procedure code hcpcs description · 2019-10-25 · j7030 normal saline solution infus j7040 normal...

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MHTPS_HCPCS_NDC_021014 Updated as of 1/30/14 1 39447TX0314 Procedure Code HCPCS Description 90283 IMMUNE GLOBULIN (IGIV), HUMAN, FOR INTRAVENOUS USE 90284 IMMUNE GLOBULIN (SCIG), HUMAN, FOR USE IN SUBCUTANEOUS INFUSIONS, 100 MG, EACH 90291 CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGIV), HUMAN, FOR INTRAVENOUS USE 90371 HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, FOR INTRAMUSCULAR USE 90375 RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR INTRAMUSCULAR AND/ OR SUBCUTANEOUS USE C9133 Factor ix (antihemophilic factor, recombinant), rixibus, per i.u. C9250 HUMAN PLASMA FIBRIN SEALANT, VAPOR-HEATED, SOLVENT-DETERGENT (ARTISS), 2ML C9254 INJECTION, LACOSAMIDE, 1 MG C9257 INJECTION, BEVACIZUMAB, 0.25 MG C9275 INJECTION, HEXAMINOLEVULINATE HYDROCHLORIDE, 100 MG, PER STUDY DOSE C9399 UNCLASSIFIED DRUGS OR BIOLOGICALS G9018 ZANAMIVIR, INHALATION POWDER ADMINISTERED THROUGH INHALER, PER 10 MG (FOR USE AS A MEDICARE APPROVED DEMONSTRATION PROJECT) G9019 OSELTAMIVIR PHOSPHATE, ORAL, PER 75 MG (FOR USE AS A MEDICARE APPROVED DEMONSTRATION PROJECT) J0120 TETRACYCLIN INJECTION J0129 ABATACEPT INJECTION J0130 ABCIXIMAB INJECTION J0131 ACETAMINOPHEN INJECTION J0132 ACETYLCYSTEINE INJECTION J0133 ACYCLOVIR INJECTION J0135 ADALIMUMAB INJECTION J0150 INJECTION ADENOSINE 6 MG

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MHTPS_HCPCS_NDC_021014 Updated as of 1/30/141

39447TX0314

Procedure Code HCPCS Description

90283 IMMUNE GLOBULIN (IGIV), HUMAN, FOR INTRAVENOUS USE

90284 IMMUNE GLOBULIN (SCIG), HUMAN, FOR USE IN SUBCUTANEOUS INFUSIONS, 100 MG, EACH

90291 CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGIV), HUMAN, FOR INTRAVENOUS USE

90371 HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, FOR INTRAMUSCULAR USE

90375 RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR INTRAMUSCULAR AND/ OR SUBCUTANEOUS USE

C9133 Factor ix (antihemophilic factor, recombinant), rixibus, per i.u.

C9250 HUMAN PLASMA FIBRIN SEALANT, VAPOR-HEATED, SOLVENT-DETERGENT (ARTISS), 2ML

C9254 INJECTION, LACOSAMIDE, 1 MG

C9257 INJECTION, BEVACIZUMAB, 0.25 MG

C9275 INJECTION, HEXAMINOLEVULINATE HYDROCHLORIDE, 100 MG, PER STUDY DOSE

C9399 UNCLASSIFIED DRUGS OR BIOLOGICALS

G9018ZANAMIVIR, INHALATION POWDER ADMINISTERED THROUGH INHALER, PER 10 MG (FOR USE AS A MEDICARE APPROVED DEMONSTRATION PROJECT)

G9019OSELTAMIVIR PHOSPHATE, ORAL, PER 75 MG (FOR USE AS A MEDICARE APPROVED DEMONSTRATION PROJECT)

J0120 TETRACYCLIN INJECTION

J0129 ABATACEPT INJECTION

J0130 ABCIXIMAB INJECTION

J0131 ACETAMINOPHEN INJECTION

J0132 ACETYLCYSTEINE INJECTION

J0133 ACYCLOVIR INJECTION

J0135 ADALIMUMAB INJECTION

J0150 INJECTION ADENOSINE 6 MG

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/142

Procedure Code HCPCS Description

J0151Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)

J0152INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE

J0171 ADRENALIN EPINEPHRINE INJECT

J0178 AFLIBERCEPT INJECTION

J0180 INJECTION, ADRENOSEM SALICYLATE UP TO 10 MG

J0190 INJ BIPERIDEN LACTATE/5 MG

J0205 ALGLUCERASE INJECTION

J0210 METHYLDOPATE HCL INJECTION

J0215 ALEFACEPT

J0220 INJECTION, ALLERGY DESENSITIZATION, AQUEOUS PREPARATION

J0256 ALPHA 1 PROTEINASE INHIBITOR

J0257 GLASSIA INJECTION

J0278 AMIKACIN SULFATE INJECTION

J0280 AMINOPHYLLIN 250 MG INJ

J0282 AMIODARONE HCL

J0285 AMPHOTERICIN B

J0287 AMPHOTERICIN B LIPID COMPLEX

J0288 AMPHO B CHOLESTERYL SULFATE

J0289 AMPHOTERICIN B LIPOSOME INJ

J0290 AMPICILLIN 500 MG INJ

J0295 AMPICILLIN SODIUM PER 1.5 GM

J0300 AMOBARBITAL 125 MG INJ

J0330 SUCCINYCHOLINE CHLORIDE INJ

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/143

Procedure Code HCPCS Description

J0348 ANADULAFUNGIN INJECTION

J0360 HYDRALAZINE HCL INJECTION

J0364 APOMORPHINE HYDROCHLORIDE

J0380 INJ METARAMINOL BITARTRATE

J0390 CHLOROQUINE INJECTION

J0395 ARBUTAMINE HCL INJECTION

J0400 INJ TRIMETHAPHAN CAMSYLATE

J0401 Injection, aripiprazole, extended release, 1 mg

J0456 AZITHROMYCIN

J0461 ATROPINE SULFATE INJECTION

J0470 DIMECAPROL INJECTION

J0475 BACLOFEN 10 MG INJECTION

J0476 BACLOFEN INTRATHECAL TRIAL

J0480 INJECTION, BELLAFOLINE, UP TO 0.5 MG

J0485 BELATACEPT INJECTION

J0490 INJECTION, BENADRYL HCL, UP TO 50 MG

J0500 DICYCLOMINE INJECTION

J0515 INJ BENZTROPINE MESYLATE

J0520 BETHANECHOL CHLORIDE INJECT

J0558 PENG BENZATHINE/PROCAINE INJ

J0561 PENICILLIN G BENZATHINE INJ

J0583 BIVALIRUDIN

J0586 ABOBOTULINUMTOXINA

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/144

Procedure Code HCPCS Description

J0587 BOTULINUM TOXIN TYPE B

J0588 INCOBOTULINUMTOXIN A

J0592 BUPRENORPHINE HYDROCHLORIDE

J0594 BUSULFAN INJECTION

J0595 BUTORPHANOL TARTRATE 1 MG

J0598 C1 ESTERASE INHIBITOR INJ

J0600 EDETATE CALCIUM DISODIUM INJ

J0610 CALCIUM GLUCONATE INJECTION

J0620 CALCIUM GLYCER & LACT/10 ML

J0630 CALCITONIN SALMON INJECTION

J0636 INJ CALCITRIOL PER 0.1 MCG

J0637 CASPOFUNGIN ACETATE

J0638 CANAKINUMAB INJECTION

J0641 INJECTION, LEVOLEUCOVORIN CALCIUM, 0.5 MG

J0670 INJ MEPIVACAINE HCL/10 ML

J0690 CEFAZOLIN SODIUM INJECTION

J0692 CEFEPIME HCL FOR INJECTION

J0694 CEFOXITIN SODIUM INJECTION

J0697 STERILE CEFUROXIME INJECTION

J0698 CEFOTAXIME SODIUM INJECTION

J0702 BETAMETHASONE ACET&SOD PHOSP

J0706 CAFFEINE CITRATE INJECTION

J0710 CEPHAPIRIN SODIUM INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/145

Procedure Code HCPCS Description

J0713 INJ CEFTAZIDIME PER 500 MG

J0715 CEFTIZOXIME SODIUM / 500 MG

J0716 CENTRUROIDES IMMUNE F(AB)

J0717 Injection, certolizumab pegol, 1 mg

J0718 CERTOLIZUMAB PEGOL INJ

J0720 CHLORAMPHENICOL SODIUM INJEC

J0725 CHORIONIC GONADOTROPIN/1000U

J0735 CLONIDINE HYDROCHLORIDE

J0740 CIDOFOVIR INJECTION

J0743 CILASTATIN SODIUM INJECTION

J0744 CIPROFLOXACIN IV

J0760 COLCHICINE INJECTION

J0770 COLISTIMETHATE SODIUM INJ

J0775 COLLAGENASE, CLOST HIST INJ

J0780 PROCHLORPERAZINE INJECTION

J0795 CORTICORELIN OVINE TRIFLUTAL

J0800 CORTICOTROPIN INJECTION

J0833 COSYNTROPIN INJECTION NOS

J0834 COSYNTROPIN CORTROSYN INJ

J0840 Injection, Crotalidae Polyvalent Immune Fab

J0850 CYTOMEGALOVIRUS IMM IV /VIAL

J0878 DAPTOMYCIN INJECTION

J0882 DARBEPOETIN ALFA, ESRD USE

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/146

Procedure Code HCPCS Description

J0895 DEFEROXAMINE MESYLATE INJ

J0897 DENOSUMAB INJECTION

J0945 BROMPHENIRAMINE MALEATE INJ

J1000 DEPO-ESTRADIOL CYPIONATE INJ

J1020 METHYLPREDNISOLONE 20 MG INJ

J1030 METHYLPREDNISOLONE 40 MG INJ

J1060 TESTOSTERONE CYPIONATE 1 ML

J1070 TESTOSTERONE CYPIONAT 100 MG

J1080 TESTOSTERONE CYPIONAT 200 MG

J1094 INJ DEXAMETHASONE ACETATE

J1110 INJ DIHYDROERGOTAMINE MESYLT

J1120 ACETAZOLAMID SODIUM INJECTIO

J1160 DIGOXIN INJECTION

J1162 DIGOXIN IMMUNE FAB (OVINE)

J1165 PHENYTOIN SODIUM INJECTION

J1190 DEXRAZOXANE HCL INJECTION

J1200 DIPHENHYDRAMINE HCL INJECTIO

J1205 CHLOROTHIAZIDE SODIUM INJ

J1212 DIMETHYL SULFOXIDE 50% 50 ML

J1230 METHADONE INJECTION

J1240 DIMENHYDRINATE INJECTION

J1245 DIPYRIDAMOLE INJECTION

J1250 INJ DOBUTAMINE HCL/250 MG

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/147

Procedure Code HCPCS Description

J1265 DOPAMINE INJECTION

J1267 DORIPENEM INJECTION

J1270 INJECTION, DOXERCALCIFEROL, 1 MCG

J1300 INJECTION, DURATRAD, UP TO 10 MG

J1324 ENFUVIRTIDE INJECTION

J1325 EPOPROSTENOL INJECTION

J1327 EPTIFIBATIDE INJECTION

J1330 ERGONOVINE MALEATE INJECTION

J1335 ERTAPENEM INJECTION

J1364 ERYTHRO LACTOBIONATE /500 MG

J1380 ESTRADIOL VALERATE 10 MG INJ

J1410 INJ ESTROGEN CONJUGATE 25 MG

J1430 INJECTION, ESTATE, UP TO 10 MG

J1435 INJECTION ESTRONE PER 1 MG

J1436 ETIDRONATE DISODIUM INJ

J1438 ETANERCEPT INJECTION

J1440 Injection, Filgrastim (G-Csf), 300 Mcg

J1441 INJECTION, FILGRASTIM (G-CSF), 480 MCG

J1442 Injection, filgrastim (g-csf), 1 microgram

J1450 FLUCONAZOLE

J1451 FOMEPIZOLE, 15 MG

J1453 INJECTION, FOSAPREPITANT, 1 MG

J1455 FOSCARNET SODIUM INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/148

Procedure Code HCPCS Description

J1457 GALLIUM NITRATE INJECTION

J1458 GALSULFASE INJECTION

J1459 Inj IVIG privigen 500 mg

J1460 GAMMA GLOBULIN 1 CC INJ

J1556 Injection, immune globulin (bivigam), 500 mg

J1557 GAMMAPLEX INJECTION

J1559 HIZENTRA INJECTION

J1560 GAMMA GLOBULIN > 10 CC INJ

J1568 OCTAGAM INJECTION

J1569 GAMMAGARD LIQUID INJECTION

J1570 GANCICLOVIR SODIUM INJECTION

J1571 HEPAGAM B IM INJECTION

J1572 FLEBOGAMMA INJECTION

J1573 HEPAGAM B INTRAVENOUS, INJ

J1580 GARAMYCIN GENTAMICIN INJ

J1590 INJECTION, GATIFLOXACIN, 10 MG

J1595 INJECTION GLATIRAMER ACETATE

J1599 IVIG NON-LYOPHILIZED, NOS

J1600 GOLD SODIUM THIOMALEATE INJ

J1602 Injection, golimumab, 1 mg, for intravenous use

J1610 GLUCAGON HYDROCHLORIDE/1 MG

J1620 GONADORELIN HYDROCH/ 100 MCG

J1630 HALOPERIDOL INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/149

Procedure Code HCPCS Description

J1640 INJECTION, HEPARIN SODIUM, 30 ML

J1642 INJ HEPARIN SODIUM PER 10 U

J1644 INJ HEPARIN SODIUM PER 1000U

J1645 DALTEPARIN SODIUM

J1650 INJ ENOXAPARIN SODIUM

J1652 FONDAPARINUX SODIUM

J1655 TINZAPARIN SODIUM INJECTION

J1670 TETANUS IMMUNE GLOBULIN INJ

J1700 HYDROCORTISONE ACETATE INJ

J1710 HYDROCORTISONE SODIUM PH INJ

J1720 HYDROCORTISONE SODIUM SUCC I

J1725 HYDROXYPROGESTERONE CAPROATE

J1730 DIAZOXIDE INJECTION

J1740 INJECTION, HYDROXYPROGESTERONE CAPROATE, DELALUTIN, UP TO 250MG

J1741 HYDROXYPROGESTERONE CAP 250

J1742 IBUTILIDE FUMARATE INJECTION

J1743 IDURSULFASE INJECTION

J1750 IRON DEXTRAN

J1756 IRON SUCROSE INJECTION

J1786 IMUGLUCERASE INJECTION

J1790 DROPERIDOL INJECTION

J1800 PROPRANOLOL INJECTION

J1826 INTERFERON BETA-1A INJ

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1410

Procedure Code HCPCS Description

J1830 INTERFERON BETA-1B / .25 MG

J1840 KANAMYCIN SULFATE 500 MG INJ

J1850 KANAMYCIN SULFATE 75 MG INJ

J1890 CEPHALOTHIN SODIUM INJECTION

J1930 Injection, Lanreotide, 1 MG

J1931 LARONIDASE INJECTION

J1940 FUROSEMIDE INJECTION

J1945 LEPIRUDIN

J1950 LEUPROLIDE ACETATE /3.75 MG

J1953 Injection, Levetiracetam, 10 MG

J1955 INJ LEVOCARNITINE PER 1 GM

J1956 LEVOFLOXACIN INJECTION

J1960 LEVORPHANOL TARTRATE INJ

J1980 HYOSCYAMINE SULFATE INJ

J1990 CHLORDIAZEPOXIDE INJECTION

J2010 LINCOMYCIN INJECTION

J2020 INJECTION, LINEZOLID, 200 MG

J2060 LORAZEPAM INJECTION

J2150 MANNITOL INJECTION

J2175 MEPERIDINE HYDROCHL /100 MG

J2180 MEPERIDINE/PROMETHAZINE INJ

J2185 MEROPENEM

J2210 METHYLERGONOVIN MALEATE INJ

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1411

Procedure Code HCPCS Description

J2248 MICAFUNGIN SODIUM INJECTION

J2250 INJ MIDAZOLAM HYDROCHLORIDE

J2260 INJ MILRINONE LACTATE / 5 ML

J2270 MORPHINE SULFATE INJECTION

J2271 MORPHINE SO4 INJECTION 100MG

J2275 MORPHINE SULFATE INJECTION

J2278 ZICONOTIDE INJECTION

J2280 INJ, MOXIFLOXACIN 100 MG

J2300 INJ NALBUPHINE HYDROCHLORIDE

J2310 INJ NALOXONE HYDROCHLORIDE

J2315 NALTREXONE, DEPOT FORM

J2320 NANDROLONE DECANOATE 50 MG

J2323 NATALIZUMAB INJECTION

J2325 NESIRITIDE INJECTION

J2353 OCTREOTIDE INJECTION, DEPOT

J2354 OCTREOTIDE INJ, NON-DEPOT

J2355 OPRELVEKIN INJECTION

J2358 OLANZAPINE LONG-ACTING INJ

J2360 ORPHENADRINE INJECTION

J2370 PHENYLEPHRINE HCL INJECTION

J2400 CHLOROPROCAINE HCL INJECTION

J2410 OXYMORPHONE HCL INJECTION

J2425 PALIFERMIN INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1412

Procedure Code HCPCS Description

J2426 PALIPERIDONE PALMITATE INJ

J2440 PAPAVERIN HCL INJECTION

J2460 OXYTETRACYCLINE INJECTION

J2501 PARICALCITOL

J2503 PEGAPTANIB SODIUM INJECTION

J2504 PEGADEMASE BOVINE, 25 IU

J2507 PEGLOTICASE INJECTION

J2510 PENICILLIN G PROCAINE INJ

J2515 PENTOBARBITAL SODIUM INJ

J2540 PENICILLIN G POTASSIUM INJ

J2543 PIPERACILLIN/TAZOBACTAM

J2545 PENTAMIDINE ISETHIONTE/300MG

J2560 PHENOBARBITAL SODIUM INJ

J2562 PLERIXAFOR INJECTION

J2590 OXYTOCIN INJECTION

J2597 INJ DESMOPRESSIN ACETATE

J2650 PREDNISOLONE ACETATE INJ

J2670 TOTAZOLINE HCL INJECTION

J2675 INJ PROGESTERONE PER 50 MG

J2680 FLUPHENAZINE DECANOATE 25 MG

J2690 PROCAINAMIDE HCL INJECTION

J2700 OXACILLIN SODIUM INJECITON

J2710 NEOSTIGMINE METHYLSLFTE INJ

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1413

Procedure Code HCPCS Description

J2720 INJ PROTAMINE SULFATE/10 MG

J2724 PROTEIN C CONCENTRATE

J2730 PRALIDOXIME CHLORIDE INJ

J2760 PHENTOLAINE MESYLATE INJ

J2765 METOCLOPRAMIDE HCL INJECTION

J2770 QUINUPRISTIN/DALFOPRISTIN

J2778 RANIBIZUMAB INJECTION

J2780 RANITIDINE HYDROCHLORIDE INJ

J2785 Injection, Regadenoson, 0.1 MG

J2788 RHO D IMMUNE GLOBULIN 50 MCG

J2790 RHO D IMMUNE GLOBULIN INJ

J2791 RHOPHYLAC INJECTION

J2792 RHO(D) IMMUNE GLOBULIN H, SD

J2793 RILONACEPT INJECTION

J2795 ROPIVACAINE HCL INJECTION

J2796 ROMIPLOSTIM INJECTION

J2800 METHOCARBAMOL INJECTION

J2805 SINCALIDE INJECTION

J2810 INJ THEOPHYLLINE PER 40 MG

J2850 INJECTION, SAVACORT-100, UP TO 100 MG

J2916 NA FERRIC GLUCONATE COMPLEX

J2920 METHYLPREDNISOLONE INJECTION

J2930 METHYLPREDNISOLONE INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1414

Procedure Code HCPCS Description

J2941 SOMATROPIN INJECTION

J2950 PROMAZINE HCL INJECITON

J2993 RETEPLASE INJECTION

J2997 ALTEPLASE RECOMBINANT

J3000 STREPTOMYCIN INJECTION

J3030 SUMATRIPTAN SUCCINATE / 6 MG

J3060 Injection, taliglucerace alfa, 10 units

J3070 PENTAZOCINE HCL INJECITON

J3095 Injection, telavancin, 10 mg

J3101 Injection, Tenecteplase, 1 MG

J3105 TERBUTALINE SULFATE INJ

J3110 INJECTION, TESLAC, UP TO 100 MG

J3120 TESTOSTERONE ENANTHATE INJ

J3130 TESTOSTERONE ENANTHATE INJ

J3140 TESTOSTERONE SUSPENSION INJ

J3150 TESTOSTERON PROPIONATE INJ

J3230 CHLORPROMAZINE HCL INJECTION

J3240 THYROTROPIN INJECTION

J3243 TIGECYCLINE INJECTION

J3246 TIROFIBAN HCL

J3250 TRIMETHOBENZAMIDE HCL INJ

J3260 TOBRAMYCIN SULFATE INJECTION

J3262 TOCILIZUMAB INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1415

Procedure Code HCPCS Description

J3265 INJECTION TORSEMIDE 10 MG/ML

J3280 THIETHYLPERAZINE MALEATE INJ

J3285 TREPROSTINIL INJECTION

J3300 Injection, Triamcinolone Acetonide, preservative free, 1 MG

J3301 TRIAMCINOLONE ACETONIDE INJ

J3302 TRIAMCINOLONE DIACETATE INJ

J3303 TRIAMCINOLONE HEXACETONL INJ

J3305 INJ TRIMETREXATE GLUCORONATE

J3310 PERPHENAZINE INJECITON

J3315 TRIPTORELIN PAMOATE

J3320 SPECTINOMYCN DI-HCL INJ

J3350 UREA INJECTION

J3357 USTEKINUMAB INJECTION

J3360 DIAZEPAM INJECTION

J3364 UROKINASE 5000 IU INJECTION

J3365 UROKINASE 250,000 IU INJ

J3385 VELAGLUCERASE ALFA

J3396 VERTEPORFIN INJECTION

J3400 TRIFLUPROMAZINE HCL INJ

J3410 HYDROXYZINE HCL INJECITON

J3411 THIAMINE HCL 100 MG

J3415 PYRIDOXINE HCL 100 MGG

J3420 VITAMIN B12 INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1416

Procedure Code HCPCS Description

J3430 VITAMIN K PHYTONADIONE INJ

J3465 INJECTION, VORICONAZOLE

J3470 HYALURONIDASE INJECTION

J3471 OVINE, UP TO 999 USP UNITS

J3472 OVINE, 1000 USP UNITS

J3473 HYALURONIDASE RECOMBINANT

J3475 INJ MAGNESIUM SULFATE

J3480 INJ POTASSIUM CHLORIDE

J3485 ZIDOVUDINE

J3486 ZIPRASIDONE MESYLATE

J3488 RECLAST INJECTION

J3489 Injection, zoledronic acid, 1 mg

J3520 EDETATE DISODIUM PER 150 MG

J3535 METERED DOSE INHALER DRUG

J3590 UNCLASSIFIED BIOLOGICS

J7030 NORMAL SALINE SOLUTION INFUS

J7040 NORMAL SALINE SOLUTION INFUS

J7042 5% DEXTROSE/NORMAL SALINE

J7060 5% DEXTROSE/WATER

J7070 D5W INFUSION

J7120 RINGERS LACTATE INFUSION

J7191 FACTOR VIII (PORCINE)

J7196 OTHR HEMOPHILIA CLOT FACTORSNew description: INJECTION, ANTITHROMBIN RECOMBINANT, 50 I.U.

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1417

Procedure Code HCPCS Description

J7199 HEMOPHILIA CLOT FACTOR NOC

J7301 Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg

J7308 AMINOLEVULINIC ACID HCL TOP

J7311 FLUOCINOLONE ACETONIDE IMPLT

J7312 DEXAMETHASONE INTRA IMPLANT

J7316 Injection, ocriplasmin, 0.125 mg

J7321 HYALGAN/SUPARTZ INJ PER DOSE

J7323 EUFLEXXA INJ PER DOSE

J7324 ORTHOVISC INJ PER DOSE

J7325 SYNVISC OR SYNVISC-ONE

J7326 GEL-ONE

J7330 CULTURED CHONDROCYTES IMPLNT

J7335 CAPSAICIN 8% PATCH

J7501 AZATHIOPRINE PARENTERAL

J7504 LYMPHOCYTE IMMUNE GLOBULIN

J7505 MONOCLONAL ANTIBODIES

J7511 ANTITHYMOCYTE GLOBULN RABBIT

J7513 DACLIZUMAB, PARENTERAL

J7516 CYCLOSPORIN PARENTERAL 250MG

J7525 TACROLIMUS INJECTION

J7599 IMMUNOSUPPRESSIVE DRUG NOC

J7605 ARFORMOTEROL NON-COMP UNIT

J7608 ACETYLCYSTEINE INH SOL U D

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1418

Procedure Code HCPCS Description

J7611 ALBUTEROL NON-COMP CON

J7612 LEVALBUTEROL NON-COMP CON

J7613 ALBUTEROL NON-COMP UNIT

J7614 LEVALBUTEROL NON-COMP UNIT

J7620 ALBUTEROL SULFATE .083%/ML

J7622 BECLOMETHASOME INHALATN SOL

J7626 BUDESONIDE INHALATION SOL

J7631 CROMOLYN SODIUM INH SOL U D

J7633 BUDESONIDE CONCENTRATED SOL

J7639 DORNASE ALPHA INHAL SOL U D

J7665 ISOPROTERENOL HCL 1% INJ

J7674 METHACHOLINE CHLORIDE, NEB

J7682 TOBRAMYCIN INHALATION SOL

J7699 INHALATION SOLUTION FOR DME

J7799 NON-INHALATION DRUG FOR DME

J8999 ORAL PRESCRIPTION DRUG CHEMO

J9002 DOXIL INJECTION

J9010 DOXORUBICIN HCL, 50 MG VIAL

J9015 ALDESLEUKIN/SINGLE USE VIAL

J9017 ARSENIC TRIOXIDE

J9019 ERWINAZE INJECTION

J9020 ASPARAGINASE INJECTION

J9027 CLOFARABINE INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1419

Procedure Code HCPCS Description

J9031 BCG LIVE INTRAVESICAL VAC

J9033 INJECTION, BENDAMUSTINE HCL, 1 MG

J9042 BRENTUXIMAB VEDOTIN INJ

J9043 CABAZITAXEL INJECTION

J9050 CARMUS BISCHL NITRO INJ

J9065 INJ CLADRIBINE PER 1 MG

J9070 CYCLOPHOSPHAMIDE 100 MG INJ

J9098 CYTARABINE LIPOSOME

J9100 CYTARABINE HCL 100 MG INJ

J9120 DACTINOMYCIN ACTINOMYCIN D

J9130 DACARBAZINE 10 MG INJ

J9150 DAUNORUBICIN

J9151 DAUNORUBICIN CITRATE LIPOSOM

J9155 DEGARELIX INJECTION

J9160 DENILEUKIN DIFTITOX, 300 MCG

J9165 DIETHYLSTILBESTROL INJECTION

J9171 DOCETAXEL INJECTION

J9175 ELLIOTTS B SOLUTION PER ML

J9179 ERIBULIN MESYLATE INJECTION

J9181 ETOPOSIDE 10 MG INJ

J9185 FLUDARABINE PHOSPHATE INJ

J9200 FLOXURIDINE INJECTION

J9202 GOSERELIN ACETATE IMPLANT

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1420

Procedure Code HCPCS Description

J9207 INJECTION, IXABEPILONE, 1 MG

J9208 IFOSFOMIDE INJECTION

J9209 MESNA INJECTION

J9211 IDARUBICIN HCL INJECITON

J9212 INTERFERON ALFACON-1

J9213 INTERFERON ALFA-2A INJ

J9214 INTERFERON ALFA-2B INJ

J9215 INTERFERON ALFA-N3 INJ

J9216 INTERFERON GAMMA 1-B INJ

J9218 LEUPROLIDE ACETATE INJECITON

J9219 LEUPROLIDE ACETATE IMPLANT

J9225 VANTAS IMPLANT

J9226 SUPPRELIN LA IMPLANT

J9228 IPILIMUMAB INJECTION

J9230 MECHLORETHAMINE HCL INJ

J9245 INJ MELPHALAN HYDROCHL 50 MG

J9250 METHOTREXATE SODIUM INJ

J9260 METHOTREXATE SODIUM INJ

J9261 NELARABINE INJECTION

J9262 Injection, omacetaxine mepesuccinate, 0.01 mg

J9266 PEGASPARGASE/SINGL DOSE VIAL

J9268 PENTOSTATIN INJECTION

J9280 MITOMYCIN 5 MG INJ

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1421

Procedure Code HCPCS Description

J9300 GEMTUZUMAB OZOGAMICIN, 5MG

J9302 OFATUMUMAB INJECTION

J9303 PANITUMUMAB INJECTION

J9306 Injection, pertuzumab, 1 mg

J9307 PRALATREXATE INJECTION

J9315 ROMIDEPSIN INJECTION

J9320 STREPTOZOCIN INJECTION

J9328 TEMOZOLOMIDE INJECTION

J9330 Injection, Temsirolimus, 1 MG

J9340 THIOTEPA INJECTION

J9351 TOPOTECAN INJECTION

J9357 VALRUBICIN, 200 MG

J9360 VINBLASTINE SULFATE INJ

J9370 VINCRISTINE SULFATE 1 MG INJ

J9371 Injection, vincristine sulfate liposome, 1 mg

J9395 INJECTION, FULVESTRANT

J9600 PORFIMER SODIUM

J9999 CHEMOTHERAPY DRUG

Q0138 FERUMOXYTOL, NON-ESRD

Q0139 FERUMOXYTOL, ESRD USE

Q0163 DIPHENHYDRAMINE HCL 50MG

Q0164 PROCHLORPERAZINE MALEATE 5MG

Q0165 PROCHLORPERAZINE MALEATE10MG

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1422

Procedure Code HCPCS Description

Q0166 GRANISETRON HCL 1 MG ORAL

Q0167 DRONABINOL 2.5MG ORAL

Q0168 DRONABINOL 5MG ORAL

Q0169 PROMETHAZINE HCL 12.5MG ORAL

Q0170 PROMETHAZINE HCL 25 MG ORAL

Q0171 CHLORPROMAZINE HCL 10MG ORAL

Q0172 CHLORPROMAZINE HCL 25MG ORAL

Q0173 TRIMETHOBENZAMIDE HCL 250MG

Q0175 PERPHENAZINE 4MG ORAL

Q0176 PERPHENAZINE 8MG ORAL

Q0177 HYDROXYZINE PAMOATE 25MG

Q0178 HYDROXYZINE PAMOATE 50MG

Q0180 DOLASETRON MESYLATE ORAL

Q0181 UNSPECIFIED ORAL ANTI-EMETIC

Q2004 BLADDER CALCULI IRRIG SOL

Q2009 FOSPHENYTOIN, 50 MG

Q2017 TENIPOSIDE, 50 MG

Q2026 RADIESSE INJECTION

Q2049 Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including

Q2050 INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL, NOT OTHERWISE SPECIFIED, 10MG

Q2051 INJECTION, ZOLEDRONIC ACID, NOT OTHERWISE SPECIFIED, 1MG

Q3025 IM INJ INTERFERON BETA 1-A

Q3026 SUBC INJ INTERFERON BETA-1A

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1423

Procedure Code HCPCS Description

Q3027 Injection, interferon beta-1a, 1 mcg for intramuscular use

Q3028 Injection, interferon beta-1a, 1 mcg for subcutaneous use

Q4074 ILOPROST NON-COMP UNIT DOSE

Q4081 EPO ALFA 100 UNITS, ESRD

Q9956 INJ OCTAFLUOROPROPANE MIC,ML

Q9957 INJ PERFLUTREN LIP MICROS, ML

S0017 INJECTION, AMINOCAPROIC ACID

S0020 Bupivicaine, HCL, 30 ml

S0021 INJECTION, CEFTOPERAZONE SODIUM, 1 G

S0023 INJECTION, CIMETIDINE HCL, 300 MG

S0028 INJECTION, FAMOTIDINE, 20 MG

S0142 COLISTIMETHATE INH SOL MG

S0145 PEG INTERFERON ALFA-2A/180

S0148 PEG INTERFERON ALFA-2B/10

S0164 INJECTION PANTROPRAZOLE

S0166 INJ OLANZAPINE 2.5MG

S0189 TESTOSTERONE PELLET 75 MG

S4993 Contraceptive pills for birth control

S5010 5% DEXTROSE AND 0.45% SALINE

S5011 5% DEXTROSE IN LACTATED RING

S5550 INSULIN RAPID 5 U

S5551 INSULIN MOST RAPID 5 U

S5552 INSULIN INTERMED 5 U

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1424

Procedure Code HCPCS Description

S5553 INSULIN LONG ACTING 5 U

J0207 AMIFOSTINE

J0585 BOTULINUM TOXIN A PER UNIT

J0640 LEUCOVORIN CALCIUM INJECTION

J0696 CEFTRIAXONE SODIUM INJECTION

J0745 INJ CODEINE PHOSPHATE /30 MG

J0881 DARBEPOETIN ALFA, NON-ESRD

J0885 EPOETIN ALFA, NON-ESRD

J0886 EPOETIN ALFA 1000 UNITS ESRD

J0894 DECITABINE INJECTION

J1040 METHYLPREDNISOLONE 80 MG INJ

J1050 MEDROXYPROGESTERONE INJ

J1100 DEXAMETHASONE SODIUM PHOS

J1170 HYDROMORPHONE INJECTION

J1260 DOLASETRON MESYLATE

J1561 IMMUNE GLOBULIN 500 MG

J1566 IMMUNE GLOBULIN, POWDER

J1626 GRANISETRON HCL INJECTION

J1631 HALOPERIDOL DECANOATE INJ

J1745 INFLIXIMAB INJECTION

J1885 KETOROLAC TROMETHAMINE INJ

J2357 OMALIZUMAB INJECTION

J2405 ONDANSETRON HCL INJECTION

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1425

Procedure Code HCPCS Description

J2430 PAMIDRONATE DISODIUM /30 MG

J2469 PALONOSETRON HCL

J2505 INJECTION, PEGFILGRASTIM 6MG

J2550 PROMETHAZINE HCL INJECTION

J2794 RISPERIDONE, LONG ACTING

J2820 SARGRAMOSTIM INJECTION

J3010 FENTANYL CITRATE INJECITON

J3370 VANCOMYCIN HCL INJECITON

J3487 ZOLEDRONIC ACID

J3490 DRUGS UNCLASSIFIED INJECTION

J7050 NORMAL SALINE SOLUTION INFUS

J7178 HUMAN FIBRINOGEN CONC INJ

J7180PRESCRIPTION, LEGEND, DRUG, FOR MENTAL OR NERVOUS CONDITIONNew description: INJECTION, FACTOR XIII (ANTIHEMOPHILIC FACTOR, HUMAN), 1 I.U.

J7183 WILATE INJECTION

J7185 XYNTHA INJ

J7186 Antihemophilic viii/vwf comp

J7187 HUMATE-P, INJ

J7189 FACTOR VIIA

J7190 FACTOR VIII

J7192 FACTOR VIII RECOMBINANT

J7193 FACTOR IX NON-RECOMBINANT

J7194 FACTOR IX COMPLEX

J7195 FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1426

Procedure Code HCPCS Description

J7197 ANTITHROMBIN III INJECTION

J7198 ANTI-INHIBITOR

J7300 INTRAUT COPPER CONTRACEPTIVE

J7302 LEVONORGESTREL IU CONTRACEPT

J7303 CONTRACEPTIVE VAGINAL RING

J7304 CONTRACEPTIVE HORMONE PATCH

J7307 ETONOGESTREL IMPLANT SYSTEM

J7644 IPRATROPIUM BROM INH SOL U D

J9000 DOXORUBIC HCL 10 MG VL CHEMO

J9025 AZACITIDINE INJECTION

J9035 BEVACIZUMAB INJECTION

J9040 BLEOMYCIN SULFATE INJECTION

J9041 BORTEZOMIB INJECTION

J9045 CARBOPLATIN INJECTION

J9055 CETUXIMAB INJECTION

J9060 CISPLATIN 10 MG INJECITON

J9178 INJ, EPIRUBICIN HCL, 2 MG

J9190 FLUOROURACIL INJECTION

J9201 GEMCITABINE HCL

J9206 IRINOTECAN INJECTION

J9217 LEUPROLIDE ACETATE SUSPNSION

J9263 OXALIPLATIN

J9264 PACLITAXEL PROTEIN BOUND

MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1427

Procedure Code HCPCS Description

J9265 PACLITAXEL INJECTION

J9293 MITOXANTRONE HYDROCHL / 5 MG

J9305 PEMETREXED INJECTION

J9310 RITUXIMAB CANCER TREATMENT

J9355 TRASTUZUMAB

J9390 VINORELBINE TARTRATE/10 MG