C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Skyrizi™ (risankizumab-rzaa) subcutaneous use* |
05/15/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Kesimpta® (ofatumumab) subcutaneous use* |
07/01/2022 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Adbry™ (tralokinumab-Idrm) |
11/01/2022 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
All insulin products |
11/19/2022 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Mounjaro™ (Tirzepatide) |
11/19/2022 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Idacio® (adalimumab-aacf) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Abrilada™ (adalimumab-afzb) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Hadlima (adalimumab-bwwd) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Hulio® (adalimumab-fkjp) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Hyrimoz® (adalimumab-adaz) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Yusimry (adalimumab-aqvh) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Entyvio® (vedolizumab), subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Yuflyma® (adalimumab-aaty) |
01/14/2024 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Omvoh™ (mirikizumab-mrkz), subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
C9399 |
UNCLASSIFIED DRUGS OR BIOLOGICALS |
Cosentyx® (secukinumab), subcutaneous use* |
10/01/2015 |
N/A |
Acceptable Evidentiary Criteria Available |
J0129 |
INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) |
Abatacept, Orencia®, subcutaneous use* |
10/03/2013 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J0135 |
INJECTION, ADALIMUMAB, 20 MG |
Humira® |
05/01/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration |
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) |
Caverjet®, Edex®, Prostin VR® |
12/01/2002 |
N/A |
Acceptable Evidentiary Criteria Available |
J0490 |
INJECTION, BELIMUMAB, 10 MG |
Benlysta® subcutaneous use* |
07/20/2019 |
N/A |
Acceptable Evidentiary Criteria Available |
J0599 |
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), (HAEGARDA), 10 UNITS |
Haegarda |
01/01/2019 |
N/A |
Acceptable Evidentiary Criteria Available |
J0801 |
INJECTION, CORTICOTROPIN (ACTHAR GEL), UP TO 40 UNITS |
Acthar® Gel, subcutaneous use* |
10/01/2023 |
N/A |
Apparent on its Face |
J0802 |
INJECTION, CORTICOTROPIN (ANI), UP TO 40 UNITS |
Purified Cortrophin Gel®, subcutaneous use* |
10/01/2023 |
N/A |
Apparent on its Face |
J1324 |
INJECTION, ENFUVIRTIDE, 1 MG |
Fuzeon® |
12/01/2002 |
N/A |
Acceptable Evidentiary Criteria Available |
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) |
Enbrel® |
12/01/2002 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J1595 |
INJECTION, GLATIRAMER ACETATE, 20 MG |
Copaxone®, Glatopa® |
09/15/2003 |
N/A |
Acceptable Evidentiary Criteria Available |
J1628 |
INJECTION, GUSELKUMAB, 1 MG |
Tremfya 1 mg |
01/01/2019 |
N/A |
Apparent on its Face |
J1675 |
INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS |
Supprelin LA® |
01/01/2006 |
N/A |
Acceptable Evidentiary Criteria Available |
J1744 |
INJECTION, ICATIBANT, 1 MG |
Firazyr® |
06/18/2012 |
N/A |
Acceptable Evidentiary Criteria Available |
J1811 |
INSULIN (FIASP) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS |
All insulin products |
07/01/2023 |
N/A |
Apparent on its Face |
J1812 |
INSULIN (FIASP), PER 5 UNITS |
All insulin products |
07/01/2023 |
N/A |
Apparent on its Face |
J1813 |
INSULIN (LYUMJEV) FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS |
All insulin products |
07/01/2023 |
N/A |
Apparent on its Face |
J1814 |
INSULIN (LYUMJEV), PER 5 UNITS |
All insulin products |
07/01/2023 |
N/A |
Apparent on its Face |
J1815 |
INJECTION, INSULIN, PER 5 UNITS |
All insulin products |
01/01/2004 |
N/A |
Acceptable Evidentiary Criteria Available |
J1817 |
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS |
All insulin products |
01/01/2004 |
N/A |
Acceptable Evidentiary Criteria Available |
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) |
Betaseron® |
12/01/2002 |
N/A |
Acceptable Evidentiary Criteria Available |
J1941 |
INJECTION, FUROSEMIDE (FUROSCIX), 20 MG |
Furoscix® |
07/01/2023 |
N/A |
Apparent on its Face |
J2170 |
INJECTION, MECASERMIN, 1 MG |
Increlex® |
07/16/2007 |
N/A |
Acceptable Evidentiary Criteria Available |
J2212 |
INJECTION, METHYLNALTREXONE, 0.1 MG |
Relistor® |
09/03/2013 |
N/A |
Acceptable Evidentiary Criteria Available |
J2354 |
INJECTION, OCTREOTIDE, NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS INJECTION, 25 MCG |
Sandostatin® subcutaneous use* |
05/01/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J2440 |
INJECTION, PAPAVERINE HCL, UP TO 60 MG |
Papaverine
(generic) |
09/03/2013 |
N/A |
Acceptable Evidentiary Criteria Available |
J2941 |
INJECTION, SOMATROPIN, 1 MG |
Biotropin®, Genotropin® Nutropin®, Humatrope®, Genotropin®, Genotropin Miniquick®, Norditropin®, Nutropin®, Nutropin AQ®, Omnitrope®, Saizen®, Saizen Somatropin RDNA Origin®, Serostim RDNA Origin®, Zorbtive®, Serostim®, Accretropin™ |
12/01/2002 |
N/A |
Presumption of Long-Term Non-Acute Administration |
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) |
Imitrex®, Imitrex Statdose Pen®, Zembrace™- SymTouch™, Alsuma™, Sumavel® DosePro® |
12/01/2002 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3031 |
INJECTION, FREMANEZUMAB-VFRM, 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) |
Ajovy® |
10/01/2019 |
N/A |
Apparent on its Face |
J3355 |
INJECTION, UROFOLLITROPIN, 75 IU |
Bravelle®, Fertinex®, Metrodin® |
01/01/2006 |
N/A |
Acceptable Evidentiary Criteria Available |
J3357 |
USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MG |
Stelara® |
10/15/2021 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Liraglutide-GLP-1, Victoza® |
09/03/2013 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Tesamorelin, Egrifta® |
09/03/2013 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Mipomersen sodium, Kynamro® |
09/03/2013 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
TriMix |
09/03/2013 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Peginterferon Alfa 2-b, Peg-Intron®, Peg-Intron Redipen®, Sylatron® |
05/01/2003 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Pramlintide acetate, Symlin®, SymlinPen 60®, SymlinPen 120® |
07/16/2007 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Exenatide, Byetta®, Bydureon® |
07/16/2007 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Anakinra, Kineret® |
09/15/2003 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
Albiglutide,
Tanzeum® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Dulaglutide,
Trulicity® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Methotrexate - Solution Auto-injector Non Chemotherapeutic,
Otrexup™,
Rasuvo® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Pasireotide,
Signifor® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Cosentyx®, secukinumab, subcutaneous use* |
10/01/2015 |
N/A |
Acceptable Evidentiary Criteria Available |
J3490 |
UNCLASSIFIED DRUGS |
QuadMix (tri-mix+atropine) |
07/17/2017 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
All insulin products |
07/20/2019 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Cyltezo® (Adalimumab-adbm) |
07/20/2019 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Skyrizi™ (risankizumab-rzaa) subcutaneous use* |
05/15/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Kesimpta® (ofatumumab) subcutaneous use* |
07/01/2022 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Adbry™ (tralokinumab-Idrm) |
11/01/2022 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Mounjaro™ (Tirzepatide) |
11/19/2022 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Idacio® (adalimumab-aacf) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Abrilada™ (adalimumab-afzb) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Hadlima (adalimumab-bwwd) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Hulio® (adalimumab-fkjp) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Hyrimoz® (adalimumab-adaz) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Yusimry (adalimumab-aqvh) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3490 |
UNCLASSIFIED DRUGS |
Entyvio® (vedolizumab), subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Yuflyma® (adalimumab-aaty) |
01/14/2024 |
N/A |
Apparent on its Face |
J3490 |
UNCLASSIFIED DRUGS |
Omvoh™ (mirikizumab-mrkz), subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Entyvio® (vedolizumab), subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Yuflyma® (adalimumab-aaty) |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Omvoh™ (mirikizumab-mrkz), subcutaneous use* |
01/14/2024 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Cosentyx® (secukinumab), subcutaneous use* |
10/01/2015 |
N/A |
Acceptable Evidentiary Criteria Available |
J3590 |
UNCLASSIFIED BIOLOGICS |
Yusimry (adalimumab-aqvh) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Hyrimoz® (adalimumab-adaz) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Hulio® (adalimumab-fkjp) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Hadlima (adalimumab-bwwd) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Abrilada™ (adalimumab-afzb) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Idacio® (adalimumab-aacf) |
06/25/2023 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Mounjaro™ (Tirzepatide) |
11/19/2022 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Adbry™ (tralokinumab-Idrm) |
11/01/2022 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Kesimpta® (ofatumumab) subcutaneous use* |
07/01/2022 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Skyrizi™ (risankizumab-rzaa) subcutaneous use* |
05/15/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Emgality® (Galcanezumab-gnlm) |
07/20/2019 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Tymlos® (abaloparatide) |
07/20/2019 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Kevzara® (Sarilumab) |
07/20/2019 |
N/A |
Acceptable Evidentiary Criteria Available |
J3590 |
UNCLASSIFIED BIOLOGICS |
Ozempic® (semaglutide) |
07/20/2019 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
Aimovig™ (erenumab-aooe) |
07/20/2019 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Dupixent® |
07/17/2017 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Siliq™ |
07/17/2017 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Erelzi™ |
07/17/2017 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Ixekizumab, Taltz® |
11/14/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Liraglutide, Saxenda®, Victoza® |
11/14/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Metreleptin, Myalept® |
11/14/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Alirocumab,
Praluent® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Evolcumab,
Repatha® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
All insulin products |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Parathyroid Hormone,
Natpara® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Peginterferon beta-1a,
Plegridy® |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Golimumab, Simponi® |
10/22/2012 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Pegvisomant, Somavert® |
07/16/2007 |
N/A |
Acceptable Evidentiary Criteria Available |
J3590 |
UNCLASSIFIED BIOLOGICS |
Pegylated Interferon Alfa-2a, Pegasys® , Pegasys ProClick™ |
10/03/2013 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J3590 |
UNCLASSIFIED BIOLOGICS |
Sogroya (somapacitan-beco) |
04/05/2021 |
N/A |
Apparent on its Face |
J3590 |
UNCLASSIFIED BIOLOGICS |
BESREMi® (ropeginterferon alfa-2b-njft) |
04/24/2022 |
N/A |
Presumption of Long-Term Non-Acute Administration |
J9216 |
INJECTION, INTERFERON, GAMMA 1-B, 3 MILLION UNITS |
Actimmune® |
05/01/2003 |
N/A |
Acceptable Evidentiary Criteria Available |
J9218 |
LEUPROLIDE ACETATE, PER 1 MG |
Eligard® |
12/01/2002 |
N/A |
Presumption of Long-Term Non-Acute Administration |
Q3027 |
INJECTION, INTERFERON BETA-1A, 1 MCG FOR INTRAMUSCULAR USE |
Avonex Pen® |
07/17/2017 |
N/A |
Presumption of Long-Term Non-Acute Administration |
Q3028 |
INJECTION, INTERFERON BETA-1A, 1 MCG FOR SUBCUTANEOUS USE |
Rebif®, Rebif®Rebidose |
05/16/2016 |
N/A |
Presumption of Long-Term Non-Acute Administration |
Q5131 |
INJECTION, ADALIMUMAB-AACF (IDACIO), BIOSIMILAR, 20 MG |
Idacio® |
07/01/2023 |
N/A |
Apparent on its Face |