| CPT Codes | Description |
|---|---|
| J0129 | Injection, abatacept, 10 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) |
| J0178 | Injection, aflibercept, 1 mg |
| J0179 | Injection, brolucizumab-dbll, 1 mg |
| J0180 | Injection, agalsidase beta, 1 mg |
| J0185 | Injection, aprepitant, 1 mg |
| J0202 | Injection, alemtuzumab, 1 mg |
| J0221 | Injection, alglucosidase alfa, (Lumizyme), 10 mg |
| J0222 | Injection, patisiran, 0.1 mg |
| J0256 | Injection, alpha 1-proteinase inhibitor (human), not otherwise specified, 10 mg |
| J0257 | Injection, alpha 1 proteinase inhibitor (human), (GLASSIA), 10 mg |
| J0364 | Injection, apomorphine hcl, 1 mg |
| J0485 | Injection, belatacept, 1 mg |
| J0490 | Injection, belimumab, 10 mg |
| J0517 | Injection, benralizumab, 1 mg |
| J0565 | Injection, bezlotoxumab, 10 mg |
| J0567 | Injection, cerliponase alfa, 1 mg |
| J0570 | Buprenorphine implant, 74.2 mg |
| J0584 | Injection, burosumab-twza 1 mg |
| J0585 | Injection, onabotulinumtoxinA, 1 unit |
| J0586 | Injection, abobotulinumtoxinA, 5 units |
| J0587 | Injection, rimabotulinumtoxinB, 100 units |
| J0588 | Injection, incobotulinumtoxinA, 1 unit |
| 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) |
| J0596 | Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units |
| J0597 | Injection, C-1 esterase inhibitor (human), Berinert, 10 units |
| J0598 | Injection, C-1 esterase inhibitor (human), Cinryze, 10 units |
| J0599 | Injection, c-1 esterase inhibitor (human), (haegarda), 10 units |
| J0606 | Injection, etelcalcetide, 0.1 mg |
| J0638 | Injection, canakinumab, 1 mg |
| J0641 | Injection, levoleucovorin, 0.5 mg |
| J0642 | Injection, levoleucovorin (Khapzory), 0.5 mg |
| J0717 | Injection, certolizumab pegol, 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) |
| J0775 | Injection, collagenase, clostridium histolyticum, 0.01 mg |
| J0800 | Injection, corticotropin, up to 40 units |
| J0850 | Injection, cytomegalovirus immune globulin intravenous (human), per vial |
| J0881 | Injection, darbepoetin alfa, 1 mcg (non-ESRD use) |
| J0885 | Injection, epoetin alfa, (for non-ESRD use), 1000 units |
| J0894 | Injection, decitabine, 1 mg |
| J0897 | Injection, denosumab, 1 mg |
| J1095 | Injection, dexamethasone 9%, intraocular, 1 mcg |
| J1096 | Dexamethasone, lacrimal ophthalmic insert, 0.1 mg |
| J1290 | Injection, ecallantide, 1 mg |
| J1300 | Injection, eculizumab, 10 mg |
| J1301 | Injection, edaravone, 1 mg |
| J1303 | Injection, ravulizumab-cwvz, 10 mg |
| J1322 | Injection, elosulfase alfa, 1 mg |
| J1325 | Injection, epoprostenol, 0.5 mg |
| J1428 | Injection, eteplirsen, 10 mg |
| J1442 | Injection, filgrastim (G-CSF), excludes biosimilars, 1 microgram |
| J1447 | Injection, tbo-filgrastim, 1 mcg |
| J1454 | Injection, fosnetupitant 235 mg and palonosetron 0.25 mg |
| J1458 | Injection, galsulfase, 1 mg |
| J1459 | Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg |
| J1555 | Injection, immune globulin (cuvitru), 100 mg |
| J1556 | Injection, immune globulin (Bivigam), 500 mg |
| J1557 | Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mg |
| J1559 | Injection, immune globulin (Hizentra), 100 mg |
| J1561 | Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg |
| J1566 | Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg |
| J1568 | Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg |
| J1569 | Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg |
| J1571 | Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml |
| J1572 | Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg |
| J1573 | Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml |
| J1575 | Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin |
| J1599 | Injection, immune globulin, intravenous, non-lyophilized (e.g. liquid), not otherwise specified, 500 mg |
| J1602 | Injection, golimumab, 1 mg, for intravenous use |
| J1726 | Injection, hydroxyprogesterone caproate, (makena), 10 mg |
| J1729 | Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg |
| J1740 | Injection, ibandronate sodium, 1 mg |
| J1743 | Injection, idursulfase, 1 mg |
| J1744 | Injection, icatibant, 1mg |
| J1745 | Injection, infliximab, excludes biosimilar, 10 mg |
| J1746 | Injection, ibalizumab-uiyk, 10 mg |
| J1786 | Injection, imiglucerase, 10 units |
| J1833 | Injection, isavuconazonium, 1 mg |
| J1930 | Injection, lanreotide, 1 mg |
| J1931 | Injection, laronidase, 0.1 mg |
| J2062 | Loxapine for inhalation, 1 mg |
| J2182 | Injection, mepolizumab, 1 mg |
| J2323 | Injection, natalizumab, 1 mg |
| J2326 | Injection, nusinersen, 0.1 mg |
| J2350 | Injection, ocrelizumab, 1 mg |
| J2353 | Injection, octreotide, depot form for intramuscular injection, 1 mg |
| J2357 | Injection, omalizumab, 5 mg |
| J2469 | Injection, palonosetron HCl, 25 mcg |
| J2502 | Injection, pasireotide long acting, 1 mg |
| J2503 | Injection, pegaptanib sodium, 0.3 mg |
| J2505 | Injection, pegfilgrastim, 6 mg |
| J2507 | Injection, Pegloticase, 1 mg |
| J2562 | Injection, plerixafor, 1 mg |
| J2724 | Injection, protein C concentrate, intravenous, human, 10 IU |
| J2778 | Injection, ranibizumab, 0.1 mg |
| J2786 | Injection, reslizumab, 1 mg |
| J2793 | Injection, rilonacept, 1 mg |
| J2796 | Injection, romiplostim, 10 mcg |
| J2797 | Injection, rolapitant, 0.5 mg |
| J2820 | Injection, sargramostim (GM-CSF), 50 mcg |
| J2840 | Injection, sebelipase alfa, 1 mg |
| J2860 | Injection, siltuximab, 10 mg |
| J3060 | Injection, taliglucerase alfa, 10 units |
| J3111 | Injection, romosozumab-aqqg, 1 mg |
| J3145 | Injection, testosterone undecanoate, 1 mg |
| J3240 | Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial |
| J3245 | Injection, tildrakizumab, 1 mg |
| J3262 | Injection, tocilizumab, 1 mg |
| J3285 | Injection, treprostinil, 1 mg |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg |
| J3316 | Injection, triptorelin, extended-release, 3.75 mg |
| J3358 | Ustekinumab, for intravenous injection, 1 mg |
| J3380 | Injection, vedolizumab, 1 mg |
| J3385 | Injection, velaglucerase alfa, 100 units |
| J3397 | Injection, vestronidase alfa-vjbk, 1 mg |
| J3398 | Injection, voretigene neparvovec-rzyl, 1 billion vector genomes |
| J3489 | Injection, zoledronic acid, 1 mg |
| J3490 | Unclassified drugs |
| J3590 | Unclassified biologics |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg |
| J7175 | Injection, factor x, (human), 1 i.u. (New Code: 01/01/2017) |
| J7178 | Injection, human fibrinogen concentrate, not otherwise specified, 1 mg |
| J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco (New Code: 01/01/2017) |
| J7180 | Injection, factor XIII (antihemophilic factor, human), 1 IU |
| J7181 | Injection, factor XIII A-subunit, (recombinant), per IU |
| J7182 | Injection, factor VIII, (antihemophilic factor, recombinant), (NovoEight), per IU |
| J7183 | Injection, von Willebrand factor complex (human), Wilate, 1 IU vWF:RCo |
| J7185 | Injection, factor VIII (antihemophilic factor, recombinant) (XYNTHA), per IU |
| J7186 | Injection, antihemophilic factor VIII/von Willebrand factor complex (human), per factor VIII i.u. |
| J7187 | Injection, von Willebrand factor complex (Humate-P), per IU VWF:RCO |
| J7188 | Injection, factor VIII (antihemophilic factor, recombinant), per IU |
| J7189 | Factor VIIa (antihemophilic factor, recombinant), per 1 mcg |
| J7190 | Factor VIII (antihemophilic factor, human) per IU |
| J7192 | Factor VIII (antihemophilic factor, recombinant) per IU, not otherwise specified |
| J7193 | Factor IX (antihemophilic factor, purified, nonrecombinant) per IU |
| J7194 | Factor IX complex, per IU |
| J7195 | Injection, factor IX (antihemophilic factor, recombinant) per IU, not otherwise specified |
| J7198 | Antiinhibitor, per IU |
| J7199 | Hemophilia clotting factor, not otherwise classified |
| J7200 | Injection, factor IX, (antihemophilic factor, recombinant), Rixubis, per IU |
| J7201 | Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. (Revised Code: 01/01/2017) |
| J7202 | Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. (New Code: 01/01/2017) |
| J7203 | Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu |
| J7205 | Injection, factor VIII Fc fusion protein (recombinant), per IU |
| J7207 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. (New Code: 01/01/2017) |
| J7208 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. |
| J7209 | Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. (New Code: 01/01/2017) |
| J7210 | Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. |
| J7211 | Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. |
| J7311 | Fluocinolone acetonide, intravitreal implant |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg |
| J7313 | Injection, fluocinolone acetonide, intravitreal implant, 0.01 mg |
| J7314 | Injection, fluocinolone acetonide, intravitreal implant (Yutiq), 0.01 mg |
| J7316 | Injection, ocriplasmin, 0.125 mg |
| J7318 | Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg |
| J7320 | Hyaluronan or derivative, GenVisc 850, for intra-articular injection, 1 mg |
| J7321 | Hyaluronan or derivative, Hyalgan or Supartz, for intra-articular injection, per dose |
| J7322 | Hyaluronan or derivative, Hymovis, for intra-articular injection, 1 mg |
| J7323 | Hyaluronan or derivative, Euflexxa, for intra-articular injection, per dose |
| J7324 | Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose |
| J7325 | Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg |
| J7326 | Hyaluronan or derivative, Gel-One, for intra-articular injection, per dose |
| J7327 | Hyaluronan or derivative, Monovisc, for intra-articular injection, per dose |
| J7328 | Hyaluronan or derivative, Gel-Syn, for intra-articular injection, 0.1 mg |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg |
| J7331 | Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg |
| J7332 | Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg |
| J7336 | Capsaicin 8% patch, per square centimeter |
| J7686 | Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg |
| J9015 | Injection, aldesleukin, per single use vial |
| J9022 | Injection, atezolizumab, 10 mg |
| J9023 | Injection, avelumab, 10 mg |
| J9025 | Injection, azacitidine, 1 mg |
| J9027 | Injection, clofarabine, 1 mg |
| J9033 | Injection, bendamustine hcl (treanda), 1 mg |
| J9034 | Injection, bendamustine hcl (bendeka), 1 mg |
| J9035 | Injection, bevacizumab, 10 mg " to "Injection, bevacizumab, (Avastin) 10 mg (Cancer indications only; ophthalmologic injections do not require PA. Submit under J3490 with NDC |
| J9036 | Injection, bendamustine hydrochloride, (Belrapzo), 1 mg |
| J9039 | Injection, blinatumomab, 1 microgram |
| J9041 | Injection, bortezomib (Velcade), 0.1 mg |
| J9042 | Injection, brentuximab vedotin, 1 mg |
| J9043 | Injection, cabazitaxel, 1 mg |
| J9044 | Injection, bortezomib, not otherwise specified, 0.1 mg |
| J9047 | Injection, Carfilzomib, 1 mg |
| J9055 | Injection, cetuximab, 10 mg |
| J9057 | Injection, copanlisib, 1 mg |
| J9118 | Injection, calaspargase pegol-mknl, 10 units |
| J9119 | Injection, cemiplimab-rwlc, 1 mg |
| J9145 | Injection, daratumumab, 10 mg |
| J9153 | Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine |
| J9173 | Injection, durvalumab, 10 mg |
| J9176 | Injection, elotuzumab, 1 mg |
| J9179 | Injection, eribulin mesylate, 0.1 mg |
| J9199 | Injection, gemcitabine HCl (Infugem), 200 mg |
| J9203 | Injection, gemtuzumab ozogamicin, 0.1 mg |
| J9204 | Injection, mogamulizumab-kpkc, 1 mg |
| J9205 | Injection, irinotecan liposome, 1 mg |
| J9207 | Injection, ixabepilone, 1 mg |
| J9210 | Injection, emapalumab-lzsg, 1 mg |
| J9219 | Leuprolide acetate implant, 65 mg |
| J9225 | Histrelin implant (Vantas), 50 mg |
| J9226 | Histrelin implant (supprelin la), 50 mg |
| J9228 | Injection, ipilimumab, 1 mg |
| J9229 | Injection, inotuzumab ozogamicin, 0.1 mg |
| J9262 | Injection, omacetaxine mepesuccinate, 0.01 mg |
| J9263 | Injection, oxaliplatin, 0.5 mg |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg |
| J9269 | Injection, tagraxofusp-erzs, 10 micrograms |
| J9271 | Injection, pembrolizumab, 1 mg |
| J9285 | Injection, olaratumab, 10 mg |
| J9295 | Injection, necitumumab, 1 mg |
| J9299 | Injection, nivolumab, 1 mg |
| J9301 | Injection, obinutuzumab, 10 mg |
| J9302 | Injection, ofatumumab, 10 mg |
| J9303 | Injection, panitumumab, 10 mg |
| J9305 | Injection, pemetrexed, 10 mg |
| J9306 | Injection, pertuzumab, 1 mg |
| J9307 | Injection, pralatrexate, 1 mg |
| J9308 | Injection, ramucirumab, 5 mg |
| J9309 | Injection, polatuzumab vedotin-piiq, 1 mg |
| J9311 | Injection, rituximab 10 mg and hyaluronidase |
| J9312 | Injection, rituximab, 10 mg |
| J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg |
| J9315 | Injection, romidepsin, 1 mg |
| J9325 | Injection, talimogene laherparepvec, per 1 million plaque forming units |
| J9328 | Injection, temozolomide, 1 mg |
| J9330 | Injection, temsirolimus, 1 mg |
| J9340 | Injection, thiotepa, 15 mg |
| J9352 | Injection, trabectedin, 0.1 mg |
| J9354 | Injection, ado-trastuzumab emtansine, 1 mg |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg |
| J9356 | Injection, trastuzumab, 10 mg and Hyaluronidase-oysk |
| J9371 | Injection, vincristine sulfate liposome, 1 mg; 1 mg = 1 billable unit |
| J9400 | Injection, ziv-aflibercept, 1 mg |
| Q2041 | Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, including leukapheresis and dose preparation procedures, per infusion |
| Q2042 | Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose |
| Q2043 | Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion |
| Q2049 | Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg |
| Q4074 | Iloprost, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 20 micrograms |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (Inflectra), 10 mg |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg |
| Q5106 | Injection, epoetin alfa, biosimilar, (Retacrit) (for non-ESRD use), 1000 units |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg |
| Q5108 | Injection, pegfilgrastim-jmdb, biosimilar, (fulphila), 0.5 mg |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram |
| Q5111 | Injection, pegfilgrastim-cbqv, biosimilar, (Udenyca), 0.5 mg |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (Ontruzant), 10 mg |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg |
| Q5114 | Injection, Trastuzumab-dkst, biosimilar, (Ogivri), 10 mg |
| Q5115 | Injection, rituximab-abbs, biosimilar, 10 mg |
| Q5116 | Injection, trastuzumab-qyyp, biosimilar, (Trazimera), 10 mg |
| Q5117 | Injection, trastuzumab-anns, biosimilar, (Kanjinti), 10 mg |
| Q5118 | Injection, bevacizumab-bvcr, biosimilar, (Zirabev), 10 mg |
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06/25/2020
