MAC Implementation File 8 - New Technology Add-on Payment (NTAP) - Technologies NO LONGER Receiving NTAP 			
Technology	Maximum Add-on Payment	ICD-10-CM/PCS Coding Used to Identify Cases Eligible for NTAP	Alternative Pathways Status
AndexXa(andexanet alfa)	"$18,281.25"	XW03372 or XW04372	
Azedra (iobenguane | 131)	"$98,150.00"	XW033S5 or XW043S5	
Balversa (erdafitinib)	"$3,563.23"	XW0DXL5	
BAROSTIM NEO System	"$22,750.00"	0JH60MZ in combination with 03HK3MZ or 03HL3MZ	Breakthrough Device
CABLIVI (caplacizumab)	"$33,215.00"	XW013W5 or XW033W5 or XW043W5	
ContaCT	"$1,040.00"	4A03X5D	
Eluvia Drug-Eluting Vascular Stent System	"$3,646.50"	"X27H385, X27H395, X27H3B5, X27H3C5, X27J385, X27J395, X27J3B5, X27J3C5, X27K385, X27K395, X27K3B5, X27K3C5, X27L385, X27L395, X27L3B5, or X27L3C5"	
Elzonris	"$144,116.04"	XW033Q5 or XW043Q5	
Exalt Model D	"$1,715.58"	XFJB8A7 or XFJD8A7	Breakthrough Device
FETROJA (cefiderocol) (cUTI/cIAI)	"$7,919.86"	XW033A6 or XW043A6	QIDP
HemosprayEndoscopic Hemostat	"$1,625.00"	XW0G886 or XW0H886	
IMFINZI (durvalumab)	"$6,875.90"	XW03336 or XW04336	
Jakafi (ruxolitimib)	"$4,475.38"	XW0DXT5	
NUZYRAfor Injection	"$1,552.50"	XW033B6 or XW043B6	QIDP
Optimizer System	"$14,950.00"	0JH60AZ or 0JH63AZ or 0JH80AZ or 0JH83AZ	Breakthrough Device
RECARBRIO (cUTI/cIAI)	"$3,532.78"	XW033U5 or XW043U5	QIDP
Soliris (eculizumab)	"$21,199.75"	XW033C6 or XW043C6	
Spravato (esketamine)	"$1,014.79"	XW097M5	
T2Bacteria Test Panel	$97.50	XXE5XM5	
TECENTRIQ (atezolizumab)	"$6,875.90"	XW033D6 or XW043D6	
The SpineJackSystem	"$3,654.72"	XNU0356 or XNU4356	
XENLETA(lefamulin)	"$1,275.75"	XW03366 or XW04366 or XW0DX66	QIDP
Xospata(gilteritinib)	"$7,312.50"	XW0DXV5	
ZEMDRI (plazomicin)	"$4,083.75"	XW033G4 or XW043G4	QIDP
ZERBAXA (ceftolozane and tazobactam)	"$1,836.98"	XW03396 or XW04396	QIDP
