Searchable Medical Pharmacy Benefit HCPCS Listing

How to use the searchable tool

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.
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