HCPCS J Codes Last Updated January 2014
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- Rudolf Logan
- 8 years ago
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1 J s Last Updated January 2014 Term J0120 INJECTION, TETRACYCLINE, UP TO 250 MG D J0128 INJECTION, ABARELIX, 10 MG C J0130 INJECTION ABCIXIMAB, 10 MG D J0131 P INJECTION, ACETAMINOPHEN, 10 MG C J0132 INJECTION, ACETYLCYSTEINE, 100 MG C J0133 INJECTION, ACYCLOVIR, 5 MG C J0135 INJECTION, ADALIMUMAB, 20 MG C J0150 INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270) D J0151 A INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270) C J0152 D INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270) C J0170 INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE D J0178 INJECTION, AFLIBERCEPT, 1MG C J0180 INJECTION, AGALSIDASE BETA, 1 MG C J0190 INJECTION, BIPERIDEN LACTATE, PER 5 MG D J0200 INJECTION, ALATROFLOXACIN MESYLATE, 100 MG D J0205 INJECTION, ALGLUCERASE, PER 10 UNITS D J0207 INJECTION, AMIFOSTINE, 500 MG D J0210 P INJECTION, METHYLDOPATE HCL, UP TO 250 MG D J0215 INJECTION, ALEFACEPT, 0.5 MG C
2 J s Last Updated January 2014 Term J0220 INJECTION, ALGLUCOSIDASE ALFA, 10 MG, NOT OTHERWISE SPECIFIED C J0221 INJECTION, ALGLUCOSIDASE ALFA, (LUMIZYME), 10 MG D J0256 INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG D J0257 INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), (GLASSIA), 10 MG D J0270 INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) D J0275 ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) D J0278 INJECTION, AMIKACIN SULFATE, 100 MG C J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG D J0282 INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG D J0285 INJECTION, AMPHOTERICIN B, 50 MG D J0287 INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG D J0288 P INJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG D J0289 INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG D J0290 INJECTION, AMPICILLIN SODIUM, 500 MG D J0295 INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM D J0300 INJECTION, AMOBARBITAL, UP TO 125 MG D J0330 INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG D J0348 P INJECTION, ANIDULAFUNGIN, 1 MG C
3 J s Last Updated January 2014 Term J0350 INJECTION, ANISTREPLASE, PER 30 UNITS D J0360 INJECTION, HYDRALAZINE HCL, UP TO 20 MG D J0365 INJECTION, APROTONIN, 10,000 KIU D J0380 INJECTION, METARAMINOL BITARTRATE, PER 10 MG D J0390 INJECTION, CHLOROQUINE HYDROCHLORIDE, UP TO 250 MG D J0395 P INJECTION, ARBUTAMINE HCL, 1 MG D J0400 INJECTION, ARIPIPRAZOLE, INTRAMUSCULAR, 0.25 MG C J0401 A INJECTION, ARIPIPRAZOLE, EXTENDED RELEASE, 1 MG C J0456 INJECTION, AZITHROMYCIN, 500 MG D J0460 INJECTION, ATROPINE SULFATE, UP TO 0.3 MG D J0470 INJECTION, DIMERCAPROL, PER 100 MG D J0475 INJECTION, BACLOFEN, 10 MG D J0476 INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL D J0480 INJECTION, BASILIXIMAB, 20 MG D J0485 INJECTION, BELATACEPT, 1MG J0490 INJECTION, BELIMUMAB, 10 MG D J0500 INJECTION, DICYCLOMINE HCL, UP TO 20 MG D J0515 INJECTION, BENZTROPINE MESYLATE, PER 1 MG D J0520 INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE, UP TO 5 MG D J0530 INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000 UNITS D
4 J s Last Updated January 2014 Term J0540 INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000 UNITS D J0550 INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000 UNITS D J0560 INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS D J0570 INJECTION, PENICILLIN G BENZATHINE, UP TO 1,200,000 UNITS D J0580 INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000 UNITS D J0583 INJECTION, BIVALIRUDIN, 1 MG C J0585 BOTULINUM TOXIN TYPE A, PER UNIT D J0587 BOTULINUM TOXIN TYPE B, PER 100 UNITS D J0588 INJECTION, INCOBOTULINUMTOXIN A, 1 UNIT D J0592 INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG D J0595 INJECTION, BUTORPHANOL TARTRATE, 1 MG C J0600 INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG D J0610 INJECTION, CALCIUM GLUCONATE, PER 10 ML D J0620 INJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER 10 ML D J0630 INJECTION, CALCITONIN SALMON, UP TO 400 UNITS D J0636 INJECTION, CALCITRIOL, 0.1 MCG D J0637 INJECTION, CASPOFUNGIN ACETATE, 5 MG C J0640 INJECTION, LEUCOVORIN CALCIUM, PER 50 MG D J0641 INJECTION, LEVOLEUCOVORIN CALCIUM, 0.5 MG D J0670 INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML D
5 J s Last Updated January 2014 Term J0690 INJECTION, CEFAZOLIN SODIUM, 500 MG D J0692 INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG C J0694 INJECTION, CEFOXITIN SODIUM, 1 GM D J0696 INJECTION, CEFTRIAXONE SODIUM, PER 250 MG D J0697 INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG D J0698 INJECTION, CEFOTAXIME SODIUM, PER GM D J0702 INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIUM PHOSPHATE 3MG D J0704 INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG D J0706 INJECTION, CAFFEINE CITRATE, 5MG C J0710 INJECTION, CEPHAPIRIN SODIUM, UP TO 1 GM D J0712 P INJECTION, CEFTAROLINE FOSAMIL, 10 MG C J0713 INJECTION, CEFTAZIDIME, PER 500 MG D J0715 INJECTION, CEFTIZOXIME SODIUM, PER 500 MG D J0716 INJECTION, CENTRUROIDES IMMUNE F(AB), UP TO 120 MILLIGRAMS D J0717 A 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) C J0718 D INJECTION, CERTOLIZUMAB PEGOL, 1 MG C J0720 INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM D J0725 INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS D J0735 INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG D
6 J s Last Updated January 2014 Term J0740 INJECTION, CIDOFOVIR, 375 MG D J0743 INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG D J0744 INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG C J0745 INJECTION, CODEINE PHOSPHATE, PER 30 MG D J0760 INJECTION, COLCHICINE, PER 1MG D J0770 INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG D J0780 INJECTION, PROCHLORPERAZINE, UP TO 10 MG D J0795 INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM D J0800 INJECTION, CORTICOTROPIN, UP TO 40 UNITS D J0835 INJECTION, COSYNTROPIN, PER 0.25 MG D J0840 INJECTION, CROTALIDAE POLYVALENT IMMUNE FAB (OVINE), UP TO 1 GRAM D J0850 INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL D J0878 INJECTION, DAPTOMYCIN, 1 MG C J0880 INJECTION, DARBEPOETIN ALFA, 5 MCG C J0881 INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE) D J0882 INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS) D J0885 INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS D J0886 INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS) D J0890 INJECTION, PEGINESATIDE, 0.1MG (FOR ESRD ON DIALYSIS) D J0894 INJECTION, DECITABINE, 1 MG C
7 J s Last Updated January 2014 Term J0895 INJECTION, DEFEROXAMINE MESYLATE, 500 MG D J0897 INJECTION, DENOSUMAB, 1 MG D J0900 P INJECTION, TESTOSTERONE ENANTHATE AND ESTRADIOL VALERATE, UP TO 1 CC D J0945 INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG D J0970 INJECTION, ESTRADIOL VALERATE, UP TO 40 MG D J1000 INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG D J1020 INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG D J1030 INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG D J1040 INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG D J1050 INJECTION,MEDROXYPROGESTERONE ACETATE, 1MG D J1051 INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG D J1055 INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG S J1056 INJECTION, MEDROXYPROGESTERONE ACETATE / ESTRADIOL CYPIONATE, 5MG / 25MG C J1060 INJECTION, TESTOSTERONE CYPIONATE AND ESTRADIOL CYPIONATE, UP TO 1 ML D J1070 INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG D J1080 INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG D J1094 INJECTION, DEXAMETHASONE ACETATE, 1 MG D J1100 INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG D J1110 INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG D J1120 INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG D
8 J s Last Updated January 2014 Term J1160 INJECTION, DIGOXIN, UP TO 0.5 MG D J1162 INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL D J1165 INJECTION, PHENYTOIN SODIUM, PER 50 MG D J1170 INJECTION, HYDROMORPHONE, UP TO 4 MG D J1180 INJECTION, DYPHYLLINE, UP TO 500 MG D J1190 INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG D J1200 INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG D J1205 INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG D J1212 P INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML D J1230 INJECTION, METHADONE HCL, UP TO 10 MG D J1240 INJECTION, DIMENHYDRINATE, UP TO 50 MG D J1245 INJECTION, DIPYRIDAMOLE, PER 10 MG D J1250 INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG D J1260 INJECTION, DOLASETRON MESYLATE, 10 MG D J1265 INJECTION, DOPAMINE HCL, 40 MG C J1267 INJECTION, DORIPENEM, 10 MG D J1270 INJECTION, DOXERCALCIFEROL, 1 MCG C J1300 INJECTION, ECULIZUMAB, 10 MG C J1320 INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG D J1325 INJECTION, EPOPROSTENOL, 0.5 MG D
9 J s Last Updated January 2014 Term J1327 INJECTION, EPTIFIBATIDE, 5 MG D J1330 INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG D J1335 INJECTION, ERTAPENEM SODIUM, 500 MG C J1364 INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG D J1380 INJECTION, ESTRADIOL VALERATE, UP TO 10 MG D J1390 INJECTION, ESTRADIOL VALERATE, UP TO 20 MG D J1410 INJECTION, ESTROGEN CONJUGATED, PER 25 MG D J1430 INJECTION, ETHANOLAMINE OLEATE, 100 MG D J1435 P INJECTION, ESTRONE, PER 1 MG D J1436 INJECTION, ETIDRONATE DISODIUM, PER 300 MG D 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) D J1440 D INJECTION, FILGRASTIM (G-CSF), 300 MCG D J1441 D INJECTION, FILGRASTIM (G-CSF), 480 MCG D J1442 A INJECTION, FILGRASTIM (G-CSF), 1 MICROGRAM D J1446 A INJECTION, TBO-FILGRASTIM, 5 MICROGRAMS D J1450 INJECTION FLUCONAZOLE, 200 MG D J1451 INJECTION, FOMEPIZOLE, 15 MG D J1452 P INJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG D J1453 INJECTION, FOSAPREPITANT, 1 MG D
10 J s Last Updated January 2014 Term J1455 INJECTION, FOSCARNET SODIUM, PER 1000 MG D J1457 INJECTION, GALLIUM NITRATE, 1 MG C J1459 INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G. D J1460 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC D J1470 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC D J1480 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC D J1490 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC D J1500 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC D J1510 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC D J1520 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC D J1530 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC D J1556 A INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MG C J1599 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), NOTOTHERWISE SPECIFIED, 500 MG C J1540 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC D J1550 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC D J1557 INJECTION, IMMUNE GLOBULIN, (GAMMAPLEX), INTRAVENOUS, NON-LYOPHILIZED (E.G.LIQUID), 500 MG C J1559 INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG C J1560 INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC D J1561 Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e. G. Liquid), 500 mg D
11 J s Last Updated January 2014 Term J1562 INJECTION, IMMUNE GLOBULIN (VIVAGLOBIN), 100 MG C J1563 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G I J1564 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 10 MG I J1565 INJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG D J1566 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. POWDER), NOT OTHERWISE SPECIFIED, 500 MG D J1567 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG I J1568 J1569 INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILIZED, (E. G. LIQUID), 500 MG C D J1570 INJECTION, GANCICLOVIR SODIUM, 500 MG D J1571 INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUSCULAR, 0.5 ML D J1572 INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA/FLEBOGAMMA DIF)), INTRAVENOUS, NON- LYOPHILIZED (E.G. LIQUID), 500 MG D J1573 INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVENOUS, 0.5 ML C J1580 INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG D J1590 P INJECTION, GATIFLOXACIN, 10MG C J1595 INJECTION, GLATIRAMER ACETATE, 20 MG D J1600 INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG D J1602 A INJECTION, GOLIMUMAB, 1 MG, FOR INTRAVENOUS USE C J1610 INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG D
12 J s Last Updated January 2014 Term J1620 P INJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG D J1626 INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG D J1630 INJECTION, HALOPERIDOL, UP TO 5 MG D J1631 INJECTION, HALOPERIDOL DECANOATE, PER 50 MG D J1640 INJECTION, HEMIN, 1 MG D J1642 INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS D J1644 INJECTION, HEPARIN SODIUM, PER 1000 UNITS D J1645 INJECTION, DALTEPARIN SODIUM, PER 2500 IU D J1650 INJECTION, ENOXAPARIN SODIUM, 10 MG C J1652 INJECTION, FONDAPARINUX SODIUM, 0.5 MG D J1655 INJECTION, TINZAPARIN SODIUM, 1000 IU C J1670 INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS D J1675 INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS D J1700 INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG D J1710 INJECTION, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG D J1720 INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG D J1725 INJECTION, HYDROXYPROGESTERONE CAPROATE, 1 MG D J1730 P INJECTION, DIAZOXIDE, UP TO 300 MG D J1741 INJECTION, IBUPROFEN, 100MG D J1742 INJECTION, IBUTILIDE FUMARATE, 1 MG D
13 J s Last Updated January 2014 Term J1743 INJECTION, IDURSULFASE, 1 MG C J1744 INJECTION, ICATIBANT, 1MG C J1745 INJECTION INFLIXIMAB, 10 MG D J1750 INJECTION, IRON DEXTRAN, 50 MG D J1751 INJECTION, IRON DEXTRAN 165, 50 MG D J1752 INJECTION, IRON DEXTRAN 267, 50 MG D J1755 INJECTION, IRON SUCROSE, 20MG C J1756 INJECTION, IRON SUCROSE, 1 MG C J1785 INJECTION, IMIGLUCERASE, PER UNIT D J1790 INJECTION, DROPERIDOL, UP TO 5 MG D J1800 INJECTION, PROPRANOLOL HCL, UP TO 1 MG D J1810 INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE D J1815 INJECTION, INSULIN, PER 5 UNITS D J1817 INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS C J1820 INJECTION, INSULIN, UP TO 100 UNITS D J1825 INJECTION, INTERFERON BETA-1A, 33 MCG I J1830 INJECTION INTERFERON BETA-1B, 0.25 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) D J1835 INJECTION, ITRACONAZOLE, 50 MG C J1840 INJECTION, KANAMYCIN SULFATE, UP TO 500 MG D
14 J s Last Updated January 2014 Term J1850 INJECTION, KANAMYCIN SULFATE, UP TO 75 MG D J1885 INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG D J1890 INJECTION, CEPHALOTHIN SODIUM, UP TO 1 GRAM D J1910 INJECTION, KUTAPRESSIN, UP TO 2 ML D J1931 INJECTION, LARONIDASE, 0.1 MG C J1930 INJECTION, LANREOTIDE, 1 MG D J1940 INJECTION, FUROSEMIDE, UP TO 20 MG D J1945 INJECTION, LEPIRUDIN, 50 MG D J1950 INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG D J1953 INJECTION, LEVETIRACETAM, 10 MG D J1955 INJECTION, LEVOCARNITINE, PER 1 GM D J1956 INJECTION, LEVOFLOXACIN, 250 MG D J1960 INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG D J1980 INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG D J1990 INJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG D J2000 INJECTION, LIDOCAINE HCL, 50 CC D J2001 INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG D J2010 INJECTION, LINCOMYCIN HCL, UP TO 300 MG D J2020 INJECTION, LINEZOLID, 200MG C J2060 INJECTION, LORAZEPAM, 2 MG D
15 J s Last Updated January 2014 Term J2150 INJECTION, MANNITOL, 25% IN 50 ML D J2175 INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG D J2180 INJECTION, MEPERIDINE AND PROMETHAZINE HCL, UP TO 50 MG D J2185 INJECTION, MEROPENEM, 100 MG C J2210 INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG D J2212 INJECTION, METHYLNALTREXONE, 0.1 MG D J2250 INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG D J2260 INJECTION, MILRINONE LACTATE, 5 MG D J2265 INJECTION, MINOCYCLINE HYDROCHLORIDE, 1 MG D J2270 INJECTION, MORPHINE SULFATE, UP TO 10 MG D J2271 INJECTION, MORPHINE SULFATE, 100MG D J2275 INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG D J2278 INJECTION, ZICONOTIDE, 1 MICROGRAM D J2280 INJECTION, MOXIFLOXACIN, 100 MG C J2300 INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG D J2310 INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG D J2320 INJECTION, NANDROLONE DECANOATE, UP TO 50 MG D J2321 INJECTION, NANDROLONE DECANOATE, UP TO 100 MG D J2322 INJECTION, NANDROLONE DECANOATE, UP TO 200 MG D J2323 INJECTION, NATALIZUMAB, 1 MG C
16 J s Last Updated January 2014 Term J2324 INJECTION, NESIRITIDE, 0.25 MG D J2325 INJECTION, NESIRITIDE, 0.1 MG D J2352 INJECTION, OCTREOTIDE ACETATE, 1 MG D J2353 INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG C J2354 INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG C J2355 INJECTION, OPRELVEKIN, 5 MG D J2357 INJECTION, OMALIZUMAB, 5 MG C J2360 INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG D J2370 INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML D J2400 INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML D J2405 INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG D J2410 INJECTION, OXYMORPHONE HCL, UP TO 1 MG D J2425 INJECTION, PALIFERMIN, 50 MICROGRAMS C J2430 INJECTION, PAMIDRONATE DISODIUM, PER 30 MG D J2440 INJECTION, PAPAVERINE HCL, UP TO 60 MG D J2460 INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG D J2469 INJECTION, PALONOSETRON HCL, 25 MCG C J2501 INJECTION, PARICALCITOL, 1 MCG D J2503 INJECTION, PEGAPTANIB SODIUM, 0.3 MG C J2504 INJECTION, PEGADEMASE BOVINE, 25 IU D
17 J s Last Updated January 2014 Term J2505 INJECTION, PEGFILGRASTIM, 6 MG C J2507 INJECTION, PEGLOTICASE, 1 MG D J2510 INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS D J2513 INJECTION, PENTASTARCH, 10% SOLUTION, 100 ML D J2515 INJECTION, PENTOBARBITAL SODIUM, PER 50 MG D J2540 INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS D J2543 INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS) D J2545 PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 300 MG D J2550 INJECTION, PROMETHAZINE HCL, UP TO 50 MG D J2560 INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG D J2590 INJECTION, OXYTOCIN, UP TO 10 UNITS D J2597 INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG D J2650 INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML D J2670 INJECTION, TOLAZOLINE HCL, UP TO 25 MG D J2675 INJECTION, PROGESTERONE, PER 50 MG D J2680 INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG D J2690 INJECTION, PROCAINAMIDE HCL, UP TO 1 GM D J2700 P INJECTION, OXACILLIN SODIUM, UP TO 250 MG D J2710 INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG D J2720 INJECTION, PROTAMINE SULFATE, PER 10 MG D
18 J s Last Updated January 2014 Term J2724 INJECTION, PROTEIN C CONCENTRATE, INTRAVENOUS, HUMAN, 10 IU C J2725 P INJECTION, PROTIRELIN, PER 250 MCG D J2730 INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM D J2760 INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG D J2765 INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG D J2770 INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350) D J2778 INJECTION, RANIBIZUMAB, 0.1 MG C J2780 INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG D J2783 INJECTION, RASBURICASE, 0.5 MG C J2785 P INJECTION, REGADENOSON, 0.1 MG C J2788 P INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MICROGRAMS (250 I.U.) D J2790 P INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICROGRAMS (1500 I.U.) D J2791 INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVENOUS, 100 IU D J2792 INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU D J2794 INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG C J2795 INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG C J2800 INJECTION, METHOCARBAMOL, UP TO 10 ML D J2805 INJECTION, SINCALIDE, 5 MICROGRAMS C J2810 INJECTION, THEOPHYLLINE, PER 40 MG D J2820 INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG D
19 J s Last Updated January 2014 Term J2850 INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM D J2910 INJECTION, AUROTHIOGLUCOSE, UP TO 50 MG D J2912 INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML D J2916 INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG D J2920 INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG D J2930 INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG D J2940 INJECTION, SOMATREM, 1 MG D J2941 P INJECTION, SOMATROPIN, 1 MG D J2950 INJECTION, PROMAZINE HCL, UP TO 25 MG D J2993 INJECTION, RETEPLASE, 18.1 MG D J2995 INJECTION, STREPTOKINASE, PER 250,000 IU D J2997 INJECTION, ALTEPLASE RECOMBINANT, 1 MG D J3000 INJECTION, STREPTOMYCIN, UP TO 1 GM D J3010 INJECTION, FENTANYL CITRATE, 0.1 MG D J3030 INJECTION, SUMATRIPTAN SUCCINATE, 6 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) D J3060 A INJECTION, TALIGLUCERACE ALFA, 10 UNITS C J3070 INJECTION, PENTAZOCINE, 30 MG D J3100 INJECTION, TENECTEPLASE, 50MG C J3101 INJECTION, TENECTEPLASE, 1 MG D
20 J s Last Updated January 2014 Term J3105 INJECTION, TERBUTALINE SULFATE, UP TO 1 MG D J3110 INJECTION, TERIPARATIDE, 10 MCG D J3120 INJECTION, TESTOSTERONE ENANTHATE, UP TO 100 MG D J3130 INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG D J3140 INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG D J3150 INJECTION, TESTOSTERONE PROPIONATE, UP TO 100 MG D J3230 INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG D J3240 INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL D J3245 INJECTION, TIROFIBAN HYDROCHLORIDE, 12.5 MG D J3246 INJECTION, TIROFIBAN HCL, 0.25MG C J3250 INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG D J3260 INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG D J3265 INJECTION, TORSEMIDE, 10 MG/ML D J3280 INJECTION, THIETHYLPERAZINE MALEATE, UP TO 10 MG D J3285 INJECTION, TREPROSTINIL, 1 MG C J3300 INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE FREE, 1 MG D J3301 INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10MG D J3302 INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG D J3303 INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG D J3305 INJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG D
21 J s Last Updated January 2014 Term J3310 P INJECTION, PERPHENAZINE, UP TO 5 MG D J3315 INJECTION, TRIPTORELIN PAMOATE, 3.75 MG D J3320 INJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 GM D J3350 INJECTION, UREA, UP TO 40 GM D J3355 INJECTION, UROFOLLITROPIN, 75 IU D J3360 INJECTION, DIAZEPAM, UP TO 5 MG D J3364 INJECTION, UROKINASE, 5000 IU VIAL D J3365 INJECTION, IV, UROKINASE, 250,000 I.U. VIAL D J3370 INJECTION, VANCOMYCIN HCL, 500 MG D J3395 INJECTION, VERTEPORFIN, 15MG D J3396 INJECTION, VERTEPORFIN, 0.1 MG D J3400 INJECTION, TRIFLUPROMAZINE HCL, UP TO 20 MG D J3410 INJECTION, HYDROXYZINE HCL, UP TO 25 MG D J3411 INJECTION, THIAMINE HCL, 100 MG C J3415 INJECTION, PYRIDOXINE HCL, 100 MG C J3420 INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG D J3430 INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG D J3465 INJECTION, VORICONAZOLE, 10 MG D J3470 INJECTION, HYALURONIDASE, UP TO 150 UNITS D J3471 INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 USP UNIT (UP TO 999 USP UNITS) D
22 J s Last Updated January 2014 Term J3472 INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1000 USP UNITS D J3475 INJECTION, MAGNESIUM SULFATE, PER 500 MG D J3480 INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ D J3485 INJECTION, ZIDOVUDINE, 10 MG D J3486 INJECTION, ZIPRASIDONE MESYLATE, 10 MG C J3487 D INJECTION, ZOLEDRONIC ACID (ZOMETA), 1 MG I J3488 D INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG I J3489 A INJECTION, ZOLEDRONIC ACID, 1 MG C J3490 UNCLASSIFIED DRUGS D J3520 EDETATE DISODIUM, PER 150 MG M J3530 NASAL VACCINE INHALATION D J3535 DRUG ADMINISTERED THROUGH A METERED DOSE INHALER M J3570 LAETRILE, AMYGDALIN, VITAMIN B17 M J3590 UNCLASSIFIED BIOLOGICS C J7030 INFUSION, NORMAL SALINE SOLUTION, 1000 CC D J7040 INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) D J7042 5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT) D J7050 INFUSION, NORMAL SALINE SOLUTION, 250 CC D J7051 STERILE SALINE OR WATER, UP TO 5 CC D J7060 5% DEXTROSE/WATER (500 ML = 1 UNIT) D
23 J s Last Updated January 2014 Term J7070 INFUSION, D5W, 1000 CC D J7100 INFUSION, DEXTRAN 40, 500 ML D J7110 INFUSION, DEXTRAN 75, 500 ML D J7120 RINGERS LACTATE INFUSION, UP TO 1000 CC D J7130 HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL D J7131 HYPERTONIC SALINE SOLUTION, 1 ML D J7178 P INJECTION, HUMAN FIBRINOGEN CONCENTRATE,! MG C J7180 INJECTION, FACTOR XIII (ANTIHEMOPHILIC FACTOR, HUMAN), 1 I.U. D J7183 INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMAN), WILATE, 1 I.U. VWF:RCO D J7186 INJECTION, ANTIHEMOPHILIC FACTOR VIII/VON WILLEBRAND FACTOR COMPLEX (HUMAN), PER FACTOR VIII I.U. D J7187 INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMATE-P), PER IU VWF-RCO D J7188 INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU D J7189 FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICROGRAM D J7190 FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U. D J7191 FACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER I.U. D J7192 FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U. D J7193 FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U. D J7194 FACTOR IX, COMPLEX, PER I.U. D J7195 FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U. D J7197 ANTITHROMBIN III (HUMAN), PER I.U. D
24 J s Last Updated January 2014 Term J7198 ANTI-INHIBITOR, PER I.U. D J7199 HEMOPHILIA CLOTTING FACTOR, NOT OTHERWISE CLASSIFIED D J7300 INTRAUTERINE COPPER CONTRACEPTIVE S J7301 A LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM (SKYLA), 13.5 MG S J7302 LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG S J7303 CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH S J7304 CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH S J7306 LEVONORGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANTS AND SUPPLIES I J7307 ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANT AND SUPPLIES I J7308 AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE FORM (354 MG) C J7310 GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT D J7315 MITOMYCIN, OPTHALMIC, 0.2 MG D J7316 A INJECTION, OCRIPLASMIN, MG C J7317 SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION C J7318 HYALURONAN (SODIUM HYALURONATE) OR DERIVATIVE, INTRA-ARTICULAR INJECTION, 1 MG C J7320 HYLAN G-F 20, 16 MG, FOR INTRA ARTICULAR INJECTION C J7321 HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTICULAR INJECTION, PER DOSE C J7322 HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE C J7323 HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE C
25 J s Last Updated January 2014 Term J7324 HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE C J7326 HYALURONAN OR DERIVATIVE, GEL-ONE, FOR INTRA-ARTICULAR INJECTION, PER DOSE C J7330 AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT C J7340 DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT BIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER C J7341 DERMAL (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER C J7342 DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER C J7343 DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER C J7344 DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER C J7347 DERMAL (SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS (INTEGRA MATRIX), PER SQUARE CENTIMETER C J7348 DERMAL (SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS (TISSUEMEND), PER SQUARE CENTIMETER C J7349 DERMAL (SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS (PRIMATRIX), PER SQUARE CENTIMETER C J7350 DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, INJECTABLE, WITH OR WITHOUT OTHER BIOENGINEERED OR PROCESSED ELEMENTS, BUT WITHOUT METABOLIZED ACTIVE ELEMENTS, PER 10 MG C J7500 AZATHIOPRINE, ORAL, 50 MG D
26 J s Last Updated January 2014 Term J7501 AZATHIOPRINE, PARENTERAL, 100 MG D J7502 CYCLOSPORINE, ORAL, 100 MG D J7504 LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE, PARENTERAL, 250 MG D J7505 MUROMONAB-CD3, PARENTERAL, 5 MG D J7506 PREDNISONE, ORAL, PER 5MG D J7507 C TACROLIMUS, IMMEDIATE RELEASE, ORAL, 1 MG D J7508 A TACROLIMUS, EXTENDED RELEASE, ORAL, 0.1 MG D J7509 METHYLPREDNISOLONE ORAL, PER 4 MG D J7510 PREDNISOLONE ORAL, PER 5 MG D J7511 LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG C J7513 DACLIZUMAB, PARENTERAL, 25 MG D J7515 CYCLOSPORINE, ORAL, 25 MG C J7516 CYCLOSPORIN, PARENTERAL, 250 MG C J7517 MYCOPHENOLATE MOFETIL, ORAL, 250 MG C J7518 MYCOPHENOLIC ACID, ORAL, 180 MG D J7520 SIROLIMUS, ORAL, 1 MG D J7525 TACROLIMUS, PARENTERAL, 5 MG D J7527 P EVEROLIMUS, ORAL, 0.25 MG D J7599 IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED D
27 J s Last Updated January 2014 Term J7602 ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) D J7603 ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) D J7604 J7605 J7606 J7607 J7608 J7609 J7610 J7611 J7612 J7613 J7614 ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAM ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS FORMOTEROL FUMARATE, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT,NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 20 MICROGRAMS LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAM ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1 MG ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1 MG LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG C C D C D C C I I I I
28 J s Last Updated January 2014 Term J7615 J7616 J7617 LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG ALBUTEROL, UP TO 5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME LEVALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME C D D J7618 ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) D J7619 ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL) D J7620 ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME D J7621 ALBUTEROL, ALL FORMULATIONS, INCLUDING SEPARATED ISOMERS, UP TO 5 MG (ALBUTEROL) OR 2.5 MG (LEVOALBUTEROL), AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION, ADMINISTERED THROUGH DME C J7622 J7624 J7626 J7627 J7628 J7629 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG BITOLTEROL MESYLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM BITOLTEROL MESYLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM C C C C D D
29 J s Last Updated January 2014 Term J7631 J7632 J7633 J7634 J7635 J7636 J7637 J7638 J7639 J7640 J7641 J7642 J7643 J7644 CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 0.25 MILLIGRAM BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 0.25 MILLIGRAM ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM DORNASE ALPHA, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, 12 MICROGRAMS FLUNISOLIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, PER MILLIGRAM GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM D C C C D D D D D I C D D D
30 J s Last Updated January 2014 Term J7645 J7647 J7648 J7649 J7650 J7657 J7658 J7659 J7660 IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM ISOETHARINE HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM ISOETHARINE HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM C C D D C C D D C J7665 MANNITOL, ADMINISTERED THROUGH AN INHALER, 5 MG D J7667 J7668 J7669 J7670 METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, CONCENTRATED FORM, PER 10 MILLIGRAMS METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 10 MILLIGRAMS METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS C D D C
31 J s Last Updated January 2014 Term J7674 J7676 J7680 J7681 J7682 J7683 J7684 J7685 J7686 METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION THROUGH A NEBULIZER, PER 1 MG PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 300 MG TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNIT DOSE FORM, ADMINISTERED THROUGH DME, PER 300 MILLIGRAMS TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, FORM, PER MILLIGRAM TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, FORM, PER MILLIGRAM TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 300 MILLIGRAMS TREPROSTINIL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON- COMPOUNDEDADMINISTERED THROUGH DME, UNIT DOSE FORM, 1.74 MG C C D D D D D C C J7699 NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME D J7799 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME D J8498 ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED D J8499 PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS M J8501 APREPITANT, ORAL, 5 MG D J8510 P BUSULFAN; ORAL, 2 MG D J8515 CABERGOLINE, ORAL, 0.25 MG M
32 J s Last Updated January 2014 Term J8520 CAPECITABINE, ORAL, 150 MG D J8521 CAPECITABINE, ORAL, 500 MG D J8530 CYCLOPHOSPHAMIDE; ORAL, 25 MG D J8540 DEXAMETHASONE, ORAL, 0.25 MG D J8560 ETOPOSIDE; ORAL, 50 MG D J8561 EVEROLIMUS, ORAL, 0.25 MG D J8562 P FLUDARABINE PHOSPHATE, ORAL, 10 MG C J8565 GEFITINIB, ORAL, 250 MG I J8597 ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED D J8600 MELPHALAN; ORAL, 2 MG D J8610 METHOTREXATE; ORAL, 2.5 MG D J8650 NABILONE, ORAL, 1MG C J8700 TEMOZOLOMIDE, ORAL, 5 MG D J8705 TOPOTECAN, ORAL, 0.25 MG D J8999 PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS D J9000 INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG D J9001 INJECTION, DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG D J9002 D INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL, DOXIL, 10 MG D J9010 INJECTION, ALEMTUZUMAB, 10 MG D J9015 INJECTION, ALDESLEUKIN, PER SINGLE USE VIAL D
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