HCPCS J Codes
HCPCS J CODES
Last Updated January 2008
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J0120
INJECTION, TETRACYCLINE, UP TO 250 MG
D
19860101
19970101
J0128
INJECTION, ABARELIX, 10 MG
C
20050101
20050101
J0130
INJECTION ABCIXIMAB, 10 MG
D
19990101
19990101
J0132
INJECTION, ACETYLCYSTEINE, 100 MG
C
20060101
20060101
J0133
INJECTION, ACYCLOVIR, 5 MG
C
20060101
20060101
J0135
INJECTION, ADALIMUMAB, 20 MG
C
20050101
20050101
INJECTION, ADENOSINE FOR THERAPEUTIC USE, 6 MG (NOT TO BE USED TO REPORT ANY ADENOSINE
J0150
D
19940101
20050101
PHOSPHATE COMPOUNDS, INSTEAD USE A9270)
INJECTION, ADENOSINE, 90 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS,
J0151
D
D
19990101
20040101
20031231
INSTEAD USE A9270)
INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY ADENOSINE
J0152
C
20040101
20050101
PHOSPHATE COMPOUNDS, INSTEAD USE A9270)
J0170
INJECTION, ADRENALIN, EPINEPHRINE, UP TO 1 ML AMPULE
D
19860101
19970101
J0180
INJECTION, AGALSIDASE BETA, 1 MG
C
20050101
20050101
J0190
INJECTION, BIPERIDEN LACTATE, PER 5 MG
D
19820101
19970101
J0200
INJECTION, ALATROFLOXACIN MESYLATE, 100 MG
D
20000101
20000101
J0205
INJECTION, ALGLUCERASE, PER 10 UNITS
D
19930101
19970101
J0207
INJECTION, AMIFOSTINE, 500 MG
D
19980101
19980101
J0210
INJECTION, METHYLDOPATE HCL, UP TO 250 MG
D
19840101
19970101
J0215
INJECTION, ALEFACEPT, 0.5 MG
C
20040101
20040101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J0220
A
INJECTION, AGLUCOSIDASE ALFA, 10 MG
C
20080101
20080101
J0256
INJECTION, ALPHA 1 - PROTEINASE INHIBITOR - HUMAN, 10 MG
D
19890101
19990101
INJECTION, ALPROSTADIL, 1.25 MCG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER
J0270
D
19970101
20000101
THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)
ALPROSTADIL URETHRAL SUPPOSITORY (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED
J0275
D
19990101
20000101
UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)
J0278
INJECTION, AMIKACIN SULFATE, 100 MG
C
20060101
20060101
J0280
INJECTION, AMINOPHYLLIN, UP TO 250 MG
D
19840101
19970101
J0282
INJECTION, AMIODARONE HYDROCHLORIDE, 30 MG
D
20010101
20010101
J0285
INJECTION, AMPHOTERICIN B, 50 MG
D
19990101
19990101
J0287
INJECTION, AMPHOTERICIN B LIPID COMPLEX, 10 MG
D
20030101
20030101
J0288
INJECTION, AMPHOTERICIN B CHOLESTERYL SULFATE COMPLEX, 10 MG
D
20030101
20030101
J0289
INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG
D
20030101
20030101
J0290
INJECTION, AMPICILLIN SODIUM, 500 MG
D
19840101
20000101
J0295
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER 1.5 GM
D
19950101
19970101
J0300
INJECTION, AMOBARBITAL, UP TO 125 MG
D
19820101
19970101
J0330
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
D
19860101
19970101
J0350
INJECTION, ANISTREPLASE, PER 30 UNITS
D
19860101
19970101
J0360
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
D
19860101
19970101
J0365
INJECTION, APROTONIN, 10,000 KIU
D
20060101
20060101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J0380
INJECTION, METARAMINOL BITARTRATE, PER 10 MG
D
19820101
19970101
J0390
INJECTION, CHLOROQUINE HYDROCHLORIDE, UP TO 250 MG
D
19860101
19970101
J0395
INJECTION, ARBUTAMINE HCL, 1 MG
D
19990101
19990101
J0400
A
INJECTION, ARIPIPRAZOLE, INTRAMUSCULAR, 0.25 MG
C
20080101
20080101
J0456
INJECTION, AZITHROMYCIN, 500 MG
D
20000101
20000101
J0460
INJECTION, ATROPINE SULFATE, UP TO 0.3 MG
D
19820101
19970101
J0470
INJECTION, DIMERCAPROL, PER 100 MG
D
19820101
19970101
J0475
INJECTION, BACLOFEN, 10 MG
D
19940101
19970101
J0476
INJECTION, BACLOFEN, 50 MCG FOR INTRATHECAL TRIAL
D
19990101
19990101
J0480
INJECTION, BASILIXIMAB, 20 MG
D
20060101
20060101
J0500
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
D
19860101
19970101
J0515
INJECTION, BENZTROPINE MESYLATE, PER 1 MG
D
19820101
19970101
J0520
INJECTION, BETHANECHOL CHLORIDE, MYOTONACHOL OR URECHOLINE, UP TO 5 MG
D
19840101
19970101
J0530
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 600,000 UNITS
D
19820101
19970101
J0540
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 1,200,000 UNITS
D
19820101
19970101
J0550
INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, UP TO 2,400,000 UNITS
D
19820101
19970101
J0560
INJECTION, PENICILLIN G BENZATHINE, UP TO 600,000 UNITS
D
19820101
19970101
J0570
INJECTION, PENICILLIN G BENZATHINE, UP TO 1,200,000 UNITS
D
19820101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J0580
INJECTION, PENICILLIN G BENZATHINE, UP TO 2,400,000 UNITS
D
19820101
19970101
J0583
INJECTION, BIVALIRUDIN, 1 MG
C
20040101
20040101
J0585
BOTULINUM TOXIN TYPE A, PER UNIT
D
19910101
19970101
J0587
BOTULINUM TOXIN TYPE B, PER 100 UNITS
D
20020101
20020101
J0592
INJECTION, BUPRENORPHINE HYDROCHLORIDE, 0.1 MG
D
20030101
20030101
J0595
INJECTION, BUTORPHANOL TARTRATE, 1 MG
C
20040101
20040101
J0600
INJECTION, EDETATE CALCIUM DISODIUM, UP TO 1000 MG
D
19820101
19970101
J0610
INJECTION, CALCIUM GLUCONATE, PER 10 ML
D
19820101
19970101
J0620
INJECTION, CALCIUM GLYCEROPHOSPHATE AND CALCIUM LACTATE, PER 10 ML
D
19820101
19970101
J0630
INJECTION, CALCITONIN SALMON, UP TO 400 UNITS
D
19820101
19970101
J0636
INJECTION, CALCITRIOL, 0.1 MCG
D
20030101
20030101
J0637
INJECTION, CASPOFUNGIN ACETATE, 5 MG
C
20030101
20030101
J0640
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
D
19820101
19970101
J0670
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
D
19860101
19970101
J0690
INJECTION, CEFAZOLIN SODIUM, 500 MG
D
19820101
20000101
J0692
INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG
C
20020101
20020101
J0694
INJECTION, CEFOXITIN SODIUM, 1 GM
D
19920101
19970101
J0696
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
D
19900101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J0697
INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG
D
19900101
19970101
J0698
INJECTION, CEFOTAXIME SODIUM, PER GM
D
19910101
19970101
J0702
C
INJECTION, BETAMETHASONE ACETATE 3MG AND BETAMETHASONE SODIUM PHOSPHATE 3MG
D
19950101
20080101
J0704
INJECTION, BETAMETHASONE SODIUM PHOSPHATE, PER 4 MG
D
19950101
19970101
J0706
INJECTION, CAFFEINE CITRATE, 5MG
C
20020101
20020101
J0710
INJECTION, CEPHAPIRIN SODIUM, UP TO 1 GM
D
19820101
19970101
J0713
INJECTION, CEFTAZIDIME, PER 500 MG
D
19960101
19970101
J0715
INJECTION, CEFTIZOXIME SODIUM, PER 500 MG
D
19950101
19970101
J0720
INJECTION, CHLORAMPHENICOL SODIUM SUCCINATE, UP TO 1 GM
D
19820101
19970101
J0725
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
D
19860101
19970101
J0735
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
D
19980101
19980101
J0740
INJECTION, CIDOFOVIR, 375 MG
D
19980101
19980101
J0743
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
D
19930101
19970101
J0744
INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG
C
20020101
20020101
J0745
INJECTION, CODEINE PHOSPHATE, PER 30 MG
D
19860101
19970101
J0760
INJECTION, COLCHICINE, PER 1MG
D
19820101
19970101
J0770
INJECTION, COLISTIMETHATE SODIUM, UP TO 150 MG
D
19820101
19970101
J0780
INJECTION, PROCHLORPERAZINE, UP TO 10 MG
D
19840101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J0795
A
INJECTION, CORTICORELIN OVINE TRIFLUTATE, 1 MICROGRAM
D
20060101
20060101
J0800
INJECTION, CORTICOTROPIN, UP TO 40 UNITS
D
19820101
19970101
J0835
INJECTION, COSYNTROPIN, PER 0.25 MG
D
19950101
19970101
J0850
INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS (HUMAN), PER VIAL
D
19820101
19970101
J0878
INJECTION, DAPTOMYCIN, 1 MG
C
20050101
20050101
J0880
D
INJECTION, DARBEPOETIN ALFA, 5 MCG
C
20030101
20060101
20051231
J0881
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
D
20060101
20060101
J0882
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)
D
20060101
20060101
J0885
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
D
20060101
20060101
J0886
INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)
D
20060101
20060101
J0894
A
INJECTION, DECITABINE, 1 MG
C
20070101
20070101
J0895
INJECTION, DEFEROXAMINE MESYLATE, 500 MG
D
19920101
20010101
J0900
INJECTION, TESTOSTERONE ENANTHATE AND ESTRADIOL VALERATE, UP TO 1 CC
D
19820101
19970101
J0945
INJECTION, BROMPHENIRAMINE MALEATE, PER 10 MG
D
19820101
19970101
J0970
INJECTION, ESTRADIOL VALERATE, UP TO 40 MG
D
19820101
19970101
J1000
INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG
D
19820101
19970101
J1020
INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
D
19820101
19970101
J1030
INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG
D
19820101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1040
INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
D
19820101
19970101
J1051
INJECTION, MEDROXYPROGESTERONE ACETATE, 50 MG
D
20030101
20030101
J1055
INJECTION, MEDROXYPROGESTERONE ACETATE FOR CONTRACEPTIVE USE, 150 MG
S
19940101
19970101
J1056
INJECTION, MEDROXYPROGESTERONE ACETATE / ESTRADIOL CYPIONATE, 5MG / 25MG
C
20020101
20030101
J1060
INJECTION, TESTOSTERONE CYPIONATE AND ESTRADIOL CYPIONATE, UP TO 1 ML
D
19820101
19970101
J1070
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
D
19820101
19970101
J1080
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
D
19820101
19970101
J1094
INJECTION, DEXAMETHASONE ACETATE, 1 MG
D
20030101
20030101
J1100
INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
D
19820101
20010101
J1110
INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG
D
19820101
19970101
J1120
INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG
D
19820101
19970101
J1160
INJECTION, DIGOXIN, UP TO 0.5 MG
D
19820101
19970101
J1162
INJECTION, DIGOXIN IMMUNE FAB (OVINE), PER VIAL
D
20060101
20060101
J1165
INJECTION, PHENYTOIN SODIUM, PER 50 MG
D
19820101
19970101
J1170
INJECTION, HYDROMORPHONE, UP TO 4 MG
D
19820101
19970101
J1180
INJECTION, DYPHYLLINE, UP TO 500 MG
D
19820101
19970101
J1190
INJECTION, DEXRAZOXANE HYDROCHLORIDE, PER 250 MG
D
19970101
19970101
J1200
INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG
D
19820101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1205
INJECTION, CHLOROTHIAZIDE SODIUM, PER 500 MG
D
19820101
19970101
J1212
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
D
19860101
19970101
J1230
INJECTION, METHADONE HCL, UP TO 10 MG
D
19820101
19970101
J1240
INJECTION, DIMENHYDRINATE, UP TO 50 MG
D
19840101
19970101
J1245
INJECTION, DIPYRIDAMOLE, PER 10 MG
D
19930101
19980101
J1250
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
D
19960101
19970101
J1260
INJECTION, DOLASETRON MESYLATE, 10 MG
D
19990101
20000101
J1265
INJECTION, DOPAMINE HCL, 40 MG
C
20060101
20060101
J1270
INJECTION, DOXERCALCIFEROL, 1 MCG
C
20020101
20020101
J1300
A
INJECTION, ECULIZUMAB, 10 MG
C
20080101
20080101
J1320
INJECTION, AMITRIPTYLINE HCL, UP TO 20 MG
D
19820101
19970101
J1325
INJECTION, EPOPROSTENOL, 0.5 MG
D
19980101
19980101
J1327
INJECTION, EPTIFIBATIDE, 5 MG
D
20000101
20000101
J1330
INJECTION, ERGONOVINE MALEATE, UP TO 0.2 MG
D
19860101
19970101
J1335
INJECTION, ERTAPENEM SODIUM, 500 MG
C
20040101
20040101
J1364
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
D
19950101
19970101
J1380
INJECTION, ESTRADIOL VALERATE, UP TO 10 MG
D
19820101
19970101
J1390
INJECTION, ESTRADIOL VALERATE, UP TO 20 MG
D
19820101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1410
INJECTION, ESTROGEN CONJUGATED, PER 25 MG
D
19820101
19970101
J1430
INJECTION, ETHANOLAMINE OLEATE, 100 MG
D
20060101
20060101
J1435
INJECTION, ESTRONE, PER 1 MG
D
19820101
19970101
J1436
INJECTION, ETIDRONATE DISODIUM, PER 300 MG
D
19900101
19970101
INJECTION, ETANERCEPT, 25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE
J1438
D
20000101
20000101
DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)
J1440
INJECTION, FILGRASTIM (G-CSF), 300 MCG
D
19940101
19970101
J1441
INJECTION, FILGRASTIM (G-CSF), 480 MCG
D
19940101
19970101
J1450
INJECTION FLUCONAZOLE, 200 MG
D
20000101
20000101
J1451
INJECTION, FOMEPIZOLE, 15 MG
D
20060101
20060101
J1452
INJECTION, FOMIVIRSEN SODIUM, INTRAOCULAR, 1.65 MG
D
20010101
20010101
J1455
INJECTION, FOSCARNET SODIUM, PER 1000 MG
D
19930101
19970101
J1457
INJECTION, GALLIUM NITRATE, 1 MG
C
20050101
20050101
J1460
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 1 CC
D
19840101
19970101
J1470
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 2 CC
D
19840101
19970101
J1480
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 3 CC
D
19850101
19970101
J1490
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 4 CC
D
19840101
19970101
J1500
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 5 CC
D
19840101
19970101
J1510
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 6 CC
D
19840101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1520
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 7 CC
D
19840101
19970101
J1530
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 8 CC
D
19840101
19970101
J1540
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 9 CC
D
19840101
19970101
J1550
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, 10 CC
D
19840101
19970101
J1560
INJECTION, GAMMA GLOBULIN, INTRAMUSCULAR, OVER 10 CC
D
19840101
19970101
J1561
A
INJECTION, IMMUNE GLOBULIN, (GAMUNEX), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
D
20080101
20080101
J1562
C
INJECTION, IMMUNE GLOBULIN (VIVAGLOBIN), 100 MG
C
20070101
20080101
J1563
D
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G
I
20010101
20060101
20051231
J1564
D
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 10 MG
I
20030101
20060101
20051231
J1565
INJECTION, RESPIRATORY SYNCYTIAL VIRUS IMMUNE GLOBULIN, INTRAVENOUS, 50 MG
D
19980101
19980101
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G. POWDER), NOT OTHERWISE SPECIFIED, 500
J1566
C
D
20060101
20080101
MG
J1567
D
INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
I
20060101
20080101
20071231
J1568
A
INJECTION, IMMUNE GLOBULIN, (OCTAGAM), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
C
20080101
20080101
INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), INTRAVENOUS, NON-LYOPHILIZED, (E.G.LIQUID), 500
J1569
A
D
20080101
20080101
MG
J1570
INJECTION, GANCICLOVIR SODIUM, 500 MG
D
19940101
19970101
J1571
A
INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAMUSCULAR, 0.5 ML
D
20080101
20080101
J1572
A
INJECTION, IMMUNE GLOBULIN, (FLEBOGAMMA), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG
D
20080101
20080101
J1573
A
INJECTION, HEPATITIS B IMMUNE GLOBULIN (HEPAGAM B), INTRAVENOUS, 0.5 ML
C
20080101
20080101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1580
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
D
19840101
19970101
J1590
INJECTION, GATIFLOXACIN, 10MG
C
20020101
20020101
J1595
INJECTION, GLATIRAMER ACETATE, 20 MG
D
20040101
20040101
J1600
INJECTION, GOLD SODIUM THIOMALATE, UP TO 50 MG
D
19820101
19970101
J1610
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
D
19860101
19970101
J1620
INJECTION, GONADORELIN HYDROCHLORIDE, PER 100 MCG
D
19820101
19970101
J1626
INJECTION, GRANISETRON HYDROCHLORIDE, 100 MCG
D
19980101
19980101
J1630
INJECTION, HALOPERIDOL, UP TO 5 MG
D
19860101
19970101
J1631
INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
D
19890101
19970101
J1640
INJECTION, HEMIN, 1 MG
D
20060101
20060101
J1642
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
D
19950101
19970101
J1644
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
D
19950101
20030101
J1645
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
D
19970101
20020701
J1650
INJECTION, ENOXAPARIN SODIUM, 10 MG
C
19960101
20040101
J1652
INJECTION, FONDAPARINUX SODIUM, 0.5 MG
D
20030101
20030101
J1655
INJECTION, TINZAPARIN SODIUM, 1000 IU
C
20020101
20020701
J1670
INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS
D
19860101
19970101
J1675
INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS
D
20060101
20060101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1700
INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG
D
19820101
19970101
J1710
INJECTION, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG
D
19820101
19970101
J1720
INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
D
19820101
19970101
J1730
INJECTION, DIAZOXIDE, UP TO 300 MG
D
19820101
19970101
J1742
INJECTION, IBUTILIDE FUMARATE, 1 MG
D
19980101
19980101
J1743
A
INJECTION, IDURSULFASE, 1 MG
C
20080101
20080101
J1745
INJECTION INFLIXIMAB, 10 MG
D
20000101
20000101
J1750
D
INJECTION, IRON DEXTRAN, 50 MG
D
20000101
20060101
20051231
J1751
INJECTION, IRON DEXTRAN 165, 50 MG
D
20060101
20060101
J1752
INJECTION, IRON DEXTRAN 267, 50 MG
D
20060101
20060101
J1755
D
INJECTION, IRON SUCROSE, 20MG
C
20020101
20030101
20021231
J1756
INJECTION, IRON SUCROSE, 1 MG
C
20030101
20030101
J1785
INJECTION, IMIGLUCERASE, PER UNIT
D
19950101
19970101
J1790
INJECTION, DROPERIDOL, UP TO 5 MG
D
19820101
19970101
J1800
INJECTION, PROPRANOLOL HCL, UP TO 1 MG
D
19820101
19970101
J1810
INJECTION, DROPERIDOL AND FENTANYL CITRATE, UP TO 2 ML AMPULE
D
19820101
19970101
J1815
INJECTION, INSULIN, PER 5 UNITS
D
20030101
20030101
J1817
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS
C
20030101
20030101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J1820
D
INJECTION, INSULIN, UP TO 100 UNITS
D
19860101
20030101
20021231
J1825
INJECTION, INTERFERON BETA-1A, 33 MCG
I
19980101
20030101
INJECTION INTERFERON BETA-1B, 0.25 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED
J1830
D
19820101
20000101
UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)
J1835
INJECTION, ITRACONAZOLE, 50 MG
C
20020101
20020101
J1840
INJECTION, KANAMYCIN SULFATE, UP TO 500 MG
D
19820101
19970101
J1850
INJECTION, KANAMYCIN SULFATE, UP TO 75 MG
D
19820101
19970101
J1885
INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
D
19930101
19970101
J1890
INJECTION, CEPHALOTHIN SODIUM, UP TO 1 GRAM
D
19820101
19970101
J1910
INJECTION, KUTAPRESSIN, UP TO 2 ML
D
19860101
20040101
20031231
J1931
INJECTION, LARONIDASE, 0.1 MG
C
20050101
20050101
J1940
INJECTION, FUROSEMIDE, UP TO 20 MG
D
19820101
19970101
J1945
INJECTION, LEPIRUDIN, 50 MG
D
20060101
20060101
J1950
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG
D
19860101
19970101
J1955
INJECTION, LEVOCARNITINE, PER 1 GM
D
19960101
19970101
J1956
INJECTION, LEVOFLOXACIN, 250 MG
D
19990101
19990101
J1960
INJECTION, LEVORPHANOL TARTRATE, UP TO 2 MG
D
19820101
19970101
J1980
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
D
19820101
19970101
J1990
INJECTION, CHLORDIAZEPOXIDE HCL, UP TO 100 MG
D
19820101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J2000
D
INJECTION, LIDOCAINE HCL, 50 CC
D
19860101
20040101
20031231
J2001
INJECTION, LIDOCAINE HCL FOR INTRAVENOUS INFUSION, 10 MG
D
20040101
20040101
J2010
INJECTION, LINCOMYCIN HCL, UP TO 300 MG
D
19820101
19970101
J2020
INJECTION, LINEZOLID, 200MG
C
20020101
20020101
J2060
INJECTION, LORAZEPAM, 2 MG
D
19820101
19970101
J2150
INJECTION, MANNITOL, 25% IN 50 ML
D
19860101
19970101
J2175
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
D
19860101
19970101
J2180
INJECTION, MEPERIDINE AND PROMETHAZINE HCL, UP TO 50 MG
D
19820101
19970101
J2185
INJECTION, MEROPENEM, 100 MG
C
20040101
20040101
J2210
INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG
D
19820101
19970101
J2250
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
D
19960101
19970101
J2260
INJECTION, MILRINONE LACTATE, 5 MG
D
19860101
20010101
J2270
INJECTION, MORPHINE SULFATE, UP TO 10 MG
D
19820101
19970101
J2271
INJECTION, MORPHINE SULFATE, 100MG
D
19990101
20010101
J2275
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG
D
19930101
20010101
J2278
INJECTION, ZICONOTIDE, 1 MICROGRAM
D
20060101
20060101
J2280
INJECTION, MOXIFLOXACIN, 100 MG
C
20040101
20040101
J2300
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
D
19960101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J2310
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
D
19960101
19970101
J2320
INJECTION, NANDROLONE DECANOATE, UP TO 50 MG
D
19860101
19970101
J2321
INJECTION, NANDROLONE DECANOATE, UP TO 100 MG
D
19870101
19970101
J2322
INJECTION, NANDROLONE DECANOATE, UP TO 200 MG
D
19870101
19970101
J2323
A
INJECTION, NATALIZUMAB, 1 MG
C
20080101
20080101
J2324
D
INJECTION, NESIRITIDE, 0.25 MG
D
20030101
20060101
20051231
J2325
INJECTION, NESIRITIDE, 0.1 MG
D
20060101
20060101
J2352
D
INJECTION, OCTREOTIDE ACETATE, 1 MG
D
20000101
20040101
20031231
J2353
INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG
C
20040101
20040101
J2354
INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG
C
20040101
20040101
J2355
INJECTION, OPRELVEKIN, 5 MG
D
19990101
19990101
J2357
INJECTION, OMALIZUMAB, 5 MG
C
20050101
20050101
J2360
INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG
D
19820101
19970101
J2370
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
D
19820101
19970101
J2400
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML
D
19860101
19970101
J2405
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
D
19930101
19970101
J2410
INJECTION, OXYMORPHONE HCL, UP TO 1 MG
D
19820101
19970101
J2425
INJECTION, PALIFERMIN, 50 MICROGRAMS
C
20060101
20060101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J2430
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
D
19820101
19970101
J2440
INJECTION, PAPAVERINE HCL, UP TO 60 MG
D
19860101
19970101
J2460
INJECTION, OXYTETRACYCLINE HCL, UP TO 50 MG
D
19820101
19970101
J2469
INJECTION, PALONOSETRON HCL, 25 MCG
C
20050101
20050101
J2501
INJECTION, PARICALCITOL, 1 MCG
D
20030101
20030101
J2503
INJECTION, PEGAPTANIB SODIUM, 0.3 MG
C
20060101
20060101
J2504
INJECTION, PEGADEMASE BOVINE, 25 IU
D
20060101
20060101
J2505
INJECTION, PEGFILGRASTIM, 6 MG
C
20040101
20040101
J2510
INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS
D
19820101
19970101
J2513
INJECTION, PENTASTARCH, 10% SOLUTION, 100 ML
D
20060101
20060101
J2515
INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
D
19820101
19970101
J2540
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
D
19820101
19970101
J2543
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS)
D
20000101
20010101
PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J2545
C
D
19920101
20080101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 300 MG
J2550
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
D
19820101
19970101
J2560
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
D
19820101
19970101
J2590
INJECTION, OXYTOCIN, UP TO 10 UNITS
D
19860101
19970101
J2597
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
D
19960101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J2650
INJECTION, PREDNISOLONE ACETATE, UP TO 1 ML
D
19820101
19970101
J2670
INJECTION, TOLAZOLINE HCL, UP TO 25 MG
D
19860101
19970101
J2675
INJECTION, PROGESTERONE, PER 50 MG
D
19860101
20020701
J2680
INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG
D
19820101
19970101
J2690
INJECTION, PROCAINAMIDE HCL, UP TO 1 GM
D
19820101
19970101
J2700
INJECTION, OXACILLIN SODIUM, UP TO 250 MG
D
19820101
19970101
J2710
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
D
19820101
19970101
J2720
INJECTION, PROTAMINE SULFATE, PER 10 MG
D
19820101
19970101
J2724
A
INJECTION, PROTEIN C CONCENTRATE, INTRAVENOUS, HUMAN, 10 IU
C
20080101
20080101
J2725
INJECTION, PROTIRELIN, PER 250 MCG
D
19950101
19970101
J2730
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
D
19860101
19970101
J2760
INJECTION, PHENTOLAMINE MESYLATE, UP TO 5 MG
D
19820101
19970101
J2765
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
D
19820101
19970101
J2770
INJECTION, QUINUPRISTIN/DALFOPRISTIN, 500 MG (150/350)
D
20010101
20010101
J2778
A
INJECTION, RANIBIZUMAB, 0.1 MG
C
20080101
20080101
J2780
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
D
20000101
20000101
J2783
INJECTION, RASBURICASE, 0.5 MG
C
20040101
20040101
J2788
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE, 50 MCG
D
20030101
20030101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J2790
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MCG
D
19860101
20030101
J2791
A
INJECTION, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC), INTRAMUSCULAR OR INTRAVENOUS, 100 IU
D
20080101
20080101
J2792
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN, SOLVENT DETERGENT, 100 IU
D
19990101
19990101
J2794
INJECTION, RISPERIDONE, LONG ACTING, 0.5 MG
C
20050101
20050101
J2795
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
C
20010101
20010101
J2800
INJECTION, METHOCARBAMOL, UP TO 10 ML
D
19820101
19970101
J2805
INJECTION, SINCALIDE, 5 MICROGRAMS
C
20060101
20060101
J2810
INJECTION, THEOPHYLLINE, PER 40 MG
D
19820101
19970101
J2820
INJECTION, SARGRAMOSTIM (GM-CSF), 50 MCG
D
19820101
19980101
J2850
INJECTION, SECRETIN, SYNTHETIC, HUMAN, 1 MICROGRAM
D
20060101
20060101
J2910
INJECTION, AUROTHIOGLUCOSE, UP TO 50 MG
D
19820101
19970101
J2912
D
INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
D
19860101
20070101
20061231
J2916
INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG
D
20030101
20030101
J2920
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG
D
19820101
19970101
J2930
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG
D
19840101
19970101
J2940
INJECTION, SOMATREM, 1 MG
D
20020101
20020101
J2941
INJECTION, SOMATROPIN, 1 MG
D
20020101
20020101
J2950
INJECTION, PROMAZINE HCL, UP TO 25 MG
D
19820101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J2993
INJECTION, RETEPLASE, 18.1 MG
D
20010101
20010101
J2995
INJECTION, STREPTOKINASE, PER 250,000 IU
D
19860101
19970101
J2997
INJECTION, ALTEPLASE RECOMBINANT, 1 MG
D
20010101
20010101
J3000
INJECTION, STREPTOMYCIN, UP TO 1 GM
D
19820101
19970101
J3010
INJECTION, FENTANYL CITRATE, 0.1 MG
D
19820101
20010101
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED
J3030
D
19860101
20000101
UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED)
J3070
INJECTION, PENTAZOCINE, 30 MG
D
19820101
20030101
J3100
INJECTION, TENECTEPLASE, 50MG
C
20020101
20020101
J3105
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG
D
19870101
19970101
J3110
INJECTION, TERIPARATIDE, 10 MCG
D
20050101
20050101
J3120
INJECTION, TESTOSTERONE ENANTHATE, UP TO 100 MG
D
19820101
19970101
J3130
INJECTION, TESTOSTERONE ENANTHATE, UP TO 200 MG
D
19820101
19970101
J3140
INJECTION, TESTOSTERONE SUSPENSION, UP TO 50 MG
D
19820101
19970101
J3150
INJECTION, TESTOSTERONE PROPIONATE, UP TO 100 MG
D
19820101
19970101
J3230
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
D
19820101
19970101
J3240
INJECTION, THYROTROPIN ALPHA, 0.9 MG, PROVIDED IN 1.1 MG VIAL
D
19860101
20030101
J3245
D
INJECTION, TIROFIBAN HYDROCHLORIDE, 12.5 MG
D
20000101
20050101
20041231
J3246
INJECTION, TIROFIBAN HCL, 0.25MG
C
20050101
20050101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J3250
INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG
D
19820101
19970101
J3260
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
D
19820101
19970101
J3265
INJECTION, TORSEMIDE, 10 MG/ML
D
19960101
19970101
J3280
INJECTION, THIETHYLPERAZINE MALEATE, UP TO 10 MG
D
19820101
19970101
J3285
INJECTION, TREPROSTINIL, 1 MG
C
20060101
20060101
J3301
INJECTION, TRIAMCINOLONE ACETONIDE, PER 10MG
D
19910101
19970101
J3302
INJECTION, TRIAMCINOLONE DIACETATE, PER 5MG
D
19910101
19970101
J3303
INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5MG
D
19910101
19970101
J3305
INJECTION, TRIMETREXATE GLUCURONATE, PER 25 MG
D
19960101
19970101
J3310
INJECTION, PERPHENAZINE, UP TO 5 MG
D
19820101
19970101
J3315
INJECTION, TRIPTORELIN PAMOATE, 3.75 MG
D
20030101
20030101
J3320
INJECTION, SPECTINOMYCIN DIHYDROCHLORIDE, UP TO 2 GM
D
19820101
19970101
J3350
INJECTION, UREA, UP TO 40 GM
D
19860101
19970101
J3355
INJECTION, UROFOLLITROPIN, 75 IU
D
20060101
20060101
J3360
INJECTION, DIAZEPAM, UP TO 5 MG
D
19820101
19970101
J3364
INJECTION, UROKINASE, 5000 IU VIAL
D
19930101
19970101
J3365
INJECTION, IV, UROKINASE, 250,000 I.U. VIAL
D
19920101
19970101
J3370
INJECTION, VANCOMYCIN HCL, 500 MG
D
19860101
20000101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J3395
D
INJECTION, VERTEPORFIN, 15MG
D
20020101
20050101
20041231
J3396
INJECTION, VERTEPORFIN, 0.1 MG
D
20050101
20050101
J3400
INJECTION, TRIFLUPROMAZINE HCL, UP TO 20 MG
D
19820101
19970101
J3410
INJECTION, HYDROXYZINE HCL, UP TO 25 MG
D
19820101
19970101
J3411
INJECTION, THIAMINE HCL, 100 MG
C
20040101
20040101
J3415
INJECTION, PYRIDOXINE HCL, 100 MG
C
20040101
20040101
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG
D
19860101
19970101
J3430
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
D
19820101
19970101
J3465
INJECTION, VORICONAZOLE, 10 MG
D
20040101
20040101
J3470
INJECTION, HYALURONIDASE, UP TO 150 UNITS
D
19820101
19970101
J3471
INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 USP UNIT (UP TO 999 USP UNITS)
D
20060101
20060101
J3472
INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1000 USP UNITS
D
20060101
20060101
J3475
INJECTION, MAGNESIUM SULFATE, PER 500 MG
D
19960101
19970101
J3480
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
D
19960101
19970101
J3485
INJECTION, ZIDOVUDINE, 10 MG
D
20010101
20010101
J3486
INJECTION, ZIPRASIDONE MESYLATE, 10 MG
C
20040101
20040101
J3487
C
INJECTION, ZOLEDRONIC ACID (ZOMETA), 1 MG
C
20030101
20080101
J3488
A
INJECTION, ZOLEDRONIC ACID (RECLAST), 1 MG
D
20080101
20080101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J3490
UNCLASSIFIED DRUGS
D
19860101
19970101
J3520
EDETATE DISODIUM, PER 150 MG
M
19860101
19960101
J3530
NASAL VACCINE INHALATION
D
19860101
19970101
J3535
DRUG ADMINISTERED THROUGH A METERED DOSE INHALER
M
19940101
19970101
J3570
LAETRILE, AMYGDALIN, VITAMIN B17
M
19860101
19960101
J3590
UNCLASSIFIED BIOLOGICS
C
20030101
20030101
J7030
INFUSION, NORMAL SALINE SOLUTION , 1000 CC
D
19820101
19970101
J7040
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
D
19840101
19970101
J7042
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
D
19840101
19970101
J7050
INFUSION, NORMAL SALINE SOLUTION , 250 CC
D
19820101
19970101
J7051
D
STERILE SALINE OR WATER, UP TO 5 CC
D
19940101
20060101
20051231
J7060
5% DEXTROSE/WATER (500 ML = 1 UNIT)
D
19850101
19970101
J7070
INFUSION, D5W, 1000 CC
D
19820101
19970101
J7100
INFUSION, DEXTRAN 40, 500 ML
D
19820101
19970101
J7110
INFUSION, DEXTRAN 75, 500 ML
D
19820101
19970101
J7120
RINGERS LACTATE INFUSION, UP TO 1000 CC
D
19820101
19970101
J7130
HYPERTONIC SALINE SOLUTION, 50 OR 100 MEQ, 20 CC VIAL
D
19840101
19970101
J7187
C
INJECTION, VON WILLEBRAND FACTOR COMPLEX (HUMATE-P), PER IU VWF-RCO
D
20080101
20080101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J7188
D
INJECTION, VON WILLEBRAND FACTOR COMPLEX, HUMAN, IU
D
20060101
20070101
20061231
J7189
FACTOR VIIA (ANTIHEMOPHILIC FACTOR, RECOMBINANT), PER 1 MICROGRAM
D
20060101
20060101
J7190
FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
D
19860101
19990101
J7191
FACTOR VIII (ANTIHEMOPHILIC FACTOR (PORCINE)), PER I.U.
D
19960101
19980101
J7192
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
D
19940101
19990101
J7193
FACTOR IX (ANTIHEMOPHILIC FACTOR, PURIFIED, NON-RECOMBINANT) PER I.U.
D
20020101
20020101
J7194
FACTOR IX, COMPLEX, PER I.U.
D
19860101
19980101
J7195
FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
D
20020101
20020101
J7197
ANTITHROMBIN III (HUMAN), PER I.U.
D
19920101
19970101
J7198
ANTI-INHIBITOR, PER I.U.
D
20000101
20000101
J7199
HEMOPHILIA CLOTTING FACTOR, NOT OTHERWISE CLASSIFIED
D
20000101
20000101
J7300
INTRAUTERINE COPPER CONTRACEPTIVE
S
19860101
19950401
J7302
LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVE SYSTEM, 52 MG
S
20020101
20020101
J7303
CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH
S
20040101
20040101
J7304
CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH
S
20050101
20050101
J7306
LEVONORGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANTS AND SUPPLIES
I
20060101
20060101
J7307
A
ETONOGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMPLANT AND SUPPLIES
I
20080101
20080101
J7308
AMINOLEVULINIC ACID HCL FOR TOPICAL ADMINISTRATION, 20%, SINGLE UNIT DOSAGE FORM (354 MG)
C
20020101
20040101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J7310
GANCICLOVIR, 4.5 MG, LONG-ACTING IMPLANT
D
19970101
19970101
J7317
D
SODIUM HYALURONATE, PER 20 TO 25 MG DOSE FOR INTRA-ARTICULAR INJECTION
C
20030101
20060101
20051231
J7318
HYALURONAN (SODIUM HYALURONATE) OR DERIVATIVE, INTRA-ARTICULAR INJECTION, 1 MG
C
20060101
20060101
J7320
D
HYLAN G-F 20, 16 MG, FOR INTRA ARTICULAR INJECTION
C
19990101
20060101
20051231
J7321
A
HYALURONAN OR DERIVATIVE, HYALGAN OR SUPARTZ, FOR INTRA-ARTICULAR INJECTION, PER DOSE
C
20080101
20080101
J7322
A
HYALURONAN OR DERIVATIVE, SYNVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE
C
20080101
20080101
J7323
A
HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE
C
20080101
20080101
J7324
A
HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE
C
20080101
20080101
J7330
AUTOLOGOUS CULTURED CHONDROCYTES, IMPLANT
C
20010101
20020701
DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT BIOENGINEERED OR
J7340
C
20020101
20060101
PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR
J7341
C
20060101
20060101
PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR
J7342
C
20030101
20060101
PROCESSED ELEMENTS, WITH METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER
DERMAL AND EPIDERMAL, (SUBSTITUTE) TISSUE OF NON-HUMAN ORIGIN, WITH OR WITHOUT OTHER
J7343
BIOENGINEERED OR PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE
C
20050101
20060101
CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR
J7344
C
20050101
20060101
PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS, PER SQUARE CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR
J7347
A
PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS (INTEGRA MATRIX), PER SQUARE
C
20080101
20080101
CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR
J7348
A
PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS (TISSUEMEND), PER SQUARE
C
20080101
20080101
CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF NONHUMAN ORIGIN, WITH OR WITHOUT OTHER BIOENGINEERED OR
J7349
A
PROCESSED ELEMENTS, WITHOUT METABOLICALLY ACTIVE ELEMENTS (PRIMATRIX), PER SQUARE
C
20080101
20080101
CENTIMETER
DERMAL (SUBSTITUTE) TISSUE OF HUMAN ORIGIN, INJECTABLE, WITH OR WITHOUT OTHER BIOENGINEERED
J7350
D
C
20030101
20070101
20061231
OR PROCESSED ELEMENTS, BUT WITHOUT METABOLIZED ACTIVE ELEMENTS, PER 10 MG
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J7500
AZATHIOPRINE, ORAL, 50 MG
D
19880101
20000101
J7501
AZATHIOPRINE, PARENTERAL, 100 MG
D
19880101
20000101
J7502
CYCLOSPORINE, ORAL, 100 MG
D
20000101
20000101
J7504
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, EQUINE, PARENTERAL, 250 MG
D
19880101
20020101
J7505
MUROMONAB-CD3, PARENTERAL, 5 MG
D
19880101
20010101
J7506
PREDNISONE, ORAL, PER 5MG
D
19890101
20000101
J7507
TACROLIMUS, ORAL, PER 1 MG
D
19950101
20000101
J7508
D
TACROLIMUS, ORAL, PER 5 MG
D
19950101
20040101
20031231
J7509
METHYLPREDNISOLONE ORAL, PER 4 MG
D
19960101
20000101
J7510
PREDNISOLONE ORAL, PER 5 MG
D
19960101
20000101
J7511
LYMPHOCYTE IMMUNE GLOBULIN, ANTITHYMOCYTE GLOBULIN, RABBIT, PARENTERAL, 25MG
C
20020101
20020101
J7513
DACLIZUMAB, PARENTERAL, 25 MG
D
19990101
20000101
J7515
CYCLOSPORINE, ORAL, 25 MG
C
20000101
20000101
J7516
CYCLOSPORIN, PARENTERAL, 250 MG
C
20000101
20000101
J7517
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
C
20000101
20000101
J7518
MYCOPHENOLIC ACID, ORAL, 180 MG
D
20050101
20050101
J7520
SIROLIMUS, ORAL, 1 MG
D
20010101
20010101
J7525
TACROLIMUS, PARENTERAL, 5 MG
D
20010101
20010101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J7599
IMMUNOSUPPRESSIVE DRUG, NOT OTHERWISE CLASSIFIED
D
19960101
20000101
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED
J7602
A
FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 1 MG
D
20080101
20080101
(ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION, FDA-APPROVED
J7603
A
FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR
D
20080101
20080101
PER 0.5 MG (LEVALBUTEROL)
ACETYLCYSTEINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7604
A
C
20080101
20080101
DOSE FORM, PER GRAM
ARFORMOTEROL, INHALATION SOLUTION, FDA APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7605
A
C
20080101
20080101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, 15 MICROGRAMS
LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7607
A
C
20070101
20070101
CONCENTRATED FORM, 0.5 MG
ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7608
C
D
20000101
20080101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAM
ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 1
J7609
C
20070101
20070101
MG
ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7610
C
20070101
20070101
CONCENTRATED FORM, 1 MG
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED
J7611
D
D
20050101
20080101
20071231
THROUGH DME, CONCENTRATED FORM, 1 MG
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7612
D
D
20050101
20080101
20071231
ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG
ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED
J7613
D
D
20050101
20080101
20071231
THROUGH DME, UNIT DOSE, 1 MG
LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7614
D
D
20050101
20080101
20071231
ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG
LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE,
J7615
C
20070101
20070101
0.5 MG
ALBUTEROL, UP TO 5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION,
J7616
D
D
20050101
20060101
20051231
ADMINISTERED THROUGH DME
LEVALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION
J7617
D
D
20050101
20060101
20051231
SOLUTION, ADMINISTERED THROUGH DME
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED
J7618
D
D
20000101
20050101
20041231
THROUGH DME, CONCENTRATED FORM, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)
ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED
J7619
D
D
20000101
20050101
20041231
THROUGH DME, UNIT DOSE, PER 1 MG (ALBUTEROL) OR PER 0.5 MG (LEVALBUTEROL)
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-
J7620
B
D
20060101
20070101
COMPOUNDED, ADMINISTERED THROUGH DME
ALBUTEROL, ALL FORMULATIONS, INCLUDING SEPARATED ISOMERS, UP TO 5 MG (ALBUTEROL) OR 2.5 MG
J7621
D
(LEVOALBUTEROL), AND IPRATROPIUM BROMIDE, UP TO 1 MG, COMPOUNDED INHALATION SOLUTION,
C
20040101
20050101
20041231
ADMINISTERED THROUGH DME
BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7622
C
C
20020101
20070101
DOSE FORM, PER MILLIGRAM
BETAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7624
C
C
20020101
20070101
DOSE FORM, PER MILLIGRAM
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED
J7626
C
C
20020101
20070101
THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG
BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE
J7627
A
C
20060101
20070101
FORM, UP TO 0.5 MG
BITOLTEROL MESYLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7628
B
D
20000101
20070101
CONCENTRATED FORM, PER MILLIGRAM
BITOLTEROL MESYLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7629
B
D
20000101
20070101
UNIT DOSE FORM, PER MILLIGRAM
CROMOLYN SODIUM, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7631
C
D
20000101
20080101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS
CROMOLYN SODIUM, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7632
A
C
20080101
20080101
DOSE FORM, PER 10 MILLIGRAMS
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED
J7633
C
C
20030101
20070101
THROUGH DME, CONCENTRATED FORM, PER 0.25 MILLIGRAM
BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7634
A
C
20070101
20070101
CONCENTRATED FORM, PER 0.25 MILLIGRAM
ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED
J7635
B
D
20000101
20070101
FORM, PER MILLIGRAM
ATROPINE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE
J7636
B
D
20000101
20070101
FORM, PER MILLIGRAM
DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7637
B
D
20000101
20070101
CONCENTRATED FORM, PER MILLIGRAM
DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7638
B
D
20000101
20070101
DOSE FORM, PER MILLIGRAM
DORNASE ALPHA, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7639
C
D
20000101
20080101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
FORMOTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE
J7640
C
I
20060101
20070101
FORM, 12 MICROGRAMS
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
FLUNISOLIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE,
J7641
C
C
20020101
20070101
PER MILLIGRAM
GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7642
B
D
20000101
20070101
CONCENTRATED FORM, PER MILLIGRAM
GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7643
B
D
20000101
20070101
DOSE FORM, PER MILLIGRAM
IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7644
B
D
20000101
20070101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7645
A
C
20070101
20070101
UNIT DOSE FORM, PER MILLIGRAM
ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7647
A
C
20070101
20070101
CONCENTRATED FORM, PER MILLIGRAM
ISOETHARINE HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7648
B
D
20000101
20070101
ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM
ISOETHARINE HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7649
B
D
20000101
20070101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7650
A
C
20070101
20070101
DOSE FORM, PER MILLIGRAM
ISOETHARINE HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7657
A
C
20070101
20070101
CONCENTRATED FORM, PER MILLIGRAM
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7658
B
D
20000101
20070101
ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER MILLIGRAM
ISOPROTERENOL HCL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7659
B
D
20000101
20070101
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM
ISOPROTERENOL HCL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7660
A
C
20070101
20070101
DOSE FORM, PER MILLIGRAM
METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, CONCENTRATED FORM, PER
J7667
A
C
20070101
20070101
10 MILLIGRAMS
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7668
B
D
20000101
20070101
ADMINISTERED THROUGH DME, CONCENTRATED FORM, PER 10 MILLIGRAMS
METAPROTERENOL SULFATE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED,
J7669
B
D
20000101
20020701
ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 10 MILLIGRAMS
METAPROTERENOL SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH
J7670
A
C
20070101
20020702
DME, UNIT DOSE FORM, PER 10 MILLIGRAMS
J7674
METHACHOLINE CHLORIDE ADMINISTERED AS INHALATION SOLUTION THROUGH A NEBULIZER, PER 1 MG
C
20050101
20050101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
PENTAMIDINE ISETHIONATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7676
A
C
20080101
20080101
UNIT DOSE FORM, PER 300 MG
TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7680
B
D
20000101
20070101
CONCENTRATED FORM, PER MILLIGRAM
TERBUTALINE SULFATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7681
B
D
20000101
20070101
UNIT DOSE FORM, PER MILLIGRAM
TOBRAMYCIN, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, UNIT DOSE FORM,
J7682
B
D
20000101
20070101
ADMINISTERED THROUGH DME, PER 300 MILLIGRAMS
TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME,
J7683
B
D
20000101
20070101
CONCENTRATED FORM, FORM, PER MILLIGRAM
TRIAMCINOLONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT
J7684
B
D
20000101
20070101
DOSE FORM, FORM, PER MILLIGRAM
TOBRAMYCIN, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE
J7685
A
C
20070101
20070101
FORM, PER 300 MILLIGRAMS
J7699
F
NOC DRUGS, INHALATION SOLUTION ADMINISTERED THROUGH DME
D
19930101
20070101
J7799
NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGH DME
D
19930101
20020701
J8498
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISE SPECIFIED
D
20060101
20060101
J8499
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
M
19950101
19970101
J8501
APREPITANT, ORAL, 5 MG
D
20050101
20050101
J8510
BUSULFAN; ORAL, 2 MG
D
20000101
20000101
J8515
CABERGOLINE, ORAL, 0.25 MG
M
20060101
20060101
J8520
CAPECITABINE, ORAL, 150 MG
D
20000101
20000101
J8521
CAPECITABINE, ORAL, 500 MG
D
20000101
20000101
J8530
CYCLOPHOSPHAMIDE; ORAL, 25 MG
D
19950101
19970831
J8540
DEXAMETHASONE, ORAL, 0.25 MG
D
20060101
20060101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J8560
ETOPOSIDE; ORAL, 50 MG
D
19950101
19970101
J8565
GEFITINIB, ORAL, 250 MG
I
20050101
20050101
J8597
ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED
D
20060101
20060101
J8600
MELPHALAN; ORAL, 2 MG
D
19950101
19970101
J8610
METHOTREXATE; ORAL, 2.5 MG
D
19950101
19970831
J8650
NABILONE, ORAL, 1MG
C
20070101
20070101
J8700
TEMOZOLOMIDE, ORAL, 5 MG
D
20010101
20010101
J8999
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
D
19950101
19970101
J9000
DOXORUBICIN HCL, 10 MG
D
19840101
19970101
J9001
DOXORUBICIN HYDROCHLORIDE, ALL LIPID FORMULATIONS, 10 MG
D
20000101
20000101
J9010
ALEMTUZUMAB, 10 MG
D
20030101
20030101
J9015
ALDESLEUKIN, PER SINGLE USE VIAL
D
19960101
19970101
J9017
ARSENIC TRIOXIDE, 1MG
C
20020101
20020101
J9020
ASPARAGINASE, 10,000 UNITS
D
19840101
19970101
J9025
INJECTION, AZACITIDINE, 1 MG
C
20060101
20060101
J9027
INJECTION, CLOFARABINE, 1 MG
C
20060101
20060101
J9031
BCG (INTRAVESICAL) PER INSTILLATION
D
19910101
19970101
J9035
INJECTION, BEVACIZUMAB, 10 MG
C
20050101
20050101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J9040
BLEOMYCIN SULFATE, 15 UNITS
D
19840101
19970101
J9041
INJECTION, BORTEZOMIB, 0.1 MG
C
20050101
20050101
J9045
CARBOPLATIN, 50 MG
D
19900101
19970101
J9050
CARMUSTINE, 100 MG
D
19840101
19970101
J9055
INJECTION, CETUXIMAB, 10 MG
C
20050101
20050101
J9060
CISPLATIN, POWDER OR S0LUTION, PER 10 MG
D
19840101
19970101
J9062
CISPLATIN, 50 MG
D
19820101
19970101
J9065
INJECTION, CLADRIBINE, PER 1 MG
D
19950101
19970101
J9070
CYCLOPHOSPHAMIDE, 100 MG
D
19840101
19970101
J9080
CYCLOPHOSPHAMIDE, 200 MG
D
19940101
19970101
J9090
CYCLOPHOSPHAMIDE, 500 MG
D
19940101
19970101
J9091
CYCLOPHOSPHAMIDE, 1.0 GRAM
D
19940101
19970101
J9092
CYCLOPHOSPHAMIDE, 2.0 GRAM
D
19940101
19970101
J9093
CYCLOPHOSPHAMIDE, LYOPHILIZED, 100 MG
D
19880101
19970101
J9094
CYCLOPHOSPHAMIDE, LYOPHILIZED, 200 MG
D
19940101
19970101
J9095
CYCLOPHOSPHAMIDE, LYOPHILIZED, 500 MG
D
19940101
19970101
J9096
CYCLOPHOSPHAMIDE, LYOPHILIZED, 1.0 GRAM
D
19940101
19970101
J9097
CYCLOPHOSPHAMIDE, LYOPHILIZED, 2.0 GRAM
D
19940101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J9098
CYTARABINE LIPOSOME, 10 MG
C
20040101
20040101
J9100
CYTARABINE, 100 MG
D
19860101
19970101
J9110
CYTARABINE, 500 MG
D
19940101
19970101
J9120
DACTINOMYCIN, 0.5 MG
D
19840101
19970101
J9130
DACARBAZINE, 100 MG
D
19860101
20040101
J9140
DACARBAZINE, 200 MG
D
19940101
19970101
J9150
DAUNORUBICIN, 10 MG
D
19860101
19980101
J9151
DAUNORUBICIN CITRATE, LIPOSOMAL FORMULATION, 10 MG
D
19990101
19990101
J9160
DENILEUKIN DIFTITOX, 300 MCG
C
20010101
20010101
J9165
DIETHYLSTILBESTROL DIPHOSPHATE, 250 MG
D
19880101
19970101
J9170
DOCETAXEL, 20 MG
D
19980101
19980101
J9175
INJECTION, ELLIOTTS' B SOLUTION, 1 ML
D
20060101
20060101
J9178
INJECTION, EPIRUBICIN HCL, 2 MG
C
20040101
20040101
J9180
D
EPIRUBICIN HYDROCHLORIDE, 50 MG
D
20010101
20040101
20031231
J9181
ETOPOSIDE, 10 MG
D
19870101
19970101
J9182
ETOPOSIDE, 100 MG
D
19870101
19970101
J9185
FLUDARABINE PHOSPHATE, 50 MG
D
19940101
19970101
J9190
FLUOROURACIL, 500 MG
D
19840101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J9200
FLOXURIDINE, 500 MG
D
19840101
19970101
J9201
GEMCITABINE HCL, 200 MG
D
19980101
19980101
J9202
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
D
19910101
19970101
J9206
IRINOTECAN, 20 MG
D
19980101
19980101
J9208
IFOSFAMIDE, 1 GM
D
19900101
19970101
J9209
MESNA, 200 MG
D
19900101
19970101
J9211
IDARUBICIN HYDROCHLORIDE, 5 MG
D
19930101
19970101
J9212
INJECTION, INTERFERON ALFACON-1, RECOMBINANT, 1 MCG
D
19990101
19990101
J9213
INTERFERON, ALFA-2A, RECOMBINANT, 3 MILLION UNITS
D
19930101
19970101
J9214
INTERFERON, ALFA-2B, RECOMBINANT, 1 MILLION UNITS
D
19930101
19970101
J9215
INTERFERON, ALFA-N3, (HUMAN LEUKOCYTE DERIVED), 250,000 IU
D
19930101
19970101
J9216
INTERFERON, GAMMA 1-B, 3 MILLION UNITS
D
19930101
19970101
J9217
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
D
19910101
19970101
J9218
LEUPROLIDE ACETATE, PER 1 MG
D
19900101
19970101
J9219
LEUPROLIDE ACETATE IMPLANT, 65 MG
D
20010101
20010101
J9225
C
HISTRELIN IMPLANT (VANTAS), 50 MG
D
20060101
20080101
J9226
A
HISTRELIN IMPLANT (SUPPRELIN LA), 50 MG
D
20080101
20080101
J9230
MECHLORETHAMINE HYDROCHLORIDE, (NITROGEN MUSTARD), 10 MG
D
19860101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J9245
INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
D
19950101
19970101
J9250
METHOTREXATE SODIUM, 5 MG
D
19940101
19970101
J9260
METHOTREXATE SODIUM, 50 MG
D
19840101
19970101
J9263
INJECTION, OXALIPLATIN, 0.5 MG
C
20040101
20040101
J9264
INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG
C
20060101
20060101
J9265
PACLITAXEL, 30 MG
D
19940101
19970101
J9266
PEGASPARGASE, PER SINGLE DOSE VIAL
D
19960101
19970101
J9268
PENTOSTATIN, PER 10 MG
D
19940101
19970101
J9270
PLICAMYCIN, 2.5 MG
D
19840101
19970101
J9280
MITOMYCIN, 5 MG
D
19860101
19970101
J9290
MITOMYCIN, 20 MG
D
19940101
19970101
J9291
MITOMYCIN, 40 MG
D
19890101
19970101
J9293
INJECTION, MITOXANTRONE HYDROCHLORIDE, PER 5 MG
D
19900101
19970101
J9300
GEMTUZUMAB OZOGAMICIN, 5MG
C
20020101
20020101
J9303
A
INJECTION, PANITUMUMAB, 10 MG
C
20080101
20080101
J9305
INJECTION, PEMETREXED, 10 MG
C
20050101
20050101
J9310
RITUXIMAB, 100 MG
D
19990101
19990101
J9320
STREPTOZOCIN, 1 GM
D
19860101
19970101
Action
Code Add
Action Eff
HCPCS
Long Description
Coverage
Term Date
Code
Date
Date
J9340
THIOTEPA, 15 MG
D
19840101
19970101
J9350
TOPOTECAN, 4 MG
D
19980101
19980101
J9355
TRASTUZUMAB, 10 MG
C
20000101
20000101
J9357
VALRUBICIN, INTRAVESICAL, 200 MG
D
20000101
20000101
J9360
VINBLASTINE SULFATE, 1 MG
D
19860101
19970101
J9370
VINCRISTINE SULFATE, 1 MG
D
19860101
19970101
J9375
VINCRISTINE SULFATE, 2 MG
D
19880101
19970101
J9380
VINCRISTINE SULFATE, 5 MG
D
19940101
19970101
J9390
VINORELBINE TARTRATE, PER 10 MG
D
19960101
19970101
J9395
INJECTION, FULVESTRANT, 25 MG
C
20040101
20040101
J9600
PORFIMER SODIUM, 75 MG
D
19980101
19980101
J9999
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
D
19860101
19970101
