantamab mafodontin-blmf, 0.5 mg | Blenrep | Yes | |||
J9349 | Injection, tafasitamab-cxix, 2 mg | Monjuvi | Yes | |||
Q2053 | Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR positive viable T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Tecartus | Yes | |||
J7402 | Mometasone furoate sinus implant, (Sinuva), 10 mcg | Sinuva | Yes | |||
S1091 | Stent, non-coronary, temporary, with delivery system(propel) | Propel | Yes | |||
M0244 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence | n/a | Yes | |||
M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence | n/a | Yes | |||
J0224 | INJECTION LUMASIRAN 0.5 MG | Oxlumo | Yes | |||
J1951 | INJ LEU AC FOR DEP SUSP 0.25 MG | Fensolvi | Yes | |||
J7168 | PRT CMPLX CONC KCNTRA PR IU FIX ACT | Kecentra | Yes | |||
J9348 | INJECTION NAXITAMAB-GQGK 1 MG | Danyelza | Yes | |||
J9353 | INJECTION MARGETUXIMAB-CMKB 5 MG | Margenza | Yes | |||
Q5123 | INJ RITUXIMAB-ARRX BIOSIMILAR 10 MG | Riabni | Yes | |||
Q0247 | injection, sotrovimab 500mg | n/a | Yes | |||
M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | n/a | Yes | |||
Q0244 | injection, casirivimab and imdevimab, 1200mg | n/a | Yes | |||
Q0249 | INJ TOCILIZUMAB HP PT 2 YRS & > COVID-19 1 MG | n/a | Yes | |||
M0249 | IV TCZ HP PT 2 & > COVID-19 INC INF & PA MON FD | n/a | Yes | |||
M0250 | IV TCZ HP 2 & > COVID-19 INC INF & PA MON 2ND D | n/a | Yes | |||
Q0240 | Injection, casirivimab and imdevimab, 600 mg | casirivimab and imdevimab | Yes | |||
M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses | n/a | Yes | |||
M0241 | ntravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence | n/a | Yes | |||
J1305 | Injection, evinacumab-dgnb, 5mg | Evkeeza | Yes | |||
J1426 | Injection, casimersen, 10 mg | Amondys 45 | Yes | |||
J1448 | Injection, trilaciclib, 1mg | Cosela | Yes | |||
J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | n/a | Yes | |||
J9319 | Injection, romidepsin, lyophilized, 0.1 mg | Istodax | Yes | |||
Q2054 | Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Breyanzi | Yes | |||
J0699 | Injection, cefiderocol, 10 mg | Fetroja | Yes | |||
J0741 | Injection, cabotegravir and rilpivirine, 2mg/3mg | Cabenuva | Yes | |||
J1445 | Injection, ferric pyrophosphate citrate solution (triferic avnu), 0.1 mg of iron | Triferic AVNU | Yes | |||
J2406 | Injection, oritavancin (kimyrsa), 10 mg | Kimyrsa | Yes | |||
J7294 | Segesterone acetate and ethinyl estradiol 0.15 mg, 0.013 mg per 24 hours; yearly vaginal system, each | Annovera | Yes | |||
J7295 | Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each | Nuvaring | Yes | |||
J1952 | Leuprolide injectable, camcevi, 1 mg | Camcevi | Yes | |||
J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | Neulasta | Yes | |||
J9021 | Injection, asparaginase, recombinant, (Rylaze), 0.1 mg | Rylaze | Yes | |||
J9061 | Injection, amivantamab-vmjw, 2 mg | Rybrevant | Yes | |||
J9272 | Injection, dostarlimab-gxly, 10 mg | Jemperli | Yes | |||
Q2055 | Idecabtagene vicleucel, up to 460 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Abecma | Yes | |||
C9088 | Instillation, bupivacaine and meloxicam, 1 mg/0.03 mg | Zynrelef | Yes | |||
C9089 | Bupivacaine, collagen-matrix implant, 1 mg | Xaracoll | Yes | |||
J0172 | Injection, aducanumab-avwa, 2 mg | Aduhelm | Yes | |||
Q0220 | tixagevimab and cilgavimab | Evusheld | Yes | |||
M0220 | tixagevimab and cilgavimab administration code | Evusheld (administration code) | Yes | |||
M0221 | tixagevimab and cilgavimab home administration code | Evusheld ( home administration code) | Yes | |||
J0248 | injection, remdesivir | Veklury | Yes | |||
Q0222 | injection, bebtelovimab, 175mg | bebtelovimab | Yes | |||
M0222 | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | Intravenous injection, bebtelovimab, includes injection and post administration monitoring | Yes | |||
J0219 | Injection, avalglucosidase alfa-ngpt, 4 mg | Nexviazyme | Yes | |||
J0491 | Injection, anifrolumab-fnia, 1 mg | Saphnelo | Yes | |||
J0879 | Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) | Korsuva | Yes | |||
J9273 | Injection, tisotumab vedotin-tftv, 1 mg | Tivdak | Yes | |||
J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | Zynlonta | Yes | |||
Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | Byooviz | Yes | |||
J9071 | Injection, cyclophosphamide, (auromedics), 5 mg | cyclophosphamide | Yes | |||
Q0221 | Injection, tixagevimab and cilgavimab, for pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg | Evusheld | Yes | |||
J2998 | Injection, plasminogen, human-tvmh, 1 mg | Ryplazim | Yes | |||
J9331 | Injection, sirolimus protein-bound particles, 1 mg | Fyarro | Yes | |||
J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | Xipere | Yes | |||
J2779 | Injection, ranibizumab, via sustained release intravitreal implant | Susvimo | Yes | |||
J0739 | Injection, cabotegravir, 1 mg | Apretude | Yes | |||
J1306 | Injection, inclisiran, 1 mg | Leqvio | Yes | |||
J1551 | Injection, immune globulin (cutaquig), 100 mg | Cutaquig | Yes | |||
J2356 | Injection, tezepelumab-ekko, 1 mg | Tezspire | Yes | |||
J9332 | Injection, efgartigimod alfa-fcab, 2 mg | Vyvgart | Yes | |||
Q2017 | injection, teniposide, 50mg | Vumon | Yes | |||
J9999 | not otherwise classified, antineoplastic drugs | n/a | Yes | |||
J7599 | immunosuppressive drugs, not otherwise classified, | Yes | ||||
C9399 | unclassified drugs or biologicals | Yes | ||||
C9101 | Injection, oliceridine, 0.1 mg | Olinvyk | Yes | |||
J1302 | Injection, sutimlimab-jome, 10 mg | Enjaymo | Yes | |||
J1932 | Injection, lanreotide, (Cipla), 1 mg | Cipla | Yes | |||
J2777 | Injection, faricimab-svoa, 0.1 mg | Vabysmo | Yes | |||
J9274 | Injection, tebentafusp-tebn, 1 mcg | kimmtrak | Yes | |||
J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | Opdualag | Yes | |||
Q2056 | Ciltacabtagene autoleucel, up to 100 million autologous B-cell maturation antigen (BCMA) directed CAR-positive T cells, including leukapheresis and dose preparation procedures, per therapeutic dose | Carvykti | Yes | |||
Q5125 | Injection, filgrastim-ayow, biosimilar, (Releuko), 1 mcg | Releuko | Yes | |||
A9607 | Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie | Pluvicto | Yes | |||
C9143 | Cocaine hydrochloride nasal solution (numbrino), 1 mg | Numbrino | Yes | |||
C9144 | Injection, bupivacaine (posimir), 1 mg | Posimir | Yes | |||
J0134 | Injection, acetaminophen (fresenius kabi) not therapeutically equivalent to J0131, 10mg | Fresenius Kabi 505(b)2 | Yes | |||
J0136 | Injection, acetaminophen (b braun) not therapeutically equivalent to J0131, 10mg | B. Braun 505(b)2 | Yes | |||
J0173 | Injection, epinephrine (belcher) not therapeutically equivalent to J0171, 0.1mg | Belcher/Bpi lanbs 505(b)(2) | Yes | |||
J0225 | Injection, vutrisiran, 1 mg | Amvuttra | Yes | |||
J0283 | Injection, amiodarone hydrochloride (nexterone), 30 mg | Nexterone 505(b)(2) | Yes | |||
J0611 | Injection, calcium gluconate (wg critical care), per 10 ml | WG Critical Care 505(b)(2) | Yes | |||
J0689 | Injection, cefazolin sodium (baxter), not therapeutically equivalent to J0690, 500mg | Baxter 505(b)(2) | Yes | |||
J0701 | Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500mg | Baxter 505(b)(2) | Yes | |||
J0703 | Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500mg | B.Braun 505(b)(2) | Yes | |||
J0877 | Injection, daptomycin (hospira), not therapeutically equivalent to J0878, 1 mg | Hospira 505(b)(2) | Yes | |||
J0891 | Injection, argatroban (accord), not therapeutically equivalent to J0883, 1 mg(for non-esrd use) | Accord 505(b)(2) | Yes | |||
J0892 | Injection, argatroban (accord), not therapeutically equivalent to J0884, 1mg (for esrd on dialysis) | Accord 505(b)(2) | Yes | |||
J0893 | Injection, decitabine (sun pharma) not therapeutically equivalent to J0894, 1mg | Sun Pharma 505(b)(2) | Yes | |||
J0898 | Injection, argatroban (auromedics), not therapeutically equivalent to J0883, 1mg (for non-esrd use) | Auromedics/Eugia 505(b)(2) | Yes | |||
J0899 | Injection, argatroban (auromedics), not therapeutically equivalent to J0884, 1mg (for esrd on dialysis) | Auromedics/Eugia 505(b)(2) | Yes | |||
J1456 | Injection, fosaprepitant (teva), not therapeutically equivalent to J1453, 1mg | Teva/Actavis 505(b)(2) | Yes | |||
J1574 | Injection, ganciclovir sodium (exela) not therapeutically equivalent to J1570, 500mg | Exela 505(b)(2) | Yes | |||
J1611 | Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to J1610, per 1mg | Fresenius Kabi 505(b)(2) | Yes | |||
J1643 | Injection, heparin sodium (pfizer), not therapeutically equivalent to J1644, per 1000 units | Pfizer 505 (b)(2) | Yes | |||
J1954 | Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg | Lutrate | Yes | |||
J2021 | Injection, linezolid (hospira) not therapeutically equivalent to J2020, 200 mg | Hospira 505(b)(2) | Yes | |||
J2184 | Injection, meropenem (b. braun) not therapeutically equivalent to J2185, 100mg | B.Braun 505(b)(2) | Yes | |||
J2247 | Injection, micafungin sodium (par pharm) not therapeutically equivalent to J2248, 1mg | Par 505(b)(2) | Yes | |||
J2251 | Injection, midazolam hydrochloride (wg critical care) not therapeutically equivalent to J2250, 1mg | WG Critical Care 505(b)(2) | Yes | |||
J2272 | Injection, morphine sulfate (fresenius kabi) not therapeutically equivalent to J2270, up to 10mg | Fresenius Kabi 505(b)(2) | Yes | |||
J2281 | Injection, moxifloxacin (fresenius kabi) not therapeutically equivalent to J2280, 100mg | Fresenius Kabi 505(b)(2) | Yes | |||
J2311 | Injection, naloxone hydrochloride (zimhi), 1 mg | Zimhi | Yes | |||
J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | Skyrizi | Yes | |||
J2401 | Injection, chloroprocaine hydrochloride, per 1 mg | Nesacaine | Yes | |||
J2402 | Injection, chloroprocaine hydrochloride, per 1 mg | Clorotekal | Yes | |||
J3244 | Injection, tigecycline (accord) not therapeutically equivalent to J3243, 1mg | Accord 505(b)(2) | Yes | |||
J3371 | Injection, vancomycin hcl (mylan) not therapeutically equivalent to J3370, 500mg | Mylan 505(b)(2) | Yes | |||
J3372 | Injection, vancomycin hcl (xellia) not therapeutically equivalent to J3370, 500mg | Xellia 505(b)(2) | Yes | |||
J9046 | Injection, bortezomib, (dr. reddy's), not therapeutically equivalent to J9041, 0.1mg | Dr. Reddy's 505(b)(2) | Yes | |||
J9048 | Injection, bortezomib (fresenius kabi), not therapeutically equivalent to J9041, 0.1mg | Fresenius Kabi 505(b)(2) | Yes | |||
J9049 | Injection, bortezomib (hospira), not therapeutically equivalent to J9041, 0.1mg | Hospira 505(b)(2) | Yes | |||
J9314 | Injection, pemetrexed (teva) not therapeutically equivalent to J9305, 10mg | Teva 505(b)(2) | Yes | |||
J9393 | Injection, fulvestrant (teva) not therapeutically equivalent to J9395, 25mg | Teva/Actavis 505(b)(2) | Yes | |||
J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to J9395, 25mg | Fresenius Kabi 505(b)(2) | Yes | |||
Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | Alymsys | Yes |
HCPCS CODE | DESCRIPTION |
---|---|
A4261 | Cervical Cap |
A4266 | Diaphram for contraceptive use |
A4269 | Contraceptive Supply, Spermicide |
J0278 | INJECTION, AMIKACIN SULFATE, 100 MG |
J0290 | INJECTION, AMPICILLIN SODIUM, UP TO 500MG |
J0295 | INJECTION; AMPICILLIN |
J0456 | INJECTION, AZITHROMYCIN, 500 MG |
J0558 | PenG benzathine/procaine inj |
J0561 | Penicillin g benzathine inj |
J0690 | INJECTION, CEFAZOLIN SODIUM, UP TO 500 MG |
J0692 | INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG |
J0694 | INJECTION, CEFOXITIN SODIUM, 1 GM |
J0695 | INJ CEFTOLOZANE TAZOBACTAM |
J0696 | INJECTION, CEFTRIAXONE SODIUM, PER 250 MG (ROCEPHIN) |
J0697 | INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG |
J0698 | CEFOTAXIME SODIUM, PER GM |
J0713 | INJ CEFTAZIDIME PER 500 MG |
J0714 | CEFTAZIDIME AND AVIBACTAM |
J0744 | INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG |
J1000 | INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG |
J1050 | INJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG(DEPO PROVERA) |
J1364 | INJECTION; ERYTHROMYCIN LACTOBIONA |
J1450 | INJECTION FLUCONAZOLE, 200 MG |
J1580 | INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG |
J1956 | INJECTION, LEVOFLOXACIN, 250 MG |
J2265 | Minocycline hydrochloride |
J2280 | INJECTION, MOXIFLOXACIN, 100 MG |
J2510 | INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS |
J2540 | INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS |
J2543 | INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1. |
J3260 | INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG |
J7296 | Levonorgestrel-releasing intrauterine contraceptive system (Kyleena) 19.5mg |
J7297 | LEVONORGESTREL IU 52MG 3 YR |
J7298 | LEVONORGESTREL IU 52MG 5 YR |
J7300 | IUD COPPER |
J7301 | SKYLA 13.5MG |
J7303 | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH |
J7304 | CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH |
J7307 | Etonogestrel implant system |
Q0144 | AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM |
S0030 | INJECTION, METRONIDAZOLE, 500 MG |
S0032 | INJECTION, NAFCILLIN SODIUM, 2 GRAMS |
S0039 | INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML |
S0073 | INJECTION, AZTREONAM, 500 MG |
S0074 | INJECTION, CEFOTETAN DISODIUM, 500 MG |
S0077 | INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG |
J0689 | Injection, cefazolin sodium (baxter), not therapeutically equivalent to J0690, 500mg |
J0701 | Injection, cefepime hydrochloride (baxter), not therapeutically equivalent to maxipime, 500mg |
J0703 | Injection, cefepime hydrochloride (b braun), not therapeutically equivalent to maxipime, 500mg |
ICD-10 Code | ICD-10 Code Description |
---|---|
C00.0 | Malignant neoplasm of external upper lip |
C00.1 | Malignant neoplasm of external lower lip |
C00.2 | Malignant neoplasm of external lip, unspecified |
C00.3 | Malignant neoplasm of upper lip, inner aspect |
C00.4 | Malignant neoplasm of lower lip, inner aspect |
C00.5 | Malignant neoplasm of lip, unspecified, inner aspect |
C00.6 | Malignant neoplasm of commissure of lip, unspecified |
C00.8 | Malignant neoplasm of overlapping sites of lip |
C00.9 | Malignant neoplasm of lip, unspecified |
C01 | Malignant neoplasm of base of tongue |
C02.0 | Malignant neoplasm of dorsal surface of tongue |
C02.1 | Malignant neoplasm of border of tongue |
C02.2 | Malignant neoplasm of ventral surface of tongue |
C02.3 | Malignant neoplasm of anterior two-thirds of tongue, part unspecified |
C02.4 | Malignant neoplasm of lingual tonsil |
C02.8 | Malignant neoplasm of overlapping sites of tongue |
C02.9 | Malignant neoplasm of tongue, unspecified |
C03.0 | Malignant neoplasm of upper gum |
C03.1 | Malignant neoplasm of lower gum |
C03.9 | Malignant neoplasm of gum, unspecified |
C04.0 | Malignant neoplasm of anterior floor of mouth |
C04.1 | Malignant neoplasm of lateral floor of mouth |
C04.8 | Malignant neoplasm of overlapping sites of floor of mouth |
C04.9 | Malignant neoplasm of floor of mouth, unspecified |
C05.0 | Malignant neoplasm of hard palate |
C05.1 | Malignant neoplasm of soft palate |
C05.2 | Malignant neoplasm of uvula |
C05.8 | Malignant neoplasm of overlapping sites of palate |
C05.9 | Malignant neoplasm of palate, unspecified |
C06.0 | Malignant neoplasm of cheek mucosa |
C06.1 | Malignant neoplasm of vestibule of mouth |
C06.2 | Malignant neoplasm of retromolar area |
C06.80 | Malignant neoplasm of overlapping sites of unspecified parts of mouth |
C06.89 | Malignant neoplasm of overlapping sites of other parts of mouth |
C06.9 | Malignant neoplasm of mouth, unspecified |
C07 | Malignant neoplasm of parotid gland |
C08.0 | Malignant neoplasm of submandibular gland |
C08.1 | Malignant neoplasm of sublingual gland |
C08.9 | Malignant neoplasm of major salivary gland, unspecified |
C09.0 | Malignant neoplasm of tonsillar fossa |
C09.1 | Malignant neoplasm of tonsillar pillar (anterior) (posterior) |
C09.8 | Malignant neoplasm of overlapping sites of tonsil |
C09.9 | Malignant neoplasm of tonsil, unspecified |
C10.0 | Malignant neoplasm of vallecula |
C10.1 | Malignant neoplasm of anterior surface of epiglottis |
C10.2 | Malignant neoplasm of lateral wall of oropharynx |
C10.3 | Malignant neoplasm of posterior wall of oropharynx |
C10.4 | Malignant neoplasm of branchial cleft |
C10.8 | Malignant neoplasm of overlapping sites of oropharynx |
C10.9 | Malignant neoplasm of oropharynx, unspecified |
C11.0 | Malignant neoplasm of superior wall of nasopharynx |
C11.1 | Malignant neoplasm of posterior wall of nasopharynx |
C11.2 | Malignant neoplasm of lateral wall of nasopharynx |
C11.3 | Malignant neoplasm of anterior wall of nasopharynx |
C11.8 | Malignant neoplasm of overlapping sites of nasopharynx |
C11.9 | Malignant neoplasm of nasopharynx, unspecified |
C12 | Malignant neoplasm of pyriform sinus |
C13.0 | Malignant neoplasm of postcricoid region |
C13.1 | Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect |
C13.2 | Malignant neoplasm of posterior wall of hypopharynx |
C13.8 | Malignant neoplasm of overlapping sites of hypopharynx |
C13.9 | Malignant neoplasm of hypopharynx, unspecified |
C14.0 | Malignant neoplasm of pharynx, unspecified |
C14.2 | Malignant neoplasm of Waldeyer's ring |
C14.8 | Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx |
C15.3 | Malignant neoplasm of upper third of esophagus |
C15.4 | Malignant neoplasm of middle third of esophagus |
C15.5 | Malignant neoplasm of lower third of esophagus |
C15.8 | Malignant neoplasm of overlapping sites of esophagus |
C15.9 | Malignant neoplasm of esophagus, unspecified |
C16.0 | Malignant neoplasm of cardia |
C16.1 | Malignant neoplasm of fundus of stomach |
C16.2 | Malignant neoplasm of body of stomach |
C16.3 | Malignant neoplasm of pyloric antrum |
C16.4 | Malignant neoplasm of pylorus |
C16.5 | Malignant neoplasm of lesser curvature of stomach, unspecified |
C16.6 | Malignant neoplasm of greater curvature of stomach, unspecified |
C16.8 | Malignant neoplasm of overlapping sites of stomach |
C16.9 | Malignant neoplasm of stomach, unspecified |
C17.0 | Malignant neoplasm of duodenum |
C17.1 | Malignant neoplasm of jejunum |
C17.2 | Malignant neoplasm of ileum |
C17.3 | Meckel's diverticulum, malignant |
C17.8 | Malignant neoplasm of overlapping sites of small intestine |
C17.9 | Malignant neoplasm of small intestine, unspecified |
C18.0 | Malignant neoplasm of cecum |
C18.1 | Malignant neoplasm of appendix |
C18.2 | Malignant neoplasm of ascending colon |
C18.3 | Malignant neoplasm of hepatic flexure |
C18.4 | Malignant neoplasm of transverse colon |
C18.5 | Malignant neoplasm of splenic flexure |
C18.6 | Malignant neoplasm of descending colon |
C18.7 | Malignant neoplasm of sigmoid colon |
C18.8 | Malignant neoplasm of overlapping sites of colon |
C18.9 | Malignant neoplasm of colon, unspecified |
C19 | Malignant neoplasm of rectosigmoid junction |
C20 | Malignant neoplasm of rectum |
C21.0 | Malignant neoplasm of anus, unspecified |
C21.1 | Malignant neoplasm of anal canal |
C21.2 | Malignant neoplasm of cloacogenic zone |
C21.8 | Malignant neoplasm of overlapping sites of rectum, anus and anal canal |
C22.0 | Liver cell carcinoma |
C22.1 | Intrahepatic bile duct carcinoma |
C22.2 | Hepatoblastoma |
C22.3 | Angiosarcoma of liver |
C22.4 | Other sarcomas of liver |
C22.7 | Other specified carcinomas of liver |
C22.8 | Malignant neoplasm of liver, primary, unspecified as to type |
C22.9 | Malignant neoplasm of liver, not specified as primary or secondary |
C23 | Malignant neoplasm of gallbladder |
C24.0 | Malignant neoplasm of extrahepatic bile duct |
C24.1 | Malignant neoplasm of ampulla of Vater |
C24.8 | Malignant neoplasm of overlapping sites of biliary tract |
C24.9 | Malignant neoplasm of biliary tract, unspecified |
C25.0 | Malignant neoplasm of head of pancreas |
C25.1 | Malignant neoplasm of body of pancreas |
C25.2 | Malignant neoplasm of tail of pancreas |
C25.3 | Malignant neoplasm of pancreatic duct |
C25.4 | Malignant neoplasm of endocrine pancreas |
C25.7 | Malignant neoplasm of other parts of pancreas |
C25.8 | Malignant neoplasm of overlapping sites of pancreas |
C25.9 | Malignant neoplasm of pancreas, unspecified |
C26.0 | Malignant neoplasm of intestinal tract, part unspecified |
C26.1 | Malignant neoplasm of spleen |
C26.9 | Malignant neoplasm of ill-defined sites within the digestive system |
C30.0 | Malignant neoplasm of nasal cavity |
C30.1 | Malignant neoplasm of middle ear |
C31.0 | Malignant neoplasm of maxillary sinus |
C31.1 | Malignant neoplasm of ethmoidal sinus |
C31.2 | Malignant neoplasm of frontal sinus |
C31.3 | Malignant neoplasm of sphenoid sinus |
C31.8 | Malignant neoplasm of overlapping sites of accessory sinuses |
C31.9 | Malignant neoplasm of accessory sinus, unspecified |
C32.0 | Malignant neoplasm of glottis |
C32.1 | Malignant neoplasm of supraglottis |
C32.2 | Malignant neoplasm of subglottis |
C32.3 | Malignant neoplasm of laryngeal cartilage |
C32.8 | Malignant neoplasm of overlapping sites of larynx |
C32.9 | Malignant neoplasm of larynx, unspecified |
C33 | Malignant neoplasm of trachea |
C34.00 | Malignant neoplasm of unspecified main bronchus |
C34.01 | Malignant neoplasm of right main bronchus |
C34.02 | Malignant neoplasm of left main bronchus |
C34.10 | Malignant neoplasm of upper lobe, unspecified bronchus or lung |
C34.11 | Malignant neoplasm of upper lobe, right bronchus or lung |
C34.12 | Malignant neoplasm of upper lobe, left bronchus or lung |
C34.2 | Malignant neoplasm of middle lobe, bronchus or lung |
C34.30 | Malignant neoplasm of lower lobe, unspecified bronchus or lung |
C34.31 | Malignant neoplasm of lower lobe, right bronchus or lung |
C34.32 | Malignant neoplasm of lower lobe, left bronchus or lung |
C34.80 | Malignant neoplasm of overlapping sites of unspecified bronchus and lung |
C34.81 | Malignant neoplasm of overlapping sites of right bronchus and lung |
C34.82 | Malignant neoplasm of overlapping sites of left bronchus and lung |
C34.90 | Malignant neoplasm of unspecified part of unspecified bronchus or lung |
C34.91 | Malignant neoplasm of unspecified part of right bronchus or lung |
C34.92 | Malignant neoplasm of unspecified part of left bronchus or lung |
C37 | Malignant neoplasm of thymus |
C38.0 | Malignant neoplasm of heart |
C38.1 | Malignant neoplasm of anterior mediastinum |
C38.2 | Malignant neoplasm of posterior mediastinum |
C38.3 | Malignant neoplasm of mediastinum, part unspecified |
C38.4 | Malignant neoplasm of pleura |
C38.8 | Malignant neoplasm of overlapping sites of heart, mediastinum and pleura |
C39.0 | Malignant neoplasm of upper respiratory tract, part unspecified |
C39.9 | Malignant neoplasm of lower respiratory tract, part unspecified |
C40.00 | Malignant neoplasm of scapula and long bones of unspecified upper limb |
C40.01 | Malignant neoplasm of scapula and long bones of right upper limb |
C40.02 | Malignant neoplasm of scapula and long bones of left upper limb |
C40.10 | Malignant neoplasm of short bones of unspecified upper limb |
C40.11 | Malignant neoplasm of short bones of right upper limb |
C40.12 | Malignant neoplasm of short bones of left upper limb |
C40.20 | Malignant neoplasm of long bones of unspecified lower limb |
C40.21 | Malignant neoplasm of long bones of right lower limb |
C40.22 | Malignant neoplasm of long bones of left lower limb |
C40.30 | Malignant neoplasm of short bones of unspecified lower limb |
C40.31 | Malignant neoplasm of short bones of right lower limb |
C40.32 | Malignant neoplasm of short bones of left lower limb |
C40.80 | Malignant neoplasm of overlapping sites of bone and articular cartilage of unspecified limb |
C40.81 | Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb |
C40.82 | Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb |
C40.90 | Malignant neoplasm of unspecified bones and articular cartilage of unspecified limb |
C40.91 | Malignant neoplasm of unspecified bones and articular cartilage of right limb |
C40.92 | Malignant neoplasm of unspecified bones and articular cartilage of left limb |
C41.0 | Malignant neoplasm of bones of skull and face |
C41.1 | Malignant neoplasm of mandible |
C41.2 | Malignant neoplasm of vertebral column |
C41.3 | Malignant neoplasm of ribs, sternum and clavicle |
C41.4 | Malignant neoplasm of pelvic bones, sacrum and coccyx |
C41.9 | Malignant neoplasm of bone and articular cartilage, unspecified |
C43.0 | Malignant melanoma of lip |
C43.10 | Malignant melanoma of unspecified eyelid, including canthus |
C43.111 | Malignant melanoma of right upper eyelid, including canthus |
C43.112 | Malignant melanoma of right lower eyelid, including canthus |
C43.121 | Malignant melanoma of left upper eyelid, including canthus |
C43.122 | Malignant melanoma of left lower eyelid, including canthus |
C43.20 | Malignant melanoma of unspecified ear and external auricular canal |
C43.21 | Malignant melanoma of right ear and external auricular canal |
C43.22 | Malignant melanoma of left ear and external auricular canal |
C43.30 | Malignant melanoma of unspecified part of face |
C43.31 | Malignant melanoma of nose |
C43.39 | Malignant melanoma of other parts of face |
C43.4 | Malignant melanoma of scalp and neck |
C43.51 | Malignant melanoma of anal skin |
C43.52 | Malignant melanoma of skin of breast |
C43.59 | Malignant melanoma of other part of trunk |
C43.60 | Malignant melanoma of unspecified upper limb, including shoulder |
C43.61 | Malignant melanoma of right upper limb, including shoulder |
C43.62 | Malignant melanoma of left upper limb, including shoulder |
C43.70 | Malignant melanoma of unspecified lower limb, including hip |
C43.71 | Malignant melanoma of right lower limb, including hip |
C43.72 | Malignant melanoma of left lower limb, including hip |
C43.8 | Malignant melanoma of overlapping sites of skin |
C43.9 | Malignant melanoma of skin, unspecified |
C44.00 | Unspecified malignant neoplasm of skin of lip |
C44.01 | Basal cell carcinoma of skin of lip |
C44.02 | Squamous cell carcinoma of skin of lip |
C44.09 | Other specified malignant neoplasm of skin of lip |
C44.101 | Unspecified malignant neoplasm of skin of unspecified eyelid, including canthus |
C44.1021 | Unspecified malignant neoplasm of skin of right upper eyelid, including canthus |
C44.1022 | Unspecified malignant neoplasm of skin of right lower eyelid, including canthus |
C44.1091 | Unspecified malignant neoplasm of skin of left upper eyelid, including canthus |
C44.1092 | Unspecified malignant neoplasm of skin of left lower eyelid, including canthus |
C44.111 | Basal cell carcinoma of skin of unspecified eyelid, including canthus |
C44.1121 | Basal cell carcinoma of skin of right upper eyelid, including canthus |
C44.1122 | Basal cell carcinoma of skin of right lower eyelid, including canthus |
C44.1191 | Basal cell carcinoma of skin of left upper eyelid, including canthus |
C44.1192 | Basal cell carcinoma of skin of left lower eyelid, including canthus |
C44.121 | Squamous cell carcinoma of skin of unspecified eyelid, including canthus |
C44.1221 | Squamous cell carcinoma of skin of right upper eyelid, including canthus |
C44.1222 | Squamous cell carcinoma of skin of right lower eyelid, including canthus |
C44.1291 | Squamous cell carcinoma of skin of left upper eyelid, including canthus |
C44.1292 | Squamous cell carcinoma of skin of left lower eyelid, including canthus |
C44.131 | Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus |
C44.1321 | Sebaceous cell carcinoma of skin of right upper eyelid, including canthus |
C44.1322 | Sebaceous cell carcinoma of skin of right lower eyelid, including canthus |
C44.1391 | Sebaceous cell carcinoma of skin of left upper eyelid, including canthus |
C44.1392 | Sebaceous cell carcinoma of skin of left lower eyelid, including canthus |
C44.191 | Other specified malignant neoplasm of skin of unspecified eyelid, including canthus |
C44.1921 | Other specified malignant neoplasm of skin of right upper eyelid, including canthus |
C44.1922 | Other specified malignant neoplasm of skin of right lower eyelid, including canthus |
C44.1991 | Other specified malignant neoplasm of skin of left upper eyelid, including canthus |
C44.1992 | Other specified malignant neoplasm of skin of left lower eyelid, including canthus |
C44.201 | Unspecified malignant neoplasm of skin of unspecified ear and external auricular canal |
C44.202 | Unspecified malignant neoplasm of skin of right ear and external auricular canal |
C44.209 | Unspecified malignant neoplasm of skin of left ear and external auricular canal |
C44.211 | Basal cell carcinoma of skin of unspecified ear and external auricular canal |
C44.212 | Basal cell carcinoma of skin of right ear and external auricular canal |
C44.219 | Basal cell carcinoma of skin of left ear and external auricular canal |
C44.221 | Squamous cell carcinoma of skin of unspecified ear and external auricular canal |
C44.222 | Squamous cell carcinoma of skin of right ear and external auricular canal |
C44.229 | Squamous cell carcinoma of skin of left ear and external auricular canal |
C44.291 | Other specified malignant neoplasm of skin of unspecified ear and external auricular canal |
C44.292 | Other specified malignant neoplasm of skin of right ear and external auricular canal |
C44.299 | Other specified malignant neoplasm of skin of left ear and external auricular canal |
C44.300 | Unspecified malignant neoplasm of skin of unspecified part of face |
C44.301 | Unspecified malignant neoplasm of skin of nose |
C44.309 | Unspecified malignant neoplasm of skin of other parts of face |
C44.310 | Basal cell carcinoma of skin of unspecified parts of face |
C44.311 | Basal cell carcinoma of skin of nose |
C44.319 | Basal cell carcinoma of skin of other parts of face |
C44.320 | Squamous cell carcinoma of skin of unspecified parts of face |
C44.321 | Squamous cell carcinoma of skin of nose |
C44.329 | Squamous cell carcinoma of skin of other parts of face |
C44.390 | Other specified malignant neoplasm of skin of unspecified parts of face |
C44.391 | Other specified malignant neoplasm of skin of nose |
C44.399 | Other specified malignant neoplasm of skin of other parts of face |
C44.40 | Unspecified malignant neoplasm of skin of scalp and neck |
C44.41 | Basal cell carcinoma of skin of scalp and neck |
C44.42 | Squamous cell carcinoma of skin of scalp and neck |
C44.49 | Other specified malignant neoplasm of skin of scalp and neck |
C44.500 | Unspecified malignant neoplasm of anal skin |
C44.501 | Unspecified malignant neoplasm of skin of breast |
C44.509 | Unspecified malignant neoplasm of skin of other part of trunk |
C44.510 | Basal cell carcinoma of anal skin |
C44.511 | Basal cell carcinoma of skin of breast |
C44.519 | Basal cell carcinoma of skin of other part of trunk |
C44.520 | Squamous cell carcinoma of anal skin |
C44.521 | Squamous cell carcinoma of skin of breast |
C44.529 | Squamous cell carcinoma of skin of other part of trunk |
C44.590 | Other specified malignant neoplasm of anal skin |
C44.591 | Other specified malignant neoplasm of skin of breast |
C44.599 | Other specified malignant neoplasm of skin of other part of trunk |
C44.601 | Unspecified malignant neoplasm of skin of unspecified upper limb, including shoulder |
C44.602 | Unspecified malignant neoplasm of skin of right upper limb, including shoulder |
C44.609 | Unspecified malignant neoplasm of skin of left upper limb, including shoulder |
C44.611 | Basal cell carcinoma of skin of unspecified upper limb, including shoulder |
C44.612 | Basal cell carcinoma of skin of right upper limb, including shoulder |
C44.619 | Basal cell carcinoma of skin of left upper limb, including shoulder |
C44.621 | Squamous cell carcinoma of skin of unspecified upper limb, including shoulder |
C44.622 | Squamous cell carcinoma of skin of right upper limb, including shoulder |
C44.629 | Squamous cell carcinoma of skin of left upper limb, including shoulder |
C44.691 | Other specified malignant neoplasm of skin of unspecified upper limb, including shoulder |
C44.692 | Other specified malignant neoplasm of skin of right upper limb, including shoulder |
C44.699 | Other specified malignant neoplasm of skin of left upper limb, including shoulder |
C44.701 | Unspecified malignant neoplasm of skin of unspecified lower limb, including hip |
C44.702 | Unspecified malignant neoplasm of skin of right lower limb, including hip |
C44.709 | Unspecified malignant neoplasm of skin of left lower limb, including hip |
C44.711 | Basal cell carcinoma of skin of unspecified lower limb, including hip |
C44.712 | Basal cell carcinoma of skin of right lower limb, including hip |
C44.719 | Basal cell carcinoma of skin of left lower limb, including hip |
C44.721 | Squamous cell carcinoma of skin of unspecified lower limb, including hip |
C44.722 | Squamous cell carcinoma of skin of right lower limb, including hip |
C44.729 | Squamous cell carcinoma of skin of left lower limb, including hip |
C44.791 | Other specified malignant neoplasm of skin of unspecified lower limb, including hip |
C44.792 | Other specified malignant neoplasm of skin of right lower limb, including hip |
C44.799 | Other specified malignant neoplasm of skin of left lower limb, including hip |
C44.80 | Unspecified malignant neoplasm of overlapping sites of skin |
C44.81 | Basal cell carcinoma of overlapping sites of skin |
C44.82 | Squamous cell carcinoma of overlapping sites of skin |
C44.89 | Other specified malignant neoplasm of overlapping sites of skin |
C44.90 | Unspecified malignant neoplasm of skin, unspecified |
C44.91 | Basal cell carcinoma of skin, unspecified |
C44.92 | Squamous cell carcinoma of skin, unspecified |
C44.99 | Other specified malignant neoplasm of skin, unspecified |
C45.0 | Mesothelioma of pleura |
C45.1 | Mesothelioma of peritoneum |
C45.2 | Mesothelioma of pericardium |
C45.7 | Mesothelioma of other sites |
C45.9 | Mesothelioma, unspecified |
C46.0 | Kaposi's sarcoma of skin |
C46.1 | Kaposi's sarcoma of soft tissue |
C46.2 | Kaposi's sarcoma of palate |
C46.3 | Kaposi's sarcoma of lymph nodes |
C46.4 | Kaposi's sarcoma of gastrointestinal sites |
C46.50 | Kaposi's sarcoma of unspecified lung |
C46.51 | Kaposi's sarcoma of right lung |
C46.52 | Kaposi's sarcoma of left lung |
C46.7 | Kaposi's sarcoma of other sites |
C46.9 | Kaposi's sarcoma, unspecified |
C47.0 | Malignant neoplasm of peripheral nerves of head, face and neck |
C47.10 | Malignant neoplasm of peripheral nerves of unspecified upper limb, including shoulder |
C47.11 | Malignant neoplasm of peripheral nerves of right upper limb, including shoulder |
C47.12 | Malignant neoplasm of peripheral nerves of left upper limb, including shoulder |
C47.20 | Malignant neoplasm of peripheral nerves of unspecified lower limb, including hip |
C47.21 | Malignant neoplasm of peripheral nerves of right lower limb, including hip |
C47.22 | Malignant neoplasm of peripheral nerves of left lower limb, including hip |
C47.3 | Malignant neoplasm of peripheral nerves of thorax |
C47.4 | Malignant neoplasm of peripheral nerves of abdomen |
C47.5 | Malignant neoplasm of peripheral nerves of pelvis |
C47.6 | Malignant neoplasm of peripheral nerves of trunk, unspecified |
C47.8 | Malignant neoplasm of overlapping sites of peripheral nerves and autonomic nervous system |
C47.9 | Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified |
C48.0 | Malignant neoplasm of retroperitoneum |
C48.1 | Malignant neoplasm of specified parts of peritoneum |
C48.2 | Malignant neoplasm of peritoneum, unspecified |
C48.8 | Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum |
C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck |
C49.10 | Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder |
C49.11 | Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder |
C49.12 | Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder |
C49.20 | Malignant neoplasm of connective and soft tissue of unspecified lower limb, including hip |
C49.21 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip |
C49.22 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip |
C49.3 | Malignant neoplasm of connective and soft tissue of thorax |
C49.4 | Malignant neoplasm of connective and soft tissue of abdomen |
C49.5 | Malignant neoplasm of connective and soft tissue of pelvis |
C49.6 | Malignant neoplasm of connective and soft tissue of trunk, unspecified |
C49.8 | Malignant neoplasm of overlapping sites of connective and soft tissue |
C49.9 | Malignant neoplasm of connective and soft tissue, unspecified |
C49.A0 | Gastrointestinal stromal tumor, unspecified site |
C49.A1 | Gastrointestinal stromal tumor of esophagus |
C49.A2 | Gastrointestinal stromal tumor of stomach |
C49.A3 | Gastrointestinal stromal tumor of small intestine |
C49.A4 | Gastrointestinal stromal tumor of large intestine |
C49.A5 | Gastrointestinal stromal tumor of rectum |
C49.A9 | Gastrointestinal stromal tumor of other sites |
C4A.0 | Merkel cell carcinoma of lip |
C4A.10 | Merkel cell carcinoma of unspecified eyelid, including canthus |
C4A.111 | Merkel cell carcinoma of right upper eyelid, including canthus |
C4A.112 | Merkel cell carcinoma of right lower eyelid, including canthus |
C4A.121 | Merkel cell carcinoma of left upper eyelid, including canthus |
C4A.122 | Merkel cell carcinoma of left lower eyelid, including canthus |
C4A.20 | Merkel cell carcinoma of unspecified ear and external auricular canal |
C4A.21 | Merkel cell carcinoma of right ear and external auricular canal |
C4A.22 | Merkel cell carcinoma of left ear and external auricular canal |
C4A.30 | Merkel cell carcinoma of unspecified part of face |
C4A.31 | Merkel cell carcinoma of nose |
C4A.39 | Merkel cell carcinoma of other parts of face |
C4A.4 | Merkel cell carcinoma of scalp and neck |
C4A.51 | Merkel cell carcinoma of anal skin |
C4A.52 | Merkel cell carcinoma of skin of breast |
C4A.59 | Merkel cell carcinoma of other part of trunk |
C4A.60 | Merkel cell carcinoma of unspecified upper limb, including shoulder |
C4A.61 | Merkel cell carcinoma of right upper limb, including shoulder |
C4A.62 | Merkel cell carcinoma of left upper limb, including shoulder |
C4A.70 | Merkel cell carcinoma of unspecified lower limb, including hip |
C4A.71 | Merkel cell carcinoma of right lower limb, including hip |
C4A.72 | Merkel cell carcinoma of left lower limb, including hip |
C4A.8 | Merkel cell carcinoma of overlapping sites |
C4A.9 | Merkel cell carcinoma, unspecified |
C50.011 | Malignant neoplasm of nipple and areola, right female breast |
C50.012 | Malignant neoplasm of nipple and areola, left female breast |
C50.019 | Malignant neoplasm of nipple and areola, unspecified female breast |
C50.021 | Malignant neoplasm of nipple and areola, right male breast |
C50.022 | Malignant neoplasm of nipple and areola, left male breast |
C50.029 | Malignant neoplasm of nipple and areola, unspecified male breast |
C50.111 | Malignant neoplasm of central portion of right female breast |
C50.112 | Malignant neoplasm of central portion of left female breast |
C50.119 | Malignant neoplasm of central portion of unspecified female breast |
C50.121 | Malignant neoplasm of central portion of right male breast |
C50.122 | Malignant neoplasm of central portion of left male breast |
C50.129 | Malignant neoplasm of central portion of unspecified male breast |
C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast |
C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast |
C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast |
C50.221 | Malignant neoplasm of upper-inner quadrant of right male breast |
C50.222 | Malignant neoplasm of upper-inner quadrant of left male breast |
C50.229 | Malignant neoplasm of upper-inner quadrant of unspecified male breast |
C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast |
C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast |
C50.319 | Malignant neoplasm of lower-inner quadrant of unspecified female breast |
C50.321 | Malignant neoplasm of lower-inner quadrant of right male breast |
C50.322 | Malignant neoplasm of lower-inner quadrant of left male breast |
C50.329 | Malignant neoplasm of lower-inner quadrant of unspecified male breast |
C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast |
C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast |
C50.419 | Malignant neoplasm of upper-outer quadrant of unspecified female breast |
C50.421 | Malignant neoplasm of upper-outer quadrant of right male breast |
C50.422 | Malignant neoplasm of upper-outer quadrant of left male breast |
C50.429 | Malignant neoplasm of upper-outer quadrant of unspecified male breast |
C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast |
C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast |
C50.519 | Malignant neoplasm of lower-outer quadrant of unspecified female breast |
C50.521 | Malignant neoplasm of lower-outer quadrant of right male breast |
C50.522 | Malignant neoplasm of lower-outer quadrant of left male breast |
C50.529 | Malignant neoplasm of lower-outer quadrant of unspecified male breast |
C50.611 | Malignant neoplasm of axillary tail of right female breast |
C50.612 | Malignant neoplasm of axillary tail of left female breast |
C50.619 | Malignant neoplasm of axillary tail of unspecified female breast |
C50.621 | Malignant neoplasm of axillary tail of right male breast |
C50.622 | Malignant neoplasm of axillary tail of left male breast |
C50.629 | Malignant neoplasm of axillary tail of unspecified male breast |
C50.811 | Malignant neoplasm of overlapping sites of right female breast |
C50.812 | Malignant neoplasm of overlapping sites of left female breast |
C50.819 | Malignant neoplasm of overlapping sites of unspecified female breast |
C50.821 | Malignant neoplasm of overlapping sites of right male breast |
C50.822 | Malignant neoplasm of overlapping sites of left male breast |
C50.829 | Malignant neoplasm of overlapping sites of unspecified male breast |
C50.911 | Malignant neoplasm of unspecified site of right female breast |
C50.912 | Malignant neoplasm of unspecified site of left female breast |
C50.919 | Malignant neoplasm of unspecified site of unspecified female breast |
C50.921 | Malignant neoplasm of unspecified site of right male breast |
C50.922 | Malignant neoplasm of unspecified site of left male breast |
C50.929 | Malignant neoplasm of unspecified site of unspecified male breast |
C51.0 | Malignant neoplasm of labium majus |
C51.1 | Malignant neoplasm of labium minus |
C51.2 | Malignant neoplasm of clitoris |
C51.8 | Malignant neoplasm of overlapping sites of vulva |
C51.9 | Malignant neoplasm of vulva, unspecified |
C52 | Malignant neoplasm of vagina |
C53.0 | Malignant neoplasm of endocervix |
C53.1 | Malignant neoplasm of exocervix |
C53.8 | Malignant neoplasm of overlapping sites of cervix uteri |
C53.9 | Malignant neoplasm of cervix uteri, unspecified |
C54.0 | Malignant neoplasm of isthmus uteri |
C54.1 | Malignant neoplasm of endometrium |
C54.2 | Malignant neoplasm of myometrium |
C54.3 | Malignant neoplasm of fundus uteri |
C54.8 | Malignant neoplasm of overlapping sites of corpus uteri |
C54.9 | Malignant neoplasm of corpus uteri, unspecified |
C55 | Malignant neoplasm of uterus, part unspecified |
C56.1 | Malignant neoplasm of right ovary |
C56.2 | Malignant neoplasm of left ovary |
C56.9 | Malignant neoplasm of unspecified ovary |
C57.00 | Malignant neoplasm of unspecified fallopian tube |
C57.01 | Malignant neoplasm of right fallopian tube |
C57.02 | Malignant neoplasm of left fallopian tube |
C57.10 | Malignant neoplasm of unspecified broad ligament |
C57.11 | Malignant neoplasm of right broad ligament |
C57.12 | Malignant neoplasm of left broad ligament |
C57.20 | Malignant neoplasm of unspecified round ligament |
C57.21 | Malignant neoplasm of right round ligament |
C57.22 | Malignant neoplasm of left round ligament |
C57.3 | Malignant neoplasm of parametrium |
C57.4 | Malignant neoplasm of uterine adnexa, unspecified |
C57.7 | Malignant neoplasm of other specified female genital organs |
C57.8 | Malignant neoplasm of overlapping sites of female genital organs |
C57.9 | Malignant neoplasm of female genital organ, unspecified |
C58 | Malignant neoplasm of placenta |
C60.0 | Malignant neoplasm of prepuce |
C60.1 | Malignant neoplasm of glans penis |
C60.2 | Malignant neoplasm of body of penis |
C60.8 | Malignant neoplasm of overlapping sites of penis |
C60.9 | Malignant neoplasm of penis, unspecified |
C61 | Malignant neoplasm of prostate |
C62.00 | Malignant neoplasm of unspecified undescended testis |
C62.01 | Malignant neoplasm of undescended right testis |
C62.02 | Malignant neoplasm of undescended left testis |
C62.10 | Malignant neoplasm of unspecified descended testis |
C62.11 | Malignant neoplasm of descended right testis |
C62.12 | Malignant neoplasm of descended left testis |
C62.90 | Malignant neoplasm of unspecified testis, unspecified whether descended or undescended |
C62.91 | Malignant neoplasm of right testis, unspecified whether descended or undescended |
C62.92 | Malignant neoplasm of left testis, unspecified whether descended or undescended |
C63.00 | Malignant neoplasm of unspecified epididymis |
C63.01 | Malignant neoplasm of right epididymis |
C63.02 | Malignant neoplasm of left epididymis |
C63.10 | Malignant neoplasm of unspecified spermatic cord |
C63.11 | Malignant neoplasm of right spermatic cord |
C63.12 | Malignant neoplasm of left spermatic cord |
C63.2 | Malignant neoplasm of scrotum |
C63.7 | Malignant neoplasm of other specified male genital organs |
C63.8 | Malignant neoplasm of overlapping sites of male genital organs |
C63.9 | Malignant neoplasm of male genital organ, unspecified |
C64.1 | Malignant neoplasm of right kidney, except renal pelvis |
C64.2 | Malignant neoplasm of left kidney, except renal pelvis |
C64.9 | Malignant neoplasm of unspecified kidney, except renal pelvis |
C65.1 | Malignant neoplasm of right renal pelvis |
C65.2 | Malignant neoplasm of left renal pelvis |
C65.9 | Malignant neoplasm of unspecified renal pelvis |
C66.1 | Malignant neoplasm of right ureter |
C66.2 | Malignant neoplasm of left ureter |
C66.9 | Malignant neoplasm of unspecified ureter |
C67.0 | Malignant neoplasm of trigone of bladder |
C67.1 | Malignant neoplasm of dome of bladder |
C67.2 | Malignant neoplasm of lateral wall of bladder |
C67.3 | Malignant neoplasm of anterior wall of bladder |
C67.4 | Malignant neoplasm of posterior wall of bladder |
C67.5 | Malignant neoplasm of bladder neck |
C67.6 | Malignant neoplasm of ureteric orifice |
C67.7 | Malignant neoplasm of urachus |
C67.8 | Malignant neoplasm of overlapping sites of bladder |
C67.9 | Malignant neoplasm of bladder, unspecified |
C68.0 | Malignant neoplasm of urethra |
C68.1 | Malignant neoplasm of paraurethral glands |
C68.8 | Malignant neoplasm of overlapping sites of urinary organs |
C68.9 | Malignant neoplasm of urinary organ, unspecified |
C69.00 | Malignant neoplasm of unspecified conjunctiva |
C69.01 | Malignant neoplasm of right conjunctiva |
C69.02 | Malignant neoplasm of left conjunctiva |
C69.10 | Malignant neoplasm of unspecified cornea |
C69.11 | Malignant neoplasm of right cornea |
C69.12 | Malignant neoplasm of left cornea |
C69.20 | Malignant neoplasm of unspecified retina |
C69.21 | Malignant neoplasm of right retina |
C69.22 | Malignant neoplasm of left retina |
C69.30 | Malignant neoplasm of unspecified choroid |
C69.31 | Malignant neoplasm of right choroid |
C69.32 | Malignant neoplasm of left choroid |
C69.40 | Malignant neoplasm of unspecified ciliary body |
C69.41 | Malignant neoplasm of right ciliary body |
C69.42 | Malignant neoplasm of left ciliary body |
C69.50 | Malignant neoplasm of unspecified lacrimal gland and duct |
C69.51 | Malignant neoplasm of right lacrimal gland and duct |
C69.52 | Malignant neoplasm of left lacrimal gland and duct |
C69.60 | Malignant neoplasm of unspecified orbit |
C69.61 | Malignant neoplasm of right orbit |
C69.62 | Malignant neoplasm of left orbit |
C69.80 | Malignant neoplasm of overlapping sites of unspecified eye and adnexa |
C69.81 | Malignant neoplasm of overlapping sites of right eye and adnexa |
C69.82 | Malignant neoplasm of overlapping sites of left eye and adnexa |
C69.90 | Malignant neoplasm of unspecified site of unspecified eye |
C69.91 | Malignant neoplasm of unspecified site of right eye |
C69.92 | Malignant neoplasm of unspecified site of left eye |
C70.0 | Malignant neoplasm of cerebral meninges |
C70.1 | Malignant neoplasm of spinal meninges |
C70.9 | Malignant neoplasm of meninges, unspecified |
C71.0 | Malignant neoplasm of cerebrum, except lobes and ventricles |
C71.1 | Malignant neoplasm of frontal lobe |
C71.2 | Malignant neoplasm of temporal lobe |
C71.3 | Malignant neoplasm of parietal lobe |
C71.4 | Malignant neoplasm of occipital lobe |
C71.5 | Malignant neoplasm of cerebral ventricle |
C71.6 | Malignant neoplasm of cerebellum |
C71.7 | Malignant neoplasm of brain stem |
C71.8 | Malignant neoplasm of overlapping sites of brain |
C71.9 | Malignant neoplasm of brain, unspecified |
C72.0 | Malignant neoplasm of spinal cord |
C72.1 | Malignant neoplasm of cauda equina |
C72.20 | Malignant neoplasm of unspecified olfactory nerve |
C72.21 | Malignant neoplasm of right olfactory nerve |
C72.22 | Malignant neoplasm of left olfactory nerve |
C72.30 | Malignant neoplasm of unspecified optic nerve |
C72.31 | Malignant neoplasm of right optic nerve |
C72.32 | Malignant neoplasm of left optic nerve |
C72.40 | Malignant neoplasm of unspecified acoustic nerve |
C72.41 | Malignant neoplasm of right acoustic nerve |
C72.42 | Malignant neoplasm of left acoustic nerve |
C72.50 | Malignant neoplasm of unspecified cranial nerve |
C72.59 | Malignant neoplasm of other cranial nerves |
C72.9 | Malignant neoplasm of central nervous system, unspecified |
C73 | Malignant neoplasm of thyroid gland |
C74.00 | Malignant neoplasm of cortex of unspecified adrenal gland |
C74.01 | Malignant neoplasm of cortex of right adrenal gland |
C74.02 | Malignant neoplasm of cortex of left adrenal gland |
C74.10 | Malignant neoplasm of medulla of unspecified adrenal gland |
C74.11 | Malignant neoplasm of medulla of right adrenal gland |
C74.12 | Malignant neoplasm of medulla of left adrenal gland |
C74.90 | Malignant neoplasm of unspecified part of unspecified adrenal gland |
C74.91 | Malignant neoplasm of unspecified part of right adrenal gland |
C74.92 | Malignant neoplasm of unspecified part of left adrenal gland |
C75.0 | Malignant neoplasm of parathyroid gland |
C75.1 | Malignant neoplasm of pituitary gland |
C75.2 | Malignant neoplasm of craniopharyngeal duct |
C75.3 | Malignant neoplasm of pineal gland |
C75.4 | Malignant neoplasm of carotid body |
C75.5 | Malignant neoplasm of aortic body and other paraganglia |
C75.8 | Malignant neoplasm with pluriglandular involvement, unspecified |
C75.9 | Malignant neoplasm of endocrine gland, unspecified |
C76.0 | Malignant neoplasm of head, face and neck |
C76.1 | Malignant neoplasm of thorax |
C76.2 | Malignant neoplasm of abdomen |
C76.3 | Malignant neoplasm of pelvis |
C76.40 | Malignant neoplasm of unspecified upper limb |
C76.41 | Malignant neoplasm of right upper limb |
C76.42 | Malignant neoplasm of left upper limb |
C76.50 | Malignant neoplasm of unspecified lower limb |
C76.51 | Malignant neoplasm of right lower limb |
C76.52 | Malignant neoplasm of left lower limb |
C76.8 | Malignant neoplasm of other specified ill-defined sites |
C77.0 | Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck |
C77.1 | Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes |
C77.2 | Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes |
C77.3 | Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes |
C77.4 | Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes |
C77.5 | Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes |
C77.8 | Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions |
C77.9 | Secondary and unspecified malignant neoplasm of lymph node, unspecified |
C78.00 | Secondary malignant neoplasm of unspecified lung |
C78.01 | Secondary malignant neoplasm of right lung |
C78.02 | Secondary malignant neoplasm of left lung |
C78.1 | Secondary malignant neoplasm of mediastinum |
C78.2 | Secondary malignant neoplasm of pleura |
C78.30 | Secondary malignant neoplasm of unspecified respiratory organ |
C78.39 | Secondary malignant neoplasm of other respiratory organs |
C78.4 | Secondary malignant neoplasm of small intestine |
C78.5 | Secondary malignant neoplasm of large intestine and rectum |
C78.6 | Secondary malignant neoplasm of retroperitoneum and peritoneum |
C78.7 | Secondary malignant neoplasm of liver and intrahepatic bile duct |
C78.80 | Secondary malignant neoplasm of unspecified digestive organ |
C78.89 | Secondary malignant neoplasm of other digestive organs |
C79.00 | Secondary malignant neoplasm of unspecified kidney and renal pelvis |
C79.01 | Secondary malignant neoplasm of right kidney and renal pelvis |
C79.02 | Secondary malignant neoplasm of left kidney and renal pelvis |
C79.10 | Secondary malignant neoplasm of unspecified urinary organs |
C79.11 | Secondary malignant neoplasm of bladder |
C79.19 | Secondary malignant neoplasm of other urinary organs |
C79.2 | Secondary malignant neoplasm of skin |
C79.31 | Secondary malignant neoplasm of brain |
C79.32 | Secondary malignant neoplasm of cerebral meninges |
C79.40 | Secondary malignant neoplasm of unspecified part of nervous system |
C79.49 | Secondary malignant neoplasm of other parts of nervous system |
C79.51 | Secondary malignant neoplasm of bone |
C79.52 | Secondary malignant neoplasm of bone marrow |
C79.60 | Secondary malignant neoplasm of unspecified ovary |
C79.61 | Secondary malignant neoplasm of right ovary |
C79.62 | Secondary malignant neoplasm of left ovary |
C79.70 | Secondary malignant neoplasm of unspecified adrenal gland |
C79.71 | Secondary malignant neoplasm of right adrenal gland |
C79.72 | Secondary malignant neoplasm of left adrenal gland |
C79.81 | Secondary malignant neoplasm of breast |
C79.82 | Secondary malignant neoplasm of genital organs |
C79.89 | Secondary malignant neoplasm of other specified sites |
C79.9 | Secondary malignant neoplasm of unspecified site |
C7A.00 | Malignant carcinoid tumor of unspecified site |
C7A.010 | Malignant carcinoid tumor of the duodenum |
C7A.011 | Malignant carcinoid tumor of the jejunum |
C7A.012 | Malignant carcinoid tumor of the ileum |
C7A.019 | Malignant carcinoid tumor of the small intestine, unspecified portion |
C7A.020 | Malignant carcinoid tumor of the appendix |
C7A.021 | Malignant carcinoid tumor of the cecum |
C7A.022 | Malignant carcinoid tumor of the ascending colon |
C7A.023 | Malignant carcinoid tumor of the transverse colon |
C7A.024 | Malignant carcinoid tumor of the descending colon |
C7A.025 | Malignant carcinoid tumor of the sigmoid colon |
C7A.026 | Malignant carcinoid tumor of the rectum |
C7A.029 | Malignant carcinoid tumor of the large intestine, unspecified portion |
C7A.090 | Malignant carcinoid tumor of the bronchus and lung |
C7A.091 | Malignant carcinoid tumor of the thymus |
C7A.092 | Malignant carcinoid tumor of the stomach |
C7A.093 | Malignant carcinoid tumor of the kidney |
C7A.094 | Malignant carcinoid tumor of the foregut, unspecified |
C7A.095 | Malignant carcinoid tumor of the midgut, unspecified |
C7A.096 | Malignant carcinoid tumor of the hindgut, unspecified |
C7A.098 | Malignant carcinoid tumors of other sites |
C7A.1 | Malignant poorly differentiated neuroendocrine tumors |
C7A.8 | Other malignant neuroendocrine tumors |
C7B.00 | Secondary carcinoid tumors, unspecified site |
C7B.01 | Secondary carcinoid tumors of distant lymph nodes |
C7B.02 | Secondary carcinoid tumors of liver |
C7B.03 | Secondary carcinoid tumors of bone |
C7B.04 | Secondary carcinoid tumors of peritoneum |
C7B.09 | Secondary carcinoid tumors of other sites |
C7B.1 | Secondary Merkel cell carcinoma |
C7B.8 | Other secondary neuroendocrine tumors |
C80.0 | Disseminated malignant neoplasm, unspecified |
C80.1 | Malignant (primary) neoplasm, unspecified |
C80.2 | Malignant neoplasm associated with transplanted organ |
C81.00 | Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site |
C81.01 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck |
C81.02 | Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes |
C81.03 | Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes |
C81.04 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C81.05 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C81.06 | Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes |
C81.07 | Nodular lymphocyte predominant Hodgkin lymphoma, spleen |
C81.08 | Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites |
C81.09 | Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites |
C81.10 | Nodular sclerosis Hodgkin lymphoma, unspecified site |
C81.11 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck |
C81.12 | Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes |
C81.13 | Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes |
C81.14 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C81.15 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C81.16 | Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes |
C81.17 | Nodular sclerosis Hodgkin lymphoma, spleen |
C81.18 | Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites |
C81.19 | Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites |
C81.20 | Mixed cellularity Hodgkin lymphoma, unspecified site |
C81.21 | Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck |
C81.22 | Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes |
C81.23 | Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes |
C81.24 | Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C81.25 | Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C81.26 | Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes |
C81.27 | Mixed cellularity Hodgkin lymphoma, spleen |
C81.28 | Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites |
C81.29 | Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites |
C81.30 | Lymphocyte depleted Hodgkin lymphoma, unspecified site |
C81.31 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck |
C81.32 | Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes |
C81.33 | Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes |
C81.34 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C81.35 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C81.36 | Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes |
C81.37 | Lymphocyte depleted Hodgkin lymphoma, spleen |
C81.38 | Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites |
C81.39 | Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites |
C81.40 | Lymphocyte-rich Hodgkin lymphoma, unspecified site |
C81.41 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck |
C81.42 | Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes |
C81.43 | Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes |
C81.44 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C81.45 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C81.46 | Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes |
C81.47 | Lymphocyte-rich Hodgkin lymphoma, spleen |
C81.48 | Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites |
C81.49 | Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites |
C81.70 | Other Hodgkin lymphoma, unspecified site |
C81.71 | Other Hodgkin lymphoma, lymph nodes of head, face, and neck |
C81.72 | Other Hodgkin lymphoma, intrathoracic lymph nodes |
C81.73 | Other Hodgkin lymphoma, intra-abdominal lymph nodes |
C81.74 | Other Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C81.75 | Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C81.76 | Other Hodgkin lymphoma, intrapelvic lymph nodes |
C81.77 | Other Hodgkin lymphoma, spleen |
C81.78 | Other Hodgkin lymphoma, lymph nodes of multiple sites |
C81.79 | Other Hodgkin lymphoma, extranodal and solid organ sites |
C81.90 | Hodgkin lymphoma, unspecified, unspecified site |
C81.91 | Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
C81.92 | Hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
C81.93 | Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
C81.94 | Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
C81.95 | Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
C81.96 | Hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
C81.97 | Hodgkin lymphoma, unspecified, spleen |
C81.98 | Hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
C81.99 | Hodgkin lymphoma, unspecified, extranodal and solid organ sites |
C82.00 | Follicular lymphoma grade I, unspecified site |
C82.01 | Follicular lymphoma grade I, lymph nodes of head, face, and neck |
C82.02 | Follicular lymphoma grade I, intrathoracic lymph nodes |
C82.03 | Follicular lymphoma grade I, intra-abdominal lymph nodes |
C82.04 | Follicular lymphoma grade I, lymph nodes of axilla and upper limb |
C82.05 | Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb |
C82.06 | Follicular lymphoma grade I, intrapelvic lymph nodes |
C82.07 | Follicular lymphoma grade I, spleen |
C82.08 | Follicular lymphoma grade I, lymph nodes of multiple sites |
C82.09 | Follicular lymphoma grade I, extranodal and solid organ sites |
C82.10 | Follicular lymphoma grade II, unspecified site |
C82.11 | Follicular lymphoma grade II, lymph nodes of head, face, and neck |
C82.12 | Follicular lymphoma grade II, intrathoracic lymph nodes |
C82.13 | Follicular lymphoma grade II, intra-abdominal lymph nodes |
C82.14 | Follicular lymphoma grade II, lymph nodes of axilla and upper limb |
C82.15 | Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb |
C82.16 | Follicular lymphoma grade II, intrapelvic lymph nodes |
C82.17 | Follicular lymphoma grade II, spleen |
C82.18 | Follicular lymphoma grade II, lymph nodes of multiple sites |
C82.19 | Follicular lymphoma grade II, extranodal and solid organ sites |
C82.20 | Follicular lymphoma grade III, unspecified, unspecified site |
C82.21 | Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck |
C82.22 | Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes |
C82.23 | Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes |
C82.24 | Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb |
C82.25 | Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb |
C82.26 | Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes |
C82.27 | Follicular lymphoma grade III, unspecified, spleen |
C82.28 | Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites |
C82.29 | Follicular lymphoma grade III, unspecified, extranodal and solid organ sites |
C82.30 | Follicular lymphoma grade IIIa, unspecified site |
C82.31 | Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck |
C82.32 | Follicular lymphoma grade IIIa, intrathoracic lymph nodes |
C82.33 | Follicular lymphoma grade IIIa, intra-abdominal lymph nodes |
C82.34 | Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb |
C82.35 | Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb |
C82.36 | Follicular lymphoma grade IIIa, intrapelvic lymph nodes |
C82.37 | Follicular lymphoma grade IIIa, spleen |
C82.38 | Follicular lymphoma grade IIIa, lymph nodes of multiple sites |
C82.39 | Follicular lymphoma grade IIIa, extranodal and solid organ sites |
C82.40 | Follicular lymphoma grade IIIb, unspecified site |
C82.41 | Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck |
C82.42 | Follicular lymphoma grade IIIb, intrathoracic lymph nodes |
C82.43 | Follicular lymphoma grade IIIb, intra-abdominal lymph nodes |
C82.44 | Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb |
C82.45 | Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb |
C82.46 | Follicular lymphoma grade IIIb, intrapelvic lymph nodes |
C82.47 | Follicular lymphoma grade IIIb, spleen |
C82.48 | Follicular lymphoma grade IIIb, lymph nodes of multiple sites |
C82.49 | Follicular lymphoma grade IIIb, extranodal and solid organ sites |
C82.50 | Diffuse follicle center lymphoma, unspecified site |
C82.51 | Diffuse follicle center lymphoma, lymph nodes of head, face, and neck |
C82.52 | Diffuse follicle center lymphoma, intrathoracic lymph nodes |
C82.53 | Diffuse follicle center lymphoma, intra-abdominal lymph nodes |
C82.54 | Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb |
C82.55 | Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb |
C82.56 | Diffuse follicle center lymphoma, intrapelvic lymph nodes |
C82.57 | Diffuse follicle center lymphoma, spleen |
C82.58 | Diffuse follicle center lymphoma, lymph nodes of multiple sites |
C82.59 | Diffuse follicle center lymphoma, extranodal and solid organ sites |
C82.60 | Cutaneous follicle center lymphoma, unspecified site |
C82.61 | Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck |
C82.62 | Cutaneous follicle center lymphoma, intrathoracic lymph nodes |
C82.63 | Cutaneous follicle center lymphoma, intra-abdominal lymph nodes |
C82.64 | Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb |
C82.65 | Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb |
C82.66 | Cutaneous follicle center lymphoma, intrapelvic lymph nodes |
C82.67 | Cutaneous follicle center lymphoma, spleen |
C82.68 | Cutaneous follicle center lymphoma, lymph nodes of multiple sites |
C82.69 | Cutaneous follicle center lymphoma, extranodal and solid organ sites |
C82.80 | Other types of follicular lymphoma, unspecified site |
C82.81 | Other types of follicular lymphoma, lymph nodes of head, face, and neck |
C82.82 | Other types of follicular lymphoma, intrathoracic lymph nodes |
C82.83 | Other types of follicular lymphoma, intra-abdominal lymph nodes |
C82.84 | Other types of follicular lymphoma, lymph nodes of axilla and upper limb |
C82.85 | Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb |
C82.86 | Other types of follicular lymphoma, intrapelvic lymph nodes |
C82.87 | Other types of follicular lymphoma, spleen |
C82.88 | Other types of follicular lymphoma, lymph nodes of multiple sites |
C82.89 | Other types of follicular lymphoma, extranodal and solid organ sites |
C82.90 | Follicular lymphoma, unspecified, unspecified site |
C82.91 | Follicular lymphoma, unspecified, lymph nodes of head, face, and neck |
C82.92 | Follicular lymphoma, unspecified, intrathoracic lymph nodes |
C82.93 | Follicular lymphoma, unspecified, intra-abdominal lymph nodes |
C82.94 | Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb |
C82.95 | Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
C82.96 | Follicular lymphoma, unspecified, intrapelvic lymph nodes |
C82.97 | Follicular lymphoma, unspecified, spleen |
C82.98 | Follicular lymphoma, unspecified, lymph nodes of multiple sites |
C82.99 | Follicular lymphoma, unspecified, extranodal and solid organ sites |
C83.00 | Small cell B-cell lymphoma, unspecified site |
C83.01 | Small cell B-cell lymphoma, lymph nodes of head, face, and neck |
C83.02 | Small cell B-cell lymphoma, intrathoracic lymph nodes |
C83.03 | Small cell B-cell lymphoma, intra-abdominal lymph nodes |
C83.04 | Small cell B-cell lymphoma, lymph nodes of axilla and upper limb |
C83.05 | Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb |
C83.06 | Small cell B-cell lymphoma, intrapelvic lymph nodes |
C83.07 | Small cell B-cell lymphoma, spleen |
C83.08 | Small cell B-cell lymphoma, lymph nodes of multiple sites |
C83.09 | Small cell B-cell lymphoma, extranodal and solid organ sites |
C83.10 | Mantle cell lymphoma, unspecified site |
C83.11 | Mantle cell lymphoma, lymph nodes of head, face, and neck |
C83.12 | Mantle cell lymphoma, intrathoracic lymph nodes |
C83.13 | Mantle cell lymphoma, intra-abdominal lymph nodes |
C83.14 | Mantle cell lymphoma, lymph nodes of axilla and upper limb |
C83.15 | Mantle cell lymphoma, lymph nodes of inguinal region and lower limb |
C83.16 | Mantle cell lymphoma, intrapelvic lymph nodes |
C83.17 | Mantle cell lymphoma, spleen |
C83.18 | Mantle cell lymphoma, lymph nodes of multiple sites |
C83.19 | Mantle cell lymphoma, extranodal and solid organ sites |
C83.30 | Diffuse large B-cell lymphoma, unspecified site |
C83.31 | Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck |
C83.32 | Diffuse large B-cell lymphoma, intrathoracic lymph nodes |
C83.33 | Diffuse large B-cell lymphoma, intra-abdominal lymph nodes |
C83.34 | Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb |
C83.35 | Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb |
C83.36 | Diffuse large B-cell lymphoma, intrapelvic lymph nodes |
C83.37 | Diffuse large B-cell lymphoma, spleen |
C83.38 | Diffuse large B-cell lymphoma, lymph nodes of multiple sites |
C83.39 | Diffuse large B-cell lymphoma, extranodal and solid organ sites |
C83.50 | Lymphoblastic (diffuse) lymphoma, unspecified site |
C83.51 | Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck |
C83.52 | Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes |
C83.53 | Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes |
C83.54 | Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb |
C83.55 | Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb |
C83.56 | Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes |
C83.57 | Lymphoblastic (diffuse) lymphoma, spleen |
C83.58 | Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites |
C83.59 | Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites |
C83.70 | Burkitt lymphoma, unspecified site |
C83.71 | Burkitt lymphoma, lymph nodes of head, face, and neck |
C83.72 | Burkitt lymphoma, intrathoracic lymph nodes |
C83.73 | Burkitt lymphoma, intra-abdominal lymph nodes |
C83.74 | Burkitt lymphoma, lymph nodes of axilla and upper limb |
C83.75 | Burkitt lymphoma, lymph nodes of inguinal region and lower limb |
C83.76 | Burkitt lymphoma, intrapelvic lymph nodes |
C83.77 | Burkitt lymphoma, spleen |
C83.78 | Burkitt lymphoma, lymph nodes of multiple sites |
C83.79 | Burkitt lymphoma, extranodal and solid organ sites |
C83.80 | Other non-follicular lymphoma, unspecified site |
C83.81 | Other non-follicular lymphoma, lymph nodes of head, face, and neck |
C83.82 | Other non-follicular lymphoma, intrathoracic lymph nodes |
C83.83 | Other non-follicular lymphoma, intra-abdominal lymph nodes |
C83.84 | Other non-follicular lymphoma, lymph nodes of axilla and upper limb |
C83.85 | Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb |
C83.86 | Other non-follicular lymphoma, intrapelvic lymph nodes |
C83.87 | Other non-follicular lymphoma, spleen |
C83.88 | Other non-follicular lymphoma, lymph nodes of multiple sites |
C83.89 | Other non-follicular lymphoma, extranodal and solid organ sites |
C83.90 | Non-follicular (diffuse) lymphoma, unspecified, unspecified site |
C83.91 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck |
C83.92 | Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes |
C83.93 | Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes |
C83.94 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb |
C83.95 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
C83.96 | Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes |
C83.97 | Non-follicular (diffuse) lymphoma, unspecified, spleen |
C83.98 | Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites |
C83.99 | Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites |
C84.00 | Mycosis fungoides, unspecified site |
C84.01 | Mycosis fungoides, lymph nodes of head, face, and neck |
C84.02 | Mycosis fungoides, intrathoracic lymph nodes |
C84.03 | Mycosis fungoides, intra-abdominal lymph nodes |
C84.04 | Mycosis fungoides, lymph nodes of axilla and upper limb |
C84.05 | Mycosis fungoides, lymph nodes of inguinal region and lower limb |
C84.06 | Mycosis fungoides, intrapelvic lymph nodes |
C84.07 | Mycosis fungoides, spleen |
C84.08 | Mycosis fungoides, lymph nodes of multiple sites |
C84.09 | Mycosis fungoides, extranodal and solid organ sites |
C84.40 | Peripheral T-cell lymphoma, not classified, unspecified site |
C84.41 | Peripheral T-cell lymphoma, not classified, lymph nodes of head, face, and neck |
C84.42 | Peripheral T-cell lymphoma, not classified, intrathoracic lymph nodes |
C84.43 | Peripheral T-cell lymphoma, not classified, intra-abdominal lymph nodes |
C84.44 | Peripheral T-cell lymphoma, not classified, lymph nodes of axilla and upper limb |
C84.45 | Peripheral T-cell lymphoma, not classified, lymph nodes of inguinal region and lower limb |
C84.46 | Peripheral T-cell lymphoma, not classified, intrapelvic lymph nodes |
C84.47 | Peripheral T-cell lymphoma, not classified, spleen |
C84.48 | Peripheral T-cell lymphoma, not classified, lymph nodes of multiple sites |
C84.49 | Peripheral T-cell lymphoma, not classified, extranodal and solid organ sites |
C84.60 | Anaplastic large cell lymphoma, ALK-positive, unspecified site |
C84.61 | Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck |
C84.62 | Anaplastic large cell lymphoma, ALK-positive, intrathoracic lymph nodes |
C84.63 | Anaplastic large cell lymphoma, ALK-positive, intra-abdominal lymph nodes |
C84.64 | Anaplastic large cell lymphoma, ALK-positive, lymph nodes of axilla and upper limb |
C84.65 | Anaplastic large cell lymphoma, ALK-positive, lymph nodes of inguinal region and lower limb |
C84.66 | Anaplastic large cell lymphoma, ALK-positive, intrapelvic lymph nodes |
C84.67 | Anaplastic large cell lymphoma, ALK-positive, spleen |
C84.68 | Anaplastic large cell lymphoma, ALK-positive, lymph nodes of multiple sites |
C84.69 | Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites |
C84.70 | Anaplastic large cell lymphoma, ALK-negative, unspecified site |
C84.71 | Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck |
C84.72 | Anaplastic large cell lymphoma, ALK-negative, intrathoracic lymph nodes |
C84.73 | Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes |
C84.74 | Anaplastic large cell lymphoma, ALK-negative, lymph nodes of axilla and upper limb |
C84.75 | Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb |
C84.76 | Anaplastic large cell lymphoma, ALK-negative, intrapelvic lymph nodes |
C84.77 | Anaplastic large cell lymphoma, ALK-negative, spleen |
C84.78 | Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites |
C84.79 | Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites |
C84.90 | Mature T/NK-cell lymphomas, unspecified, unspecified site |
C84.91 | Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck |
C84.92 | Mature T/NK-cell lymphomas, unspecified, intrathoracic lymph nodes |
C84.93 | Mature T/NK-cell lymphomas, unspecified, intra-abdominal lymph nodes |
C84.94 | Mature T/NK-cell lymphomas, unspecified, lymph nodes of axilla and upper limb |
C84.95 | Mature T/NK-cell lymphomas, unspecified, lymph nodes of inguinal region and lower limb |
C84.96 | Mature T/NK-cell lymphomas, unspecified, intrapelvic lymph nodes |
C84.97 | Mature T/NK-cell lymphomas, unspecified, spleen |
C84.98 | Mature T/NK-cell lymphomas, unspecified, lymph nodes of multiple sites |
C84.99 | Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites |
C84.A0 | Cutaneous T-cell lymphoma, unspecified, unspecified site |
C84.A1 | Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck |
C84.A2 | Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes |
C84.A3 | Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes |
C84.A4 | Cutaneous T-cell lymphoma, unspecified, lymph nodes of axilla and upper limb |
C84.A5 | Cutaneous T-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
C84.A6 | Cutaneous T-cell lymphoma, unspecified, intrapelvic lymph nodes |
C84.A7 | Cutaneous T-cell lymphoma, unspecified, spleen |
C84.A8 | Cutaneous T-cell lymphoma, unspecified, lymph nodes of multiple sites |
C84.A9 | Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites |
C84.Z0 | Other mature T/NK-cell lymphomas, unspecified site |
C84.Z1 | Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck |
C84.Z2 | Other mature T/NK-cell lymphomas, intrathoracic lymph nodes |
C84.Z3 | Other mature T/NK-cell lymphomas, intra-abdominal lymph nodes |
C84.Z4 | Other mature T/NK-cell lymphomas, lymph nodes of axilla and upper limb |
C84.Z5 | Other mature T/NK-cell lymphomas, lymph nodes of inguinal region and lower limb |
C84.Z6 | Other mature T/NK-cell lymphomas, intrapelvic lymph nodes |
C84.Z7 | Other mature T/NK-cell lymphomas, spleen |
C84.Z8 | Other mature T/NK-cell lymphomas, lymph nodes of multiple sites |
C84.Z9 | Other mature T/NK-cell lymphomas, extranodal and solid organ sites |
C85.10 | Unspecified B-cell lymphoma, unspecified site |
C85.11 | Unspecified B-cell lymphoma, lymph nodes of head, face, and neck |
C85.12 | Unspecified B-cell lymphoma, intrathoracic lymph nodes |
C85.13 | Unspecified B-cell lymphoma, intra-abdominal lymph nodes |
C85.14 | Unspecified B-cell lymphoma, lymph nodes of axilla and upper limb |
C85.15 | Unspecified B-cell lymphoma, lymph nodes of inguinal region and lower limb |
C85.16 | Unspecified B-cell lymphoma, intrapelvic lymph nodes |
C85.17 | Unspecified B-cell lymphoma, spleen |
C85.18 | Unspecified B-cell lymphoma, lymph nodes of multiple sites |
C85.19 | Unspecified B-cell lymphoma, extranodal and solid organ sites |
C85.20 | Mediastinal (thymic) large B-cell lymphoma, unspecified site |
C85.21 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck |
C85.22 | Mediastinal (thymic) large B-cell lymphoma, intrathoracic lymph nodes |
C85.23 | Mediastinal (thymic) large B-cell lymphoma, intra-abdominal lymph nodes |
C85.24 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of axilla and upper limb |
C85.25 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of inguinal region and lower limb |
C85.26 | Mediastinal (thymic) large B-cell lymphoma, intrapelvic lymph nodes |
C85.27 | Mediastinal (thymic) large B-cell lymphoma, spleen |
C85.28 | Mediastinal (thymic) large B-cell lymphoma, lymph nodes of multiple sites |
C85.29 | Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites |
C85.80 | Other specified types of non-Hodgkin lymphoma, unspecified site |
C85.81 | Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck |
C85.82 | Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes |
C85.83 | Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes |
C85.84 | Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb |
C85.85 | Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb |
C85.86 | Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes |
C85.87 | Other specified types of non-Hodgkin lymphoma, spleen |
C85.88 | Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites |
C85.89 | Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites |
C85.90 | Non-Hodgkin lymphoma, unspecified, unspecified site |
C85.91 | Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck |
C85.92 | Non-Hodgkin lymphoma, unspecified, intrathoracic lymph nodes |
C85.93 | Non-Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes |
C85.94 | Non-Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb |
C85.95 | Non-Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb |
C85.96 | Non-Hodgkin lymphoma, unspecified, intrapelvic lymph nodes |
C85.97 | Non-Hodgkin lymphoma, unspecified, spleen |
C85.98 | Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple sites |
C85.99 | Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites |
C86.0 | Extranodal NK/T-cell lymphoma, nasal type |
C86.1 | Hepatosplenic T-cell lymphoma |
C86.2 | Enteropathy-type (intestinal) T-cell lymphoma |
C86.3 | Subcutaneous panniculitis-like T-cell lymphoma |
C86.4 | Blastic NK-cell lymphoma |
C86.5 | Angioimmunoblastic T-cell lymphoma |
C86.6 | Primary cutaneous CD30-positive T-cell proliferations |
C88.2 | Heavy chain disease |
C88.3 | Immunoproliferative small intestinal disease |
C88.4 | Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] |
C88.8 | Other malignant immunoproliferative diseases |
C88.9 | Malignant immunoproliferative disease, unspecified |
C90.00 | Multiple myeloma not having achieved remission |
C90.01 | Multiple myeloma in remission |
C90.02 | Multiple myeloma in relapse |
C90.10 | Plasma cell leukemia not having achieved remission |
C90.11 | Plasma cell leukemia in remission |
C90.12 | Plasma cell leukemia in relapse |
C90.20 | Extramedullary plasmacytoma not having achieved remission |
C90.21 | Extramedullary plasmacytoma in remission |
C90.22 | Extramedullary plasmacytoma in relapse |
C90.30 | Solitary plasmacytoma not having achieved remission |
C90.31 | Solitary plasmacytoma in remission |
C90.32 | Solitary plasmacytoma in relapse |
C91.00 | Acute lymphoblastic leukemia not having achieved remission |
C91.01 | Acute lymphoblastic leukemia, in remission |
C91.02 | Acute lymphoblastic leukemia, in relapse |
C91.10 | Chronic lymphocytic leukemia of B-cell type not having achieved remission |
C91.11 | Chronic lymphocytic leukemia of B-cell type in remission |
C91.12 | Chronic lymphocytic leukemia of B-cell type in relapse |
C91.30 | Prolymphocytic leukemia of B-cell type not having achieved remission |
C91.31 | Prolymphocytic leukemia of B-cell type, in remission |
C91.32 | Prolymphocytic leukemia of B-cell type, in relapse |
C91.40 | Hairy cell leukemia not having achieved remission |
C91.41 | Hairy cell leukemia, in remission |
C91.42 | Hairy cell leukemia, in relapse |
C91.50 | Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission |
C91.51 | Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission |
C91.52 | Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse |
C91.60 | Prolymphocytic leukemia of T-cell type not having achieved remission |
C91.61 | Prolymphocytic leukemia of T-cell type, in remission |
C91.62 | Prolymphocytic leukemia of T-cell type, in relapse |
C91.90 | Lymphoid leukemia, unspecified not having achieved remission |
C91.91 | Lymphoid leukemia, unspecified, in remission |
C91.92 | Lymphoid leukemia, unspecified, in relapse |
C91.A0 | Mature B-cell leukemia Burkitt-type not having achieved remission |
C91.A1 | Mature B-cell leukemia Burkitt-type, in remission |
C91.A2 | Mature B-cell leukemia Burkitt-type, in relapse |
C91.Z0 | Other lymphoid leukemia not having achieved remission |
C91.Z1 | Other lymphoid leukemia, in remission |
C91.Z2 | Other lymphoid leukemia, in relapse |
C92.00 | Acute myeloblastic leukemia, not having achieved remission |
C92.01 | Acute myeloblastic leukemia, in remission |
C92.02 | Acute myeloblastic leukemia, in relapse |
C92.10 | Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission |
C92.11 | Chronic myeloid leukemia, BCR/ABL-positive, in remission |
C92.12 | Chronic myeloid leukemia, BCR/ABL-positive, in relapse |
C92.20 | Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission |
C92.21 | Atypical chronic myeloid leukemia, BCR/ABL-negative, in remission |
C92.22 | Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse |
C92.30 | Myeloid sarcoma, not having achieved remission |
C92.31 | Myeloid sarcoma, in remission |
C92.32 | Myeloid sarcoma, in relapse |
C92.40 | Acute promyelocytic leukemia, not having achieved remission |
C92.41 | Acute promyelocytic leukemia, in remission |
C92.42 | Acute promyelocytic leukemia, in relapse |
C92.50 | Acute myelomonocytic leukemia, not having achieved remission |
C92.51 | Acute myelomonocytic leukemia, in remission |
C92.52 | Acute myelomonocytic leukemia, in relapse |
C92.60 | Acute myeloid leukemia with 11q23-abnormality not having achieved remission |
C92.61 | Acute myeloid leukemia with 11q23-abnormality in remission |
C92.62 | Acute myeloid leukemia with 11q23-abnormality in relapse |
C92.90 | Myeloid leukemia, unspecified, not having achieved remission |
C92.91 | Myeloid leukemia, unspecified in remission |
C92.92 | Myeloid leukemia, unspecified in relapse |
C92.A0 | Acute myeloid leukemia with multilineage dysplasia, not having achieved remission |
C92.A1 | Acute myeloid leukemia with multilineage dysplasia, in remission |
C92.A2 | Acute myeloid leukemia with multilineage dysplasia, in relapse |
C92.Z0 | Other myeloid leukemia not having achieved remission |
C92.Z1 | Other myeloid leukemia, in remission |
C92.Z2 | Other myeloid leukemia, in relapse |
C93.00 | Acute monoblastic/monocytic leukemia, not having achieved remission |
C93.01 | Acute monoblastic/monocytic leukemia, in remission |
C93.02 | Acute monoblastic/monocytic leukemia, in relapse |
C93.10 | Chronic myelomonocytic leukemia not having achieved remission |
C93.11 | Chronic myelomonocytic leukemia, in remission |
C93.12 | Chronic myelomonocytic leukemia, in relapse |
C93.30 | Juvenile myelomonocytic leukemia, not having achieved remission |
C93.31 | Juvenile myelomonocytic leukemia, in remission |
C93.32 | Juvenile myelomonocytic leukemia, in relapse |
C93.90 | Monocytic leukemia, unspecified, not having achieved remission |
C93.91 | Monocytic leukemia, unspecified in remission |
C93.92 | Monocytic leukemia, unspecified in relapse |
C93.Z0 | Other monocytic leukemia, not having achieved remission |
C93.Z1 | Other monocytic leukemia, in remission |
C93.Z2 | Other monocytic leukemia, in relapse |
C94.00 | Acute erythroid leukemia, not having achieved remission |
C94.01 | Acute erythroid leukemia, in remission |
C94.02 | Acute erythroid leukemia, in relapse |
C94.20 | Acute megakaryoblastic leukemia not having achieved remission |
C94.21 | Acute megakaryoblastic leukemia, in remission |
C94.22 | Acute megakaryoblastic leukemia, in relapse |
C94.30 | Mast cell leukemia not having achieved remission |
C94.31 | Mast cell leukemia, in remission |
C94.32 | Mast cell leukemia, in relapse |
C94.40 | Acute panmyelosis with myelofibrosis not having achieved remission |
C94.41 | Acute panmyelosis with myelofibrosis, in remission |
C94.42 | Acute panmyelosis with myelofibrosis, in relapse |
C94.6 | Myelodysplastic disease, not classified |
C94.80 | Other specified leukemias not having achieved remission |
C94.81 | Other specified leukemias, in remission |
C94.82 | Other specified leukemias, in relapse |
C95.00 | Acute leukemia of unspecified cell type not having achieved remission |
C95.01 | Acute leukemia of unspecified cell type, in remission |
C95.02 | Acute leukemia of unspecified cell type, in relapse |
C95.10 | Chronic leukemia of unspecified cell type not having achieved remission |
C95.11 | Chronic leukemia of unspecified cell type, in remission |
C95.12 | Chronic leukemia of unspecified cell type, in relapse |
C95.90 | Leukemia, unspecified not having achieved remission |
C95.91 | Leukemia, unspecified, in remission |
C95.92 | Leukemia, unspecified, in relapse |
C96.0 | Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis |
C96.20 | Malignant mast cell neoplasm, unspecified |
C96.21 | Aggressive systemic mastocytosis |
C96.22 | Mast cell sarcoma |
C96.29 | Other malignant mast cell neoplasm |
C96.4 | Sarcoma of dendritic cells (accessory cells) |
C96.6 | Unifocal Langerhans-cell histiocytosis |
C96.9 | Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified |
C96.A | Histiocytic sarcoma |
C96.Z | Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue |
D00.00 | Carcinoma in situ of oral cavity, unspecified site |
D00.01 | Carcinoma in situ of labial mucosa and vermilion border |
D00.02 | Carcinoma in situ of buccal mucosa |
D00.03 | Carcinoma in situ of gingiva and edentulous alveolar ridge |
D00.04 | Carcinoma in situ of soft palate |
D00.05 | Carcinoma in situ of hard palate |
D00.06 | Carcinoma in situ of floor of mouth |
D00.07 | Carcinoma in situ of tongue |
D00.08 | Carcinoma in situ of pharynx |
D00.1 | Carcinoma in situ of esophagus |
D00.2 | Carcinoma in situ of stomach |
D01.0 | Carcinoma in situ of colon |
D01.1 | Carcinoma in situ of rectosigmoid junction |
D01.2 | Carcinoma in situ of rectum |
D01.3 | Carcinoma in situ of anus and anal canal |
D01.40 | Carcinoma in situ of unspecified part of intestine |
D01.49 | Carcinoma in situ of other parts of intestine |
D01.5 | Carcinoma in situ of liver, gallbladder and bile ducts |
D01.7 | Carcinoma in situ of other specified digestive organs |
D01.9 | Carcinoma in situ of digestive organ, unspecified |
D02.0 | Carcinoma in situ of larynx |
D02.1 | Carcinoma in situ of trachea |
D02.20 | Carcinoma in situ of unspecified bronchus and lung |
D02.21 | Carcinoma in situ of right bronchus and lung |
D02.22 | Carcinoma in situ of left bronchus and lung |
D02.3 | Carcinoma in situ of other parts of respiratory system |
D02.4 | Carcinoma in situ of respiratory system, unspecified |
D03.0 | Melanoma in situ of lip |
D03.10 | Melanoma in situ of unspecified eyelid, including canthus |
D03.111 | Melanoma in situ of right upper eyelid, including canthus |
D03.112 | Melanoma in situ of right lower eyelid, including canthus |
D03.121 | Melanoma in situ of left upper eyelid, including canthus |
D03.122 | Melanoma in situ of left lower eyelid, including canthus |
D03.20 | Melanoma in situ of unspecified ear and external auricular canal |
D03.21 | Melanoma in situ of right ear and external auricular canal |
D03.22 | Melanoma in situ of left ear and external auricular canal |
D03.30 | Melanoma in situ of unspecified part of face |
D03.39 | Melanoma in situ of other parts of face |
D03.4 | Melanoma in situ of scalp and neck |
D03.51 | Melanoma in situ of anal skin |
D03.52 | Melanoma in situ of breast (skin) (soft tissue) |
D03.59 | Melanoma in situ of other part of trunk |
D03.60 | Melanoma in situ of unspecified upper limb, including shoulder |
D03.61 | Melanoma in situ of right upper limb, including shoulder |
D03.62 | Melanoma in situ of left upper limb, including shoulder |
D03.70 | Melanoma in situ of unspecified lower limb, including hip |
D03.71 | Melanoma in situ of right lower limb, including hip |
D03.72 | Melanoma in situ of left lower limb, including hip |
D03.8 | Melanoma in situ of other sites |
D03.9 | Melanoma in situ, unspecified |
D04.0 | Carcinoma in situ of skin of lip |
D04.10 | Carcinoma in situ of skin of unspecified eyelid, including canthus |
D04.111 | Carcinoma in situ of skin of right upper eyelid, including canthus |
D04.112 | Carcinoma in situ of skin of right lower eyelid, including canthus |
D04.121 | Carcinoma in situ of skin of left upper eyelid, including canthus |
D04.122 | Carcinoma in situ of skin of left lower eyelid, including canthus |
D04.20 | Carcinoma in situ of skin of unspecified ear and external auricular canal |
D04.21 | Carcinoma in situ of skin of right ear and external auricular canal |
D04.22 | Carcinoma in situ of skin of left ear and external auricular canal |
D04.30 | Carcinoma in situ of skin of unspecified part of face |
D04.39 | Carcinoma in situ of skin of other parts of face |
D04.4 | Carcinoma in situ of skin of scalp and neck |
D04.5 | Carcinoma in situ of skin of trunk |
D04.60 | Carcinoma in situ of skin of unspecified upper limb, including shoulder |
D04.61 | Carcinoma in situ of skin of right upper limb, including shoulder |
D04.62 | Carcinoma in situ of skin of left upper limb, including shoulder |
D04.70 | Carcinoma in situ of skin of unspecified lower limb, including hip |
D04.71 | Carcinoma in situ of skin of right lower limb, including hip |
D04.72 | Carcinoma in situ of skin of left lower limb, including hip |
D04.8 | Carcinoma in situ of skin of other sites |
D04.9 | Carcinoma in situ of skin, unspecified |
D05.00 | Lobular carcinoma in situ of unspecified breast |
D05.01 | Lobular carcinoma in situ of right breast |
D05.02 | Lobular carcinoma in situ of left breast |
D05.10 | Intraductal carcinoma in situ of unspecified breast |
D05.11 | Intraductal carcinoma in situ of right breast |
D05.12 | Intraductal carcinoma in situ of left breast |
D05.80 | Other specified type of carcinoma in situ of unspecified breast |
D05.81 | Other specified type of carcinoma in situ of right breast |
D05.82 | Other specified type of carcinoma in situ of left breast |
D05.90 | Unspecified type of carcinoma in situ of unspecified breast |
D05.91 | Unspecified type of carcinoma in situ of right breast |
D05.92 | Unspecified type of carcinoma in situ of left breast |
D06.0 | Carcinoma in situ of endocervix |
D06.1 | Carcinoma in situ of exocervix |
D06.7 | Carcinoma in situ of other parts of cervix |
D06.9 | Carcinoma in situ of cervix, unspecified |
D07.0 | Carcinoma in situ of endometrium |
D07.1 | Carcinoma in situ of vulva |
D07.2 | Carcinoma in situ of vagina |
D07.30 | Carcinoma in situ of unspecified female genital organs |
D07.39 | Carcinoma in situ of other female genital organs |
D07.4 | Carcinoma in situ of penis |
D07.5 | Carcinoma in situ of prostate |
D07.60 | Carcinoma in situ of unspecified male genital organs |
D07.61 | Carcinoma in situ of scrotum |
D07.69 | Carcinoma in situ of other male genital organs |
D09.0 | Carcinoma in situ of bladder |
D09.10 | Carcinoma in situ of unspecified urinary organ |
D09.19 | Carcinoma in situ of other urinary organs |
D09.20 | Carcinoma in situ of unspecified eye |
D09.21 | Carcinoma in situ of right eye |
D09.22 | Carcinoma in situ of left eye |
D09.3 | Carcinoma in situ of thyroid and other endocrine glands |
D09.8 | Carcinoma in situ of other specified sites |
D09.9 | Carcinoma in situ, unspecified |
D10.0 | Benign neoplasm of lip |
D10.1 | Benign neoplasm of tongue |
D10.2 | Benign neoplasm of floor of mouth |
D10.30 | Benign neoplasm of unspecified part of mouth |
D10.39 | Benign neoplasm of other parts of mouth |
D10.4 | Benign neoplasm of tonsil |
D10.5 | Benign neoplasm of other parts of oropharynx |
D10.6 | Benign neoplasm of nasopharynx |
D10.7 | Benign neoplasm of hypopharynx |
D10.9 | Benign neoplasm of pharynx, unspecified |
D11.0 | Benign neoplasm of parotid gland |
D11.7 | Benign neoplasm of other major salivary glands |
D11.9 | Benign neoplasm of major salivary gland, unspecified |
D12.0 | Benign neoplasm of cecum |
D12.1 | Benign neoplasm of appendix |
D12.2 | Benign neoplasm of ascending colon |
D12.3 | Benign neoplasm of transverse colon |
D12.4 | Benign neoplasm of descending colon |
D12.5 | Benign neoplasm of sigmoid colon |
D12.6 | Benign neoplasm of colon, unspecified |
D12.7 | Benign neoplasm of rectosigmoid junction |
D12.8 | Benign neoplasm of rectum |
D12.9 | Benign neoplasm of anus and anal canal |
D13.0 | Benign neoplasm of esophagus |
D13.1 | Benign neoplasm of stomach |
D13.2 | Benign neoplasm of duodenum |
D13.30 | Benign neoplasm of unspecified part of small intestine |
D13.39 | Benign neoplasm of other parts of small intestine |
D13.4 | Benign neoplasm of liver |
D13.5 | Benign neoplasm of extrahepatic bile ducts |
D13.6 | Benign neoplasm of pancreas |
D13.7 | Benign neoplasm of endocrine pancreas |
D13.9 | Benign neoplasm of ill-defined sites within the digestive system |
D14.0 | Benign neoplasm of middle ear, nasal cavity and accessory sinuses |
D14.1 | Benign neoplasm of larynx |
D14.2 | Benign neoplasm of trachea |
D14.30 | Benign neoplasm of unspecified bronchus and lung |
D14.31 | Benign neoplasm of right bronchus and lung |
D14.32 | Benign neoplasm of left bronchus and lung |
D14.4 | Benign neoplasm of respiratory system, unspecified |
D15.0 | Benign neoplasm of thymus |
D15.1 | Benign neoplasm of heart |
D15.2 | Beni |