Default Fee Schedules Part 4
Default Fee Schedules Part 4
| Code | Price | Type | Description |
| G9659 | 0 | HCPCS / CPT® | >85Y NO HX COLO CA/RSN SCOPE |
| G9660 | 0 | HCPCS / CPT® | DOC MED RSN SCOPE PT >85Y |
| G9661 | 0 | HCPCS / CPT® | >85Y SCOPE OTHR RSN |
| G9662 | 0 | HCPCS / CPT® | PRIOR DX/ACTIVE CLIN ASCVD |
| G9663 | 0 | HCPCS / CPT® | FAST/DIR LDL = 190 MG/DL |
| G9664 | 0 | HCPCS / CPT® | TAKING STATIN OR REC’D ORDER |
| G9665 | 0 | HCPCS / CPT® | NO STATIN/NO ORDER STATIN |
| G9666 | 0 | HCPCS / CPT® | FAS/DIR LDL 70-189MG/DL MST |
| G9674 | 0 | HCPCS / CPT® | PT W/CLIN ASCVD DX |
| G9675 | 0 | HCPCS / CPT® | PT W/FAST/DIR LAB LDL-C >190 |
| G9676 | 0 | HCPCS / CPT® | 40-75Y W/TYPE 1/2 W/LDL-C RS |
| G9678 | 0 | HCPCS / CPT® | ONCOLOGY CARE MODEL SERVICE |
| G9679 | 0 | HCPCS / CPT® | ACUTE CARE PNEUMONIA |
| G9680 | 0 | HCPCS / CPT® | ACUTE CARE CONGESTIVE HEART |
| G9681 | 0 | HCPCS / CPT® | ACUTE CARE CHRONIC OBSTRUCT |
| G9682 | 0 | HCPCS / CPT® | ACUTE CARE SKIN INFECTION |
| G9683 | 0 | HCPCS / CPT® | ACUTE CARE FLUID OR ELECTROL |
| G9684 | 0 | HCPCS / CPT® | ACUTE CARE URINARY TRACT INF |
| G9685 | 0 | HCPCS / CPT® | ACUTE NURSING FACILITY CARE |
| G9686 | 0 | HCPCS / CPT® | NURSING FACILITY CONFERENCE |
| G9687 | 0 | HCPCS / CPT® | HOSPICE ANYTIME MSMT PER |
| G9688 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9689 | 0 | HCPCS / CPT® | INPT ELECT CAROTID INTERVENT |
| G9690 | 0 | HCPCS / CPT® | PT REC HOSPICE DUR MSMT PER |
| G9691 | 0 | HCPCS / CPT® | PT HOSP DUR MSMT PERIOD |
| G9692 | 0 | HCPCS / CPT® | HOSP RECD BY PT DUR MSMT PER |
| G9693 | 0 | HCPCS / CPT® | PT USE HOSP DURING MSMT PER |
| G9694 | 0 | HCPCS / CPT® | HOSP SRV USED PT IN MSMT PER |
| G9695 | 0 | HCPCS / CPT® | LONG ACT INHAL BRONCHDIL PRE |
| G9696 | 0 | HCPCS / CPT® | MED RSN NO PRESC BRONCHDIL |
| G9697 | 0 | HCPCS / CPT® | PT RSN NO PRESC BRONCHDIL |
| G9698 | 0 | HCPCS / CPT® | SYS RSN NO PRESC BRONCHDIL |
| G9699 | 0 | HCPCS / CPT® | LONG INHAL BRONCHDIL NO PRES |
| G9700 | 0 | HCPCS / CPT® | PT IS W/HOSP DURING MSMT PER |
| G9701 | 0 | HCPCS / CPT® | CHILD ANBX 30 PRIOR DX ESTAB |
| G9702 | 0 | HCPCS / CPT® | PT USE HOSP DURING MSMT PER |
| G9703 | 0 | HCPCS / CPT® | CHILD ANBX 30 PRIOR DX PHARY |
| G9704 | 0 | HCPCS / CPT® | AJCC BR CA STG I: T1 MIC/T1A |
| G9705 | 0 | HCPCS / CPT® | AJCC BR CA STG IB |
| G9706 | 0 | HCPCS / CPT® | LOW RECUR PROST CA |
| G9707 | 0 | HCPCS / CPT® | PT HAD HOSP DUR MSMT PER |
| G9708 | 0 | HCPCS / CPT® | BILAT MAST/HX BI /UNILAT MAS |
| G9709 | 0 | HCPCS / CPT® | HOSP SRV USED PT IN MSMT PER |
| G9710 | 0 | HCPCS / CPT® | PT PROV HOSP SRV MSMT PER |
| G9711 | 0 | HCPCS / CPT® | PT HX TOT COL OR COLON CA |
| G9712 | 0 | HCPCS / CPT® | DOC MED RSN PRESC ANBX |
| G9713 | 0 | HCPCS / CPT® | PT USE HOSP DURING MSMT PER |
| G9714 | 0 | HCPCS / CPT® | PT IS W/HOSP DURING MSMT PER |
| G9715 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9716 | 0 | HCPCS / CPT® | BMI NOT NORM, NO FOLLOW, DOC |
| G9717 | 0 | HCPCS / CPT® | DOC DX DEPR/DX BIPOL, NO SCR |
| G9718 | 0 | HCPCS / CPT® | HOSPICE ANYTIME MSMT PER |
| G9719 | 0 | HCPCS / CPT® | PT NOT AMBUL/IMMOB/WC |
| G9720 | 0 | HCPCS / CPT® | HOSPICE ANYTIME MSMT PER |
| G9721 | 0 | HCPCS / CPT® | PT NOT AMBUL/IMMOB/WC |
| G9722 | 0 | HCPCS / CPT® | DOC HX RENAL FAIL OR CR+ >4 |
| G9723 | 0 | HCPCS / CPT® | HOSP RECD BY PT DUR MSMT PER |
| G9724 | 0 | HCPCS / CPT® | PT W/DOC USE ANTICOAG MST YR |
| G9725 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9726 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9727 | 0 | HCPCS / CPT® | NO KNEE INTAKE PROM, NO PROX |
| G9728 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9729 | 0 | HCPCS / CPT® | NO HIP INTAKE PROM, NO PROXY |
| G9730 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9731 | 0 | HCPCS / CPT® | NO FOOT PROM, NO PROXY |
| G9732 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9733 | 0 | HCPCS / CPT® | NO BACK INTAKE PROM, NO PROX |
| G9734 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9735 | 0 | HCPCS / CPT® | PT NO FOTO KNEE AND NO PROXY |
| G9736 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9737 | 0 | HCPCS / CPT® | PT NO FOTO ELBOW, NO PROXY |
| G9738 | 0 | HCPCS / CPT® | REFUSED TO PARTICIPATE |
| G9739 | 0 | HCPCS / CPT® | PT NO FOTO ORTH, NO PROXY |
| G9740 | 0 | HCPCS / CPT® | HOSP SRV TO PT DUR MSMT PER |
| G9741 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9742 | 0 | HCPCS / CPT® | PSYCH SYMPT ASSESSED |
| G9743 | 0 | HCPCS / CPT® | PSYCH SYMP NOT ASSESSED, RNS |
| G9744 | 0 | HCPCS / CPT® | PT NOT ELIG, DX HTN |
| G9745 | 0 | HCPCS / CPT® | DOC RSN NO SCR HIGH BP |
| G9746 | 0 | HCPCS / CPT® | MIT STEN, VALVE OR TRANS AF |
| G9747 | 0 | HCPCS / CPT® | PALL DIALYSIS WITH CATHETER |
| G9748 | 0 | HCPCS / CPT® | APP TRANSPL LVG KIDNEY DONOR |
| G9749 | 0 | HCPCS / CPT® | PALL DIALYSIS WITH CATHETER |
| G9750 | 0 | HCPCS / CPT® | APP TRANSPL LVG KIDNEY DONOR |
| G9751 | 0 | HCPCS / CPT® | PT DIED W/IN 24 MOS RPT TIME |
| G9752 | 0 | HCPCS / CPT® | URGENT SURGERY |
| G9753 | 0 | HCPCS / CPT® | DOC NO DICOM, CT OTHER FAC |
| G9754 | 0 | HCPCS / CPT® | INCID PULM NODULE |
| G9755 | 0 | HCPCS / CPT® | DOC MED RSN FOR IMAGING |
| G9756 | 0 | HCPCS / CPT® | SURG PROC W/SILICONE OIL |
| G9757 | 0 | HCPCS / CPT® | SURG PROC W/SILICONE OIL |
| G9758 | 0 | HCPCS / CPT® | HOSPICE OR TERM PHASE |
| G9759 | 0 | HCPCS / CPT® | HX PREOP POST CAP RUP |
| G9760 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9761 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9762 | 0 | HCPCS / CPT® | PT HAD HPV B/T 9-13 YR |
| G9763 | 0 | HCPCS / CPT® | PT NO HPV B/T 9-13 YR |
| G9764 | 0 | HCPCS / CPT® | PT TX ORAL SYST/BIO MED PSOR |
| G9765 | 0 | HCPCS / CPT® | PT DECL CHAN/CONIND OR <6M |
| G9766 | 0 | HCPCS / CPT® | CVA STROKE DX TX TRANSF FAC |
| G9767 | 0 | HCPCS / CPT® | HOSP NEW DX CVA CONSID EVST |
| G9768 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9769 | 0 | HCPCS / CPT® | BN DEN 2YR/GOT OST MED/THER |
| G9770 | 0 | HCPCS / CPT® | PERIP NERVE BLOCK |
| G9771 | 0 | HCPCS / CPT® | ANES END, 1 TEMP >35.5(95.9) |
| G9772 | 0 | HCPCS / CPT® | DOC TEMP >35.5(95.9), ANEST |
| G9773 | 0 | HCPCS / CPT® | NO TEMP >35.5(95.9), ANES |
| G9774 | 0 | HCPCS / CPT® | PT HAD HYST |
| G9775 | 0 | HCPCS / CPT® | RECD 2 ANTI-EMET PRE/INTRAOP |
| G9776 | 0 | HCPCS / CPT® | DOC MED RSN NO PROPH ANTIEM |
| G9777 | 0 | HCPCS / CPT® | PT NO ANTIEMET PRE/INTRAOP |
| G9778 | 0 | HCPCS / CPT® | PTS DX W/PREGN |
| G9779 | 0 | HCPCS / CPT® | PTS BREASTFEEDING |
| G9780 | 0 | HCPCS / CPT® | PTS DX W/RHABDOMYOLYSIS |
| G9781 | 0 | HCPCS / CPT® | DOC RSN NO STATIN |
| G9782 | 0 | HCPCS / CPT® | HX DX FAM/PURE HYPERCHOLES |
| G9783 | 0 | HCPCS / CPT® | DOC DX DM, FAST <70, NO STAT |
| G9784 | 0 | HCPCS / CPT® | PATH/DERM 2ND OPIN BX |
| G9785 | 0 | HCPCS / CPT® | PATH RPT SNT PATH/DERM IN 7D |
| G9786 | 0 | HCPCS / CPT® | NO PATH RPT SENT IN 7D |
| G9787 | 0 | HCPCS / CPT® | PT ALIVE LST DAY MSMT YR |
| G9788 | 0 | HCPCS / CPT® | MOST RCT BP </= 140/90 |
| G9789 | 0 | HCPCS / CPT® | RECORD BP IP, ER, URG/SELF |
| G9790 | 0 | HCPCS / CPT® | MOST RCT BP >/= 140/90 |
| G9791 | 0 | HCPCS / CPT® | MOST RCT TOB STAT FREE |
| G9792 | 0 | HCPCS / CPT® | MOST RCT TOB STAT NOT FREE |
| G9793 | 0 | HCPCS / CPT® | PT ON DAILY ASA/ANTIPLAT |
| G9794 | 0 | HCPCS / CPT® | DOC MED RSN NO ASA/ANTIPLAT |
| G9795 | 0 | HCPCS / CPT® | PT NO DAILY ASA/ANTIPLAT |
| G9796 | 0 | HCPCS / CPT® | PT NOT CURRENTLY ON STATIN |
| G9797 | 0 | HCPCS / CPT® | PT CURRENTLY ON STATIN |
| G9798 | 0 | HCPCS / CPT® | D/C AMI BTW 7/1-6/30 MST PER |
| G9799 | 0 | HCPCS / CPT® | MED DISP EVT INDIC HX ASTH |
| G9800 | 0 | HCPCS / CPT® | PT ID INTOL/ALLEG BETA-BLOCK |
| G9801 | 0 | HCPCS / CPT® | NONACUT TRANSF FROM INPT |
| G9802 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9803 | 0 | HCPCS / CPT® | POST D/C 180D TX BETA-BL AMI |
| G9804 | 0 | HCPCS / CPT® | NO POST D/C 180D TX BB AMI |
| G9805 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9806 | 0 | HCPCS / CPT® | PT RECD CERV CYTO/HPV |
| G9807 | 0 | HCPCS / CPT® | PT NO RECD CERV CYTO/HPV |
| G9808 | 0 | HCPCS / CPT® | PT NO ASTHM CONT MED MST PER |
| G9809 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9810 | 0 | HCPCS / CPT® | PDC 75% W/ASTH CONT MED |
| G9811 | 0 | HCPCS / CPT® | NO PDC 75% W/ASTH CONT MED |
| G9812 | 0 | HCPCS / CPT® | PT DIED DURING INPT/30D AFT |
| G9813 | 0 | HCPCS / CPT® | PT NOT DIED W/IN 30D OF PROC |
| G9814 | 0 | HCPCS / CPT® | DEATH OCC DUR HOSPITALIZ |
| G9815 | 0 | HCPCS / CPT® | NO DEATH OCC DUR HOSPITALIZ |
| G9816 | 0 | HCPCS / CPT® | DEATH OCC 30D POST PROC |
| G9817 | 0 | HCPCS / CPT® | NO DEATH OCC 30D POST PROC |
| G9818 | 0 | HCPCS / CPT® | DOC SEX ACTIVITY |
| G9819 | 0 | HCPCS / CPT® | PT W/HOSP ANYTIME MSMT PER |
| G9820 | 0 | HCPCS / CPT® | DOC CHLAM SCR TEST W/FOLLOW |
| G9821 | 0 | HCPCS / CPT® | NO DOC CHLAM SCR TS W/FOLLOW |
| G9822 | 0 | HCPCS / CPT® | ENDO ABL PROC YR PREV IND DT |
| G9823 | 0 | HCPCS / CPT® | ENDO SMPL/HYST BX RES DOC |
| G9824 | 0 | HCPCS / CPT® | ENDO SMPL/HYST BX RES NO DOC |
| G9825 | 0 | HCPCS / CPT® | HER-2 NEG,UNDOC/UNKN |
| G9826 | 0 | HCPCS / CPT® | TRANSF PRACT AFT INIT CHEMO |
| G9827 | 0 | HCPCS / CPT® | HER-2 TARG THER NO INIT TX |
| G9828 | 0 | HCPCS / CPT® | HER-2 TARG THER DUR INIT TX |
| G9829 | 0 | HCPCS / CPT® | BREAST ADJ CHEMO ADMIN |
| G9830 | 0 | HCPCS / CPT® | HER-2 POS |
| G9831 | 0 | HCPCS / CPT® | AJCC STG BRT CA DX II OR III |
| G9832 | 0 | HCPCS / CPT® | BRT CA DX I, NO T1/T1A/T1B |
| G9833 | 0 | HCPCS / CPT® | TRANSF PRACT AFT INIT CHEMO |
| G9834 | 0 | HCPCS / CPT® | PT MET DIS AT DX |
| G9835 | 0 | HCPCS / CPT® | TRASTUZ GIVEN W/IN 12 MOS DX |
| G9836 | 0 | HCPCS / CPT® | RSN NO TRAST GIVEN DOC |
| G9837 | 0 | HCPCS / CPT® | TRASTUZ NOT IN 12 MOS DX |
| G9838 | 0 | HCPCS / CPT® | PT MET DIS AT DX |
| G9839 | 0 | HCPCS / CPT® | ANTI-EGFR MON ANTI THER |
| G9840 | 0 | HCPCS / CPT® | KRAS TST BFR BEG ANTI MOAB |
| G9841 | 0 | HCPCS / CPT® | NO KRAS TST BFR BEG ANT MOAB |
| G9842 | 0 | HCPCS / CPT® | PT MET DIS AT DX |
| G9843 | 0 | HCPCS / CPT® | KRAS GENE MUT |
| G9844 | 0 | HCPCS / CPT® | PT NO RECD ANTI-EGFR THER |
| G9845 | 0 | HCPCS / CPT® | PT RECD ANTI-EGFR THER |
| G9846 | 0 | HCPCS / CPT® | PT DIED FROM CANCER |
| G9847 | 0 | HCPCS / CPT® | PT RECD CHEMO LAST 14D LIFE |
| G9848 | 0 | HCPCS / CPT® | PT NO CHEMO LAST 14D LIFE |
| G9849 | 0 | HCPCS / CPT® | PT DIED FROM CANCER |
| G9850 | 0 | HCPCS / CPT® | 1/MORE ED LAST 30D LIFE |
| G9851 | 0 | HCPCS / CPT® | 1/NO ED VISIT LAST 30D LIFE |
| G9852 | 0 | HCPCS / CPT® | PT DIED FROM CANCER |
| G9853 | 0 | HCPCS / CPT® | ICU STAY LAST 30D LIFE |
| G9854 | 0 | HCPCS / CPT® | NO ICU STAY LAST 30D LIFE |
| G9855 | 0 | HCPCS / CPT® | PT DIED FROM CANCER |
| G9856 | 0 | HCPCS / CPT® | PT NO HOSPICE |
| G9857 | 0 | HCPCS / CPT® | PT ADMIT HOSPICE |
| G9858 | 0 | HCPCS / CPT® | PT ENROLL HOSPICE |
| G9859 | 0 | HCPCS / CPT® | PT DIED FROM CANCER |
| G9860 | 0 | HCPCS / CPT® | PT LESS 3D HOSPICE |
| G9861 | 0 | HCPCS / CPT® | PT MORE THAN 3D HOSPICE |
| G9862 | 0 | HCPCS / CPT® | DOC RSN NO 10 YR FOLLOW |
| H0001 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG ASSESS |
| H0002 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SCREENIN |
| H0003 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SCREENIN |
| H0004 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0005 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0006 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0007 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0008 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0009 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0010 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0011 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0012 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0013 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0014 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0015 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0016 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0017 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0018 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0019 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0020 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG SERVICES |
| H0021 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG TRAINING |
| H0022 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG INTERVEN |
| H0023 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG OUTREACH |
| H0024 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG PREVENTI |
| H0025 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG PREVENTI |
| H0026 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG PREVENTI |
| H0027 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG PREVENTI |
| H0028 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG PREVENTI |
| H0029 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG PREVENTI |
| H0030 | 0 | HCPCS / CPT® | ALCOHOL AND/OR DRUG HOTLINE |
| H0031 | 0 | HCPCS / CPT® | MH HEALTH ASSESS BY NON-MD |
| H0032 | 0 | HCPCS / CPT® | MH SVC PLAN DEV BY NON-MD |
| H0033 | 0 | HCPCS / CPT® | ORAL MED ADM DIRECT OBSERVE |
| H0034 | 0 | HCPCS / CPT® | MED TRNG & SUPPORT PER 15MIN |
| H0035 | 0 | HCPCS / CPT® | MH PARTIAL HOSP TX UNDER 24H |
| H0036 | 0 | HCPCS / CPT® | COMM PSY FACE-FACE PER 15MIN |
| H0037 | 0 | HCPCS / CPT® | COMM PSY SUP TX PGM PER DIEM |
| H0038 | 0 | HCPCS / CPT® | SELF-HELP/PEER SVC PER 15MIN |
| H0039 | 0 | HCPCS / CPT® | ASSER COM TX FACE-FACE/15MIN |
| H0040 | 0 | HCPCS / CPT® | ASSERT COMM TX PGM PER DIEM |
| H0041 | 0 | HCPCS / CPT® | FOS C CHLD NON-THER PER DIEM |
| H0042 | 0 | HCPCS / CPT® | FOS C CHLD NON-THER PER MON |
| H0043 | 0 | HCPCS / CPT® | SUPPORTED HOUSING, PER DIEM |
| H0044 | 0 | HCPCS / CPT® | SUPPORTED HOUSING, PER MONTH |
| H0045 | 0 | HCPCS / CPT® | RESPITE NOT-IN-HOME PER DIEM |
| H0046 | 0 | HCPCS / CPT® | MENTAL HEALTH SERVICE, NOS |
| H0047 | 0 | HCPCS / CPT® | ALCOHOL/DRUG ABUSE SVC NOS |
| H0048 | 0 | HCPCS / CPT® | SPEC COLL NON-BLOOD:A/D TEST |
| H0049 | 0 | HCPCS / CPT® | ALCOHOL/DRUG SCREENING |
| H0050 | 0 | HCPCS / CPT® | ALCOHOL/DRUG SERVICE 15 MIN |
| H1000 | 0 | HCPCS / CPT® | PRENATAL CARE ATRISK ASSESSM |
| H1001 | 0 | HCPCS / CPT® | ANTEPARTUM MANAGEMENT |
| H1002 | 0 | HCPCS / CPT® | CARECOORDINATION PRENATAL |
| H1003 | 0 | HCPCS / CPT® | PRENATAL AT RISK EDUCATION |
| H1004 | 0 | HCPCS / CPT® | FOLLOW UP HOME VISIT/PRENTAL |
| H1005 | 0 | HCPCS / CPT® | PRENATALCARE ENHANCED SRV PK |
| H1010 | 0 | HCPCS / CPT® | NONMED FAMILY PLANNING ED |
| H1011 | 0 | HCPCS / CPT® | FAMILY ASSESSMENT |
| H2000 | 0 | HCPCS / CPT® | COMP MULTIDISIPLN EVALUATION |
| H2001 | 0 | HCPCS / CPT® | REHABILITATION PROGRAM 1/2 D |
| H2010 | 0 | HCPCS / CPT® | COMPREHENSIVE MED SVC 15 MIN |
| H2011 | 0 | HCPCS / CPT® | CRISIS INTERVEN SVC, 15 MIN |
| H2012 | 0 | HCPCS / CPT® | BEHAV HLTH DAY TREAT, PER HR |
| H2013 | 0 | HCPCS / CPT® | PSYCH HLTH FAC SVC, PER DIEM |
| H2014 | 0 | HCPCS / CPT® | SKILLS TRAIN AND DEV, 15 MIN |
| H2015 | 0 | HCPCS / CPT® | COMP COMM SUPP SVC, 15 MIN |
| H2016 | 0 | HCPCS / CPT® | COMP COMM SUPP SVC, PER DIEM |
| H2017 | 0 | HCPCS / CPT® | PSYSOC REHAB SVC, PER 15 MIN |
| H2018 | 0 | HCPCS / CPT® | PSYSOC REHAB SVC, PER DIEM |
| H2019 | 0 | HCPCS / CPT® | THER BEHAV SVC, PER 15 MIN |
| H2020 | 0 | HCPCS / CPT® | THER BEHAV SVC, PER DIEM |
| H2021 | 0 | HCPCS / CPT® | COM WRAP-AROUND SV, 15 MIN |
| H2022 | 0 | HCPCS / CPT® | COM WRAP-AROUND SV, PER DIEM |
| H2023 | 0 | HCPCS / CPT® | SUPPORTED EMPLOY, PER 15 MIN |
| H2024 | 0 | HCPCS / CPT® | SUPPORTED EMPLOY, PER DIEM |
| H2025 | 0 | HCPCS / CPT® | SUPP MAINT EMPLOY, 15 MIN |
| H2026 | 0 | HCPCS / CPT® | SUPP MAINT EMPLOY, PER DIEM |
| H2027 | 0 | HCPCS / CPT® | PSYCHOED SVC, PER 15 MIN |
| H2028 | 0 | HCPCS / CPT® | SEX OFFEND TX SVC, 15 MIN |
| H2029 | 0 | HCPCS / CPT® | SEX OFFEND TX SVC, PER DIEM |
| H2030 | 0 | HCPCS / CPT® | MH CLUBHOUSE SVC, PER 15 MIN |
| H2031 | 0 | HCPCS / CPT® | MH CLUBHOUSE SVC, PER DIEM |
| H2032 | 0 | HCPCS / CPT® | ACTIVITY THERAPY, PER 15 MIN |
| H2033 | 0 | HCPCS / CPT® | MULTISYS THER/JUVENILE 15MIN |
| H2034 | 0 | HCPCS / CPT® | A/D HALFWAY HOUSE, PER DIEM |
| H2035 | 0 | HCPCS / CPT® | A/D TX PROGRAM, PER HOUR |
| H2036 | 0 | HCPCS / CPT® | A/D TX PROGRAM, PER DIEM |
| H2037 | 0 | HCPCS / CPT® | DEV DELAY PREV DP CH, 15 MIN |
| J0120 | 65 | HCPCS / CPT® | TETRACYCLIN INJECTION |
| J0129 | 65 | HCPCS / CPT® | ABATACEPT INJECTION |
| J0130 | 65 | HCPCS / CPT® | ABCIXIMAB INJECTION |
| J0131 | 65 | HCPCS / CPT® | ACETAMINOPHEN INJECTION |
| J0132 | 65 | HCPCS / CPT® | ACETYLCYSTEINE INJECTION |
| J0133 | 65 | HCPCS / CPT® | ACYCLOVIR INJECTION |
| J0135 | 65 | HCPCS / CPT® | ADALIMUMAB INJECTION |
| J0153 | 10 | HCPCS / CPT® | ADENOSINE INJ 1MG |
| J0171 | 10 | HCPCS / CPT® | ADRENALIN EPINEPHRINE INJECT |
| J0178 | 65 | HCPCS / CPT® | AFLIBERCEPT INJECTION |
| J0180 | 65 | HCPCS / CPT® | AGALSIDASE BETA INJECTION |
| J0190 | 65 | HCPCS / CPT® | INJ BIPERIDEN LACTATE/5 MG |
| J0200 | 65 | HCPCS / CPT® | ALATROFLOXACIN MESYLATE |
| J0202 | 65 | HCPCS / CPT® | INJECTION, ALEMTUZUMAB |
| J0205 | 65 | HCPCS / CPT® | ALGLUCERASE INJECTION |
| J0207 | 65 | HCPCS / CPT® | AMIFOSTINE |
| J0210 | 65 | HCPCS / CPT® | METHYLDOPATE HCL INJECTION |
| J0215 | 65 | HCPCS / CPT® | ALEFACEPT |
| J0220 | 65 | HCPCS / CPT® | ALGLUCOSIDASE ALFA INJECTION |
| J0221 | 65 | HCPCS / CPT® | LUMIZYME INJECTION |
| J0256 | 65 | HCPCS / CPT® | ALPHA 1 PROTEINASE INHIBITOR |
| J0257 | 65 | HCPCS / CPT® | GLASSIA INJECTION |
| J0270 | 65 | HCPCS / CPT® | ALPROSTADIL FOR INJECTION |
| J0275 | 65 | HCPCS / CPT® | ALPROSTADIL URETHRAL SUPPOS |
| J0278 | 65 | HCPCS / CPT® | AMIKACIN SULFATE INJECTION |
| J0280 | 65 | HCPCS / CPT® | AMINOPHYLLIN 250 MG INJ |
| J0282 | 12 | HCPCS / CPT® | AMIODARONE HCL |
| J0285 | 65 | HCPCS / CPT® | AMPHOTERICIN B |
| J0287 | 65 | HCPCS / CPT® | AMPHOTERICIN B LIPID COMPLEX |
| J0288 | 65 | HCPCS / CPT® | AMPHO B CHOLESTERYL SULFATE |
| J0289 | 65 | HCPCS / CPT® | AMPHOTERICIN B LIPOSOME INJ |
| J0290 | 22 | HCPCS / CPT® | AMPICILLIN 500 MG INJ |
| J0295 | 49 | HCPCS / CPT® | AMPICILLIN SODIUM PER 1.5 GM |
| J0300 | 65 | HCPCS / CPT® | AMOBARBITAL 125 MG INJ |
| J0330 | 157 | HCPCS / CPT® | SUCCINYCHOLINE CHLORIDE INJ |
| J0348 | 65 | HCPCS / CPT® | ANIDULAFUNGIN INJECTION |
| J0350 | 65 | HCPCS / CPT® | INJECTION ANISTREPLASE 30 U |
| J0360 | 65 | HCPCS / CPT® | HYDRALAZINE HCL INJECTION |
| J0364 | 65 | HCPCS / CPT® | APOMORPHINE HYDROCHLORIDE |
| J0365 | 65 | HCPCS / CPT® | APROTONIN, 10,000 KIU |
| J0380 | 65 | HCPCS / CPT® | INJ METARAMINOL BITARTRATE |
| J0390 | 65 | HCPCS / CPT® | CHLOROQUINE INJECTION |
| J0395 | 65 | HCPCS / CPT® | ARBUTAMINE HCL INJECTION |
| J0400 | 65 | HCPCS / CPT® | ARIPIPRAZOLE INJECTION |
| J0401 | 65 | HCPCS / CPT® | INJ ARIPIPRAZOLE EXT REL 1MG |
| J0456 | 74 | HCPCS / CPT® | AZITHROMYCIN |
| J0461 | 65 | HCPCS / CPT® | ATROPINE SULFATE INJECTION |
| J0470 | 65 | HCPCS / CPT® | DIMECAPROL INJECTION |
| J0475 | 65 | HCPCS / CPT® | BACLOFEN 10 MG INJECTION |
| J0476 | 65 | HCPCS / CPT® | BACLOFEN INTRATHECAL TRIAL |
| J0480 | 65 | HCPCS / CPT® | BASILIXIMAB |
| J0485 | 65 | HCPCS / CPT® | BELATACEPT INJECTION |
| J0490 | 65 | HCPCS / CPT® | BELIMUMAB INJECTION |
| J0500 | 22 | HCPCS / CPT® | DICYCLOMINE INJECTION |
| J0515 | 65 | HCPCS / CPT® | INJ BENZTROPINE MESYLATE |
| J0520 | 65 | HCPCS / CPT® | BETHANECHOL CHLORIDE INJECT |
| J0558 | 68 | HCPCS / CPT® | PENG BENZATHINE/PROCAINE INJ |
| J0561 | 56 | HCPCS / CPT® | PENICILLIN G BENZATHINE INJ |
| J0570 | 65 | HCPCS / CPT® | BUPRENORPHINE IMPLANT 74.2MG |
| J0571 | 65 | HCPCS / CPT® | BUPRENORPHINE ORAL 1MG |
| J0572 | 65 | HCPCS / CPT® | BUPREN/NAL UP TO 3MG BUPRENO |
| J0573 | 65 | HCPCS / CPT® | BUPREN/NAL 3.1 TO 6MG BUPREN |
| J0574 | 65 | HCPCS / CPT® | BUPREN/NAL 6.1 TO 10MG BUPRE |
| J0575 | 65 | HCPCS / CPT® | BUPREN/NAL OVER 10MG BUPRENO |
| J0583 | 65 | HCPCS / CPT® | BIVALIRUDIN |
| J0585 | 65 | HCPCS / CPT® | INJECTION,ONABOTULINUMTOXINA |
| J0586 | 65 | HCPCS / CPT® | ABOBOTULINUMTOXINA |
| J0587 | 65 | HCPCS / CPT® | INJ, RIMABOTULINUMTOXINB |
| J0588 | 65 | HCPCS / CPT® | INCOBOTULINUMTOXIN A |
| J0592 | 65 | HCPCS / CPT® | BUPRENORPHINE HYDROCHLORIDE |
| J0594 | 65 | HCPCS / CPT® | BUSULFAN INJECTION |
| J0595 | 65 | HCPCS / CPT® | BUTORPHANOL TARTRATE 1 MG |
| J0596 | 65 | HCPCS / CPT® | INJECTION, RUCONEST |
| J0597 | 65 | HCPCS / CPT® | C-1 ESTERASE, BERINERT |
| J0598 | 65 | HCPCS / CPT® | C-1 ESTERASE, CINRYZE |
| J0600 | 65 | HCPCS / CPT® | EDETATE CALCIUM DISODIUM INJ |
| J0610 | 65 | HCPCS / CPT® | CALCIUM GLUCONATE INJECTION |
| J0620 | 65 | HCPCS / CPT® | CALCIUM GLYCER & LACT/10 ML |
| J0630 | 65 | HCPCS / CPT® | CALCITONIN SALMON INJECTION |
| J0636 | 65 | HCPCS / CPT® | INJ CALCITRIOL PER 0.1 MCG |
| J0637 | 65 | HCPCS / CPT® | CASPOFUNGIN ACETATE |
| J0638 | 65 | HCPCS / CPT® | CANAKINUMAB INJECTION |
| J0640 | 65 | HCPCS / CPT® | LEUCOVORIN CALCIUM INJECTION |
| J0641 | 6 | HCPCS / CPT® | LEVOLEUCOVORIN INJECTION |
| J0670 | 65 | HCPCS / CPT® | INJ MEPIVACAINE HCL/10 ML |
| J0690 | 22 | HCPCS / CPT® | CEFAZOLIN SODIUM INJECTION |
| J0692 | 42 | HCPCS / CPT® | CEFEPIME HCL FOR INJECTION |
| J0694 | 65 | HCPCS / CPT® | CEFOXITIN SODIUM INJECTION |
| J0695 | 65 | HCPCS / CPT® | INJ CEFTOLOZANE TAZOBACTAM |
| J0696 | 63 | HCPCS / CPT® | Rocephin/Ceftriaxone Sodium 250 mg |
| J0697 | 65 | HCPCS / CPT® | STERILE CEFUROXIME INJECTION |
| J0698 | 65 | HCPCS / CPT® | CEFOTAXIME SODIUM INJECTION |
| J0702 | 65 | HCPCS / CPT® | BETAMETHASONE ACET&SOD PHOSP |
| J0706 | 65 | HCPCS / CPT® | CAFFEINE CITRATE INJECTION |
| J0710 | 65 | HCPCS / CPT® | CEPHAPIRIN SODIUM INJECTION |
| J0712 | 65 | HCPCS / CPT® | CEFTAROLINE FOSAMIL INJ |
| J0713 | 65 | HCPCS / CPT® | INJ CEFTAZIDIME PER 500 MG |
| J0714 | 65 | HCPCS / CPT® | CEFTAZIDIME AND AVIBACTAM |
| J0715 | 65 | HCPCS / CPT® | CEFTIZOXIME SODIUM / 500 MG |
| J0716 | 65 | HCPCS / CPT® | CENTRUROIDES IMMUNE F(AB) |
| J0717 | 65 | HCPCS / CPT® | CERTOLIZUMAB PEGOL INJ 1MG |
| J0720 | 65 | HCPCS / CPT® | CHLORAMPHENICOL SODIUM INJEC |
| J0725 | 65 | HCPCS / CPT® | CHORIONIC GONADOTROPIN/1000U |
| J0735 | 17 | HCPCS / CPT® | CLONIDINE HYDROCHLORIDE |
| J0740 | 65 | HCPCS / CPT® | CIDOFOVIR INJECTION |
| J0743 | 65 | HCPCS / CPT® | CILASTATIN SODIUM INJECTION |
| J0744 | 66 | HCPCS / CPT® | CIPROFLOXACIN IV |
| J0745 | 65 | HCPCS / CPT® | INJ CODEINE PHOSPHATE /30 MG |
| J0770 | 65 | HCPCS / CPT® | COLISTIMETHATE SODIUM INJ |
| J0775 | 65 | HCPCS / CPT® | COLLAGENASE, CLOST HIST INJ |
| J0780 | 11 | HCPCS / CPT® | PROCHLORPERAZINE INJECTION |
| J0795 | 65 | HCPCS / CPT® | CORTICORELIN OVINE TRIFLUTAL |
| J0800 | 65 | HCPCS / CPT® | CORTICOTROPIN INJECTION |
| J0833 | 65 | HCPCS / CPT® | COSYNTROPIN INJECTION NOS |
| J0834 | 65 | HCPCS / CPT® | COSYNTROPIN CORTROSYN INJ |
| J0840 | 65 | HCPCS / CPT® | CROTALIDAE POLY IMMUNE FAB |
| J0850 | 65 | HCPCS / CPT® | CYTOMEGALOVIRUS IMM IV /VIAL |
| J0875 | 65 | HCPCS / CPT® | INJECTION, DALBAVANCIN |
| J0878 | 65 | HCPCS / CPT® | DAPTOMYCIN INJECTION |
| J0881 | 65 | HCPCS / CPT® | DARBEPOETIN ALFA, NON-ESRD |
| J0882 | 65 | HCPCS / CPT® | DARBEPOETIN ALFA, ESRD USE |
| J0883 | 0 | HCPCS / CPT® | ARGATROBAN NONESRD USE 1MG |
| J0884 | 65 | HCPCS / CPT® | ARGATROBAN ESRD DIALYSIS 1MG |
| J0885 | 65 | HCPCS / CPT® | EPOETIN ALFA, NON-ESRD |
| J0887 | 65 | HCPCS / CPT® | EPOETIN BETA ESRD USE |
| J0888 | 65 | HCPCS / CPT® | EPOETIN BETA NON ESRD |
| J0890 | 65 | HCPCS / CPT® | PEGINESATIDE INJECTION |
| J0894 | 65 | HCPCS / CPT® | DECITABINE INJECTION |
| J0895 | 65 | HCPCS / CPT® | DEFEROXAMINE MESYLATE INJ |
| J0897 | 65 | HCPCS / CPT® | DENOSUMAB INJECTION |
| J0945 | 65 | HCPCS / CPT® | BROMPHENIRAMINE MALEATE INJ |
| J1000 | 65 | HCPCS / CPT® | DEPO-ESTRADIOL CYPIONATE INJ |
| J1020 | 6 | HCPCS / CPT® | METHYLPREDNISOLONE 20 MG INJ |
| J1030 | 15 | HCPCS / CPT® | METHYLPREDNISOLONE 40 MG INJ |
| J1040 | 9 | HCPCS / CPT® | METHYLPREDNISOLONE 80 MG INJ |
| J1050 | 65 | HCPCS / CPT® | MEDROXYPROGESTERONE ACETATE |
| J1071 | 65 | HCPCS / CPT® | INJ TESTOSTERONE CYPIONATE |
| J1094 | 22 | HCPCS / CPT® | INJ DEXAMETHASONE ACETATE |
| J1100 | 34 | HCPCS / CPT® | DECADRON 1MG |
| J1110 | 65 | HCPCS / CPT® | INJ DIHYDROERGOTAMINE MESYLT |
| J1120 | 65 | HCPCS / CPT® | ACETAZOLAMID SODIUM INJECTIO |
| J1130 | 65 | HCPCS / CPT® | INJ DICLOFENAC SODIUM 0.5MG |
| J1160 | 65 | HCPCS / CPT® | DIGOXIN INJECTION |
| J1162 | 65 | HCPCS / CPT® | DIGOXIN IMMUNE FAB (OVINE) |
| J1165 | 37 | HCPCS / CPT® | PHENYTOIN SODIUM INJECTION |
| J1170 | 31 | HCPCS / CPT® | HYDROMORPHONE INJECTION |
| J1180 | 65 | HCPCS / CPT® | DYPHYLLINE INJECTION |
| J1190 | 65 | HCPCS / CPT® | DEXRAZOXANE HCL INJECTION |
| J1200 | 22 | HCPCS / CPT® | BENADRYL-DIPHENHYDRAMINE HCL INJECTIO |
| J1205 | 65 | HCPCS / CPT® | CHLOROTHIAZIDE SODIUM INJ |
| J1212 | 65 | HCPCS / CPT® | DIMETHYL SULFOXIDE 50% 50 ML |
| J1230 | 65 | HCPCS / CPT® | METHADONE INJECTION |
| J1240 | 30 | HCPCS / CPT® | DIMENHYDRINATE INJECTION |
| J1245 | 65 | HCPCS / CPT® | DIPYRIDAMOLE INJECTION |
| J1250 | 0 | HCPCS / CPT® | INJ DOBUTAMINE HCL/250 MG |
| J1260 | 65 | HCPCS / CPT® | DOLASETRON MESYLATE |
| J1265 | 65 | HCPCS / CPT® | DOPAMINE INJECTION |
| J1267 | 65 | HCPCS / CPT® | DORIPENEM INJECTION |
| J1270 | 65 | HCPCS / CPT® | INJECTION, DOXERCALCIFEROL |
| J1290 | 65 | HCPCS / CPT® | ECALLANTIDE INJECTION |
| J1300 | 65 | HCPCS / CPT® | ECULIZUMAB INJECTION |
| J1320 | 65 | HCPCS / CPT® | AMITRIPTYLINE INJECTION |
| J1322 | 65 | HCPCS / CPT® | ELOSULFASE ALFA, INJECTION |
| J1324 | 65 | HCPCS / CPT® | ENFUVIRTIDE INJECTION |
| J1325 | 65 | HCPCS / CPT® | EPOPROSTENOL INJECTION |
| J1327 | 65 | HCPCS / CPT® | EPTIFIBATIDE INJECTION |
| J1330 | 65 | HCPCS / CPT® | ERGONOVINE MALEATE INJECTION |
| J1335 | 65 | HCPCS / CPT® | ERTAPENEM INJECTION |
| J1364 | 65 | HCPCS / CPT® | ERYTHRO LACTOBIONATE /500 MG |
| J1380 | 65 | HCPCS / CPT® | ESTRADIOL VALERATE 10 MG INJ |
| J1410 | 65 | HCPCS / CPT® | INJ ESTROGEN CONJUGATE 25 MG |
| J1430 | 65 | HCPCS / CPT® | ETHANOLAMINE OLEATE 100 MG |
| J1435 | 65 | HCPCS / CPT® | INJECTION ESTRONE PER 1 MG |
| J1436 | 65 | HCPCS / CPT® | ETIDRONATE DISODIUM INJ |
| J1438 | 65 | HCPCS / CPT® | ETANERCEPT INJECTION |
| J1439 | 65 | HCPCS / CPT® | INJ FERRIC CARBOXYMALTOS 1MG |
| J1442 | 65 | HCPCS / CPT® | INJ FILGRASTIM EXCL BIOSIMIL |
| J1443 | 65 | HCPCS / CPT® | INJ FERRIC PYROPHOSPHATE CIT |
| J1447 | 65 | HCPCS / CPT® | INJ TBO FILGRASTIM 1 MICROG |
| J1450 | 65 | HCPCS / CPT® | FLUCONAZOLE |
| J1451 | 65 | HCPCS / CPT® | FOMEPIZOLE, 15 MG |
| J1452 | 65 | HCPCS / CPT® | INTRAOCULAR FOMIVIRSEN NA |
| J1453 | 65 | HCPCS / CPT® | FOSAPREPITANT INJECTION |
| J1455 | 65 | HCPCS / CPT® | FOSCARNET SODIUM INJECTION |
| J1457 | 65 | HCPCS / CPT® | GALLIUM NITRATE INJECTION |
| J1458 | 0 | HCPCS / CPT® | GALSULFASE INJECTION |
| J1459 | 65 | HCPCS / CPT® | INJ IVIG PRIVIGEN 500 MG |
| J1460 | 65 | HCPCS / CPT® | GAMMA GLOBULIN 1 CC INJ |
| J1556 | 65 | HCPCS / CPT® | INJ, IMM GLOB BIVIGAM, 500MG |
| J1557 | 65 | HCPCS / CPT® | GAMMAPLEX INJECTION |
| J1559 | 65 | HCPCS / CPT® | HIZENTRA INJECTION |
| J1560 | 65 | HCPCS / CPT® | GAMMA GLOBULIN > 10 CC INJ |
| J1561 | 65 | HCPCS / CPT® | GAMUNEX-C/GAMMAKED |
| J1562 | 65 | HCPCS / CPT® | VIVAGLOBIN, INJ |
| J1566 | 65 | HCPCS / CPT® | IMMUNE GLOBULIN, POWDER |
| J1568 | 65 | HCPCS / CPT® | OCTAGAM INJECTION |
| J1569 | 65 | HCPCS / CPT® | GAMMAGARD LIQUID INJECTION |
| J1570 | 65 | HCPCS / CPT® | GANCICLOVIR SODIUM INJECTION |
| J1571 | 65 | HCPCS / CPT® | HEPAGAM B IM INJECTION |
| J1572 | 65 | HCPCS / CPT® | FLEBOGAMMA INJECTION |
| J1573 | 65 | HCPCS / CPT® | HEPAGAM B INTRAVENOUS, INJ |
| J1575 | 65 | HCPCS / CPT® | HYQVIA 100MG IMMUNEGLOBULIN |
| J1580 | 65 | HCPCS / CPT® | GARAMYCIN GENTAMICIN INJ |
| J1595 | 65 | HCPCS / CPT® | INJECTION GLATIRAMER ACETATE |
| J1599 | 65 | HCPCS / CPT® | IVIG NON-LYOPHILIZED, NOS |
| J1600 | 65 | HCPCS / CPT® | GOLD SODIUM THIOMALEATE INJ |
| J1602 | 65 | HCPCS / CPT® | GOLIMUMAB FOR IV USE 1MG |
| J1610 | 16 | HCPCS / CPT® | GLUCAGON HYDROCHLORIDE/1 MG |
| J1620 | 65 | HCPCS / CPT® | GONADORELIN HYDROCH/ 100 MCG |
| J1626 | 65 | HCPCS / CPT® | GRANISETRON HCL INJECTION |
| J1630 | 65 | HCPCS / CPT® | HALOPERIDOL INJECTION |
| J1631 | 65 | HCPCS / CPT® | HALOPERIDOL DECANOATE INJ |
| J1640 | 65 | HCPCS / CPT® | HEMIN, 1 MG |
| J1642 | 12 | HCPCS / CPT® | INJ HEPARIN SODIUM PER 10 U |
| J1644 | 79 | HCPCS / CPT® | INJ HEPARIN SODIUM PER 1000U |
| J1645 | 65 | HCPCS / CPT® | DALTEPARIN SODIUM |
| J1650 | 65 | HCPCS / CPT® | INJ ENOXAPARIN SODIUM |
| J1652 | 65 | HCPCS / CPT® | FONDAPARINUX SODIUM |
| J1655 | 65 | HCPCS / CPT® | TINZAPARIN SODIUM INJECTION |
| J1670 | 65 | HCPCS / CPT® | TETANUS IMMUNE GLOBULIN INJ |
| J1675 | 65 | HCPCS / CPT® | HISTRELIN ACETATE |
| J1700 | 65 | HCPCS / CPT® | HYDROCORTISONE ACETATE INJ |
| J1710 | 65 | HCPCS / CPT® | HYDROCORTISONE SODIUM PH INJ |
| J1720 | 0 | HCPCS / CPT® | HYDROCORTISONE SODIUM SUCC I |
| J1725 | 0 | HCPCS / CPT® | HYDROXYPROGESTERONE CAPROATE |
| J1730 | 0 | HCPCS / CPT® | DIAZOXIDE INJECTION |
| J1740 | 0 | HCPCS / CPT® | IBANDRONATE SODIUM INJECTION |
| J1741 | 0 | HCPCS / CPT® | IBUPROFEN INJECTION |
| J1742 | 0 | HCPCS / CPT® | IBUTILIDE FUMARATE INJECTION |
| J1743 | 0 | HCPCS / CPT® | IDURSULFASE INJECTION |
| J1744 | 0 | HCPCS / CPT® | ICATIBANT INJECTION |
| J1745 | 0 | HCPCS / CPT® | INFLIXIMAB NOT BIOSIMIL 10MG |
| J1750 | 0 | HCPCS / CPT® | INJ IRON DEXTRAN |
| J1756 | 0 | HCPCS / CPT® | IRON SUCROSE INJECTION |
| J1786 | 0 | HCPCS / CPT® | IMUGLUCERASE INJECTION |
| J1790 | 0 | HCPCS / CPT® | DROPERIDOL INJECTION |
| J1800 | 0 | HCPCS / CPT® | PROPRANOLOL INJECTION |
| J1810 | 7 | HCPCS / CPT® | DROPERIDOL/FENTANYL INJ |
| J1815 | 32 | HCPCS / CPT® | INSULIN INJECTION |
| J1817 | 0 | HCPCS / CPT® | INSULIN FOR INSULIN PUMP USE |
| J1826 | 0 | HCPCS / CPT® | INTERFERON BETA-1A INJ |
| J1830 | 0 | HCPCS / CPT® | INTERFERON BETA-1B / .25 MG |
| J1833 | 0 | HCPCS / CPT® | INJECTION, ISAVUCONAZONIUM |
| J1835 | 0 | HCPCS / CPT® | ITRACONAZOLE INJECTION |
| J1840 | 0 | HCPCS / CPT® | KANAMYCIN SULFATE 500 MG INJ |
| J1850 | 0 | HCPCS / CPT® | KANAMYCIN SULFATE 75 MG INJ |
| J1885 | 22 | HCPCS / CPT® | KETOROLAC TROMETHAMINE INJ |
| J1890 | 0 | HCPCS / CPT® | CEPHALOTHIN SODIUM INJECTION |
| J1930 | 0 | HCPCS / CPT® | LANREOTIDE INJECTION |
| J1931 | 0 | HCPCS / CPT® | LARONIDASE INJECTION |
| J1940 | 2000 | HCPCS / CPT® | FUROSEMIDE INJECTION |
| J1942 | 0 | HCPCS / CPT® | ARIPIPRAZOLE LAUROXIL 1MG |
| J1945 | 0 | HCPCS / CPT® | LEPIRUDIN |
| J1950 | 0 | HCPCS / CPT® | LEUPROLIDE ACETATE /3.75 MG |
| J1953 | 0 | HCPCS / CPT® | LEVETIRACETAM INJECTION |
| J1955 | 0 | HCPCS / CPT® | INJ LEVOCARNITINE PER 1 GM |
| J1956 | 86 | HCPCS / CPT® | LEVOFLOXACIN INJECTION |
| J1960 | 0 | HCPCS / CPT® | LEVORPHANOL TARTRATE INJ |
| J1980 | 0 | HCPCS / CPT® | HYOSCYAMINE SULFATE INJ |
| J1990 | 0 | HCPCS / CPT® | CHLORDIAZEPOXIDE INJECTION |
| J2001 | 32 | HCPCS / CPT® | LIDOCAINE INJECTION |
| J2010 | 0 | HCPCS / CPT® | LINCOMYCIN INJECTION |
| J2020 | 0 | HCPCS / CPT® | LINEZOLID INJECTION |
| J2060 | 54 | HCPCS / CPT® | LORAZEPAM INJECTION |
| J2150 | 0 | HCPCS / CPT® | MANNITOL INJECTION |
| J2170 | 0 | HCPCS / CPT® | MECASERMIN INJECTION |
| J2175 | 27 | HCPCS / CPT® | DEMOROL/ MEPERIDINE HYDROCHL /100 MG |
| J2180 | 0 | HCPCS / CPT® | MEPERIDINE/PROMETHAZINE INJ |
| J2182 | 0 | HCPCS / CPT® | INJECTION, MEPOLIZUMAB, 1MG |
| J2185 | 0 | HCPCS / CPT® | MEROPENEM |
| J2210 | 0 | HCPCS / CPT® | METHYLERGONOVIN MALEATE INJ |
| J2212 | 0 | HCPCS / CPT® | METHYLNALTREXONE INJECTION |
| J2248 | 0 | HCPCS / CPT® | MICAFUNGIN SODIUM INJECTION |
| J2250 | 12 | HCPCS / CPT® | INJ MIDAZOLAM HYDROCHLORIDE |
| J2260 | 0 | HCPCS / CPT® | INJ MILRINONE LACTATE / 5 MG |
| J2265 | 0 | HCPCS / CPT® | MINOCYCLINE HYDROCHLORIDE |
| J2270 | 15.1 | HCPCS / CPT® | INJECTION, MORPHINE SULFATE, UP TO 10 MG |
| J2274 | 65 | HCPCS / CPT® | IN MORPHINE PRESERVATIV FREE |
| J2278 | 65 | HCPCS / CPT® | ZICONOTIDE INJECTION |
| J2280 | 0 | HCPCS / CPT® | INJ, MOXIFLOXACIN 100 MG |
| J2300 | 0 | HCPCS / CPT® | INJ NALBUPHINE HYDROCHLORIDE |
| J2310 | 0 | HCPCS / CPT® | INJ NALOXONE HYDROCHLORIDE |
| J2315 | 0 | HCPCS / CPT® | NALTREXONE, DEPOT FORM |
| J2320 | 0 | HCPCS / CPT® | NANDROLONE DECANOATE 50 MG |
| J2323 | 0 | HCPCS / CPT® | NATALIZUMAB INJECTION |
| J2325 | 0 | HCPCS / CPT® | NESIRITIDE INJECTION |
| J2353 | 0 | HCPCS / CPT® | OCTREOTIDE INJECTION, DEPOT |
| J2354 | 0 | HCPCS / CPT® | OCTREOTIDE INJ, NON-DEPOT |
| J2355 | 0 | HCPCS / CPT® | OPRELVEKIN INJECTION |
| J2357 | 0 | HCPCS / CPT® | OMALIZUMAB INJECTION |
| J2358 | 0 | HCPCS / CPT® | OLANZAPINE LONG-ACTING INJ |
| J2360 | 0 | HCPCS / CPT® | ORPHENADRINE INJECTION |
| J2370 | 0 | HCPCS / CPT® | PHENYLEPHRINE HCL INJECTION |
| J2400 | 0 | HCPCS / CPT® | CHLOROPROCAINE HCL INJECTION |
| J2405 | 20 | HCPCS / CPT® | ONDANSETRON HCL INJECTION |
| J2407 | 0 | HCPCS / CPT® | INJECTION, ORITAVANCIN |
| J2410 | 0 | HCPCS / CPT® | OXYMORPHONE HCL INJECTION |
| J2425 | 0 | HCPCS / CPT® | PALIFERMIN INJECTION |
| J2426 | 0 | HCPCS / CPT® | PALIPERIDONE PALMITATE INJ |
| J2430 | 0 | HCPCS / CPT® | PAMIDRONATE DISODIUM /30 MG |
| J2440 | 0 | HCPCS / CPT® | PAPAVERIN HCL INJECTION |
| J2460 | 0 | HCPCS / CPT® | OXYTETRACYCLINE INJECTION |
| J2469 | 0 | HCPCS / CPT® | PALONOSETRON HCL |
| J2501 | 0 | HCPCS / CPT® | PARICALCITOL |
| J2502 | 0 | HCPCS / CPT® | INJ, PASIREOTIDE LONG ACTING |
| J2503 | 0 | HCPCS / CPT® | PEGAPTANIB SODIUM INJECTION |
| J2504 | 0 | HCPCS / CPT® | PEGADEMASE BOVINE, 25 IU |
| J2505 | 0 | HCPCS / CPT® | INJECTION, PEGFILGRASTIM 6MG |
| J2507 | 0 | HCPCS / CPT® | PEGLOTICASE INJECTION |
| J2510 | 0 | HCPCS / CPT® | PENICILLIN G PROCAINE INJ |
| J2513 | 0 | HCPCS / CPT® | PENTASTARCH 10% SOLUTION |
| J2515 | 0 | HCPCS / CPT® | PENTOBARBITAL SODIUM INJ |
| J2540 | 0 | HCPCS / CPT® | PENICILLIN G POTASSIUM INJ |
| J2543 | 0 | HCPCS / CPT® | PIPERACILLIN/TAZOBACTAM |
| J2545 | 0 | HCPCS / CPT® | PENTAMIDINE NON-COMP UNIT |
| J2547 | 0 | HCPCS / CPT® | INJECTION, PERAMIVIR |
| J2550 | 20.8 | HCPCS / CPT® | INJECTION, PROMETHAZINE HCL, UP TO 50 MG |
| J2560 | 0 | HCPCS / CPT® | PHENOBARBITAL SODIUM INJ |
| J2562 | 0 | HCPCS / CPT® | PLERIXAFOR INJECTION |
| J2590 | 0 | HCPCS / CPT® | OXYTOCIN INJECTION |
| J2597 | 0 | HCPCS / CPT® | INJ DESMOPRESSIN ACETATE |
| J2650 | 0 | HCPCS / CPT® | PREDNISOLONE ACETATE INJ |
| J2670 | 0 | HCPCS / CPT® | TOTAZOLINE HCL INJECTION |
| J2675 | 0 | HCPCS / CPT® | INJ PROGESTERONE PER 50 MG |
| J2680 | 0 | HCPCS / CPT® | FLUPHENAZINE DECANOATE 25 MG |
| J2690 | 0 | HCPCS / CPT® | PROCAINAMIDE HCL INJECTION |
| J2700 | 0 | HCPCS / CPT® | OXACILLIN SODIUM INJECITON |
| J2704 | 65 | HCPCS / CPT® | INJ, PROPOFOL, 10 MG |
| J2710 | 65 | HCPCS / CPT® | NEOSTIGMINE METHYLSLFTE INJ |
| J2720 | 0 | HCPCS / CPT® | INJ PROTAMINE SULFATE/10 MG |
| J2724 | 0 | HCPCS / CPT® | PROTEIN C CONCENTRATE |
| J2725 | 0 | HCPCS / CPT® | INJ PROTIRELIN PER 250 MCG |
| J2730 | 0 | HCPCS / CPT® | PRALIDOXIME CHLORIDE INJ |
| J2760 | 0 | HCPCS / CPT® | PHENTOLAINE MESYLATE INJ |
| J2765 | 65 | HCPCS / CPT® | METOCLOPRAMIDE HCL INJECTION |
| J2770 | 0 | HCPCS / CPT® | QUINUPRISTIN/DALFOPRISTIN |
| J2778 | 0 | HCPCS / CPT® | RANIBIZUMAB INJECTION |
| J2780 | 65 | HCPCS / CPT® | RANITIDINE HYDROCHLORIDE INJ |
| J2783 | 0 | HCPCS / CPT® | RASBURICASE |
| J2785 | 0 | HCPCS / CPT® | REGADENOSON INJECTION |
| J2786 | 0 | HCPCS / CPT® | INJECTION, RESLIZUMAB, 1MG |
| J2788 | 0 | HCPCS / CPT® | RHO D IMMUNE GLOBULIN 50 MCG |
| J2790 | 65 | HCPCS / CPT® | RHO D IMMUNE GLOBULIN INJ |
| J2791 | 0 | HCPCS / CPT® | RHOPHYLAC INJECTION |
| J2792 | 0 | HCPCS / CPT® | RHO(D) IMMUNE GLOBULIN H, SD |
| J2793 | 0 | HCPCS / CPT® | RILONACEPT INJECTION |
| J2794 | 0 | HCPCS / CPT® | RISPERIDONE, LONG ACTING |
| J2795 | 0 | HCPCS / CPT® | ROPIVACAINE HCL INJECTION |
| J2796 | 0 | HCPCS / CPT® | ROMIPLOSTIM INJECTION |
| J2800 | 0 | HCPCS / CPT® | METHOCARBAMOL INJECTION |
| J2805 | 0 | HCPCS / CPT® | SINCALIDE INJECTION |
| J2810 | 0 | HCPCS / CPT® | INJ THEOPHYLLINE PER 40 MG |
| J2820 | 0 | HCPCS / CPT® | SARGRAMOSTIM INJECTION |
| J2840 | 0 | HCPCS / CPT® | INJ SEBELIPASE ALFA 1 MG |
| J2850 | 0 | HCPCS / CPT® | INJ SECRETIN SYNTHETIC HUMAN |
| J2860 | 0 | HCPCS / CPT® | INJECTION, SILTUXIMAB |
| J2910 | 0 | HCPCS / CPT® | AUROTHIOGLUCOSE INJECITON |
| J2916 | 0 | HCPCS / CPT® | NA FERRIC GLUCONATE COMPLEX |
| J2920 | 19 | HCPCS / CPT® | METHYLPREDNISOLONE INJECTION |
| J2930 | 17 | HCPCS / CPT® | METHYLPREDNISOLONE INJECTION |
| J2940 | 0 | HCPCS / CPT® | SOMATREM INJECTION |
| J2941 | 0 | HCPCS / CPT® | SOMATROPIN INJECTION |
| J2950 | 0 | HCPCS / CPT® | PROMAZINE HCL INJECTION |
| J2993 | 0 | HCPCS / CPT® | RETEPLASE INJECTION |
| J2995 | 0 | HCPCS / CPT® | INJ STREPTOKINASE /250000 IU |
| J2997 | 0 | HCPCS / CPT® | ALTEPLASE RECOMBINANT |
| J3000 | 0 | HCPCS / CPT® | STREPTOMYCIN INJECTION |
| J3010 | 6 | HCPCS / CPT® | FENTANYL CITRATE INJECITON |
| J3030 | 11 | HCPCS / CPT® | SUMATRIPTAN SUCCINATE / 6 MG |
| J3060 | 0 | HCPCS / CPT® | INJ, TALIGLUCERACE ALFA 10 U |
| J3070 | 0 | HCPCS / CPT® | PENTAZOCINE INJECTION |
| J3090 | 0 | HCPCS / CPT® | INJ TEDIZOLID PHOSPHATE |
| J3095 | 0 | HCPCS / CPT® | TELAVANCIN INJECTION |
| J3101 | 0 | HCPCS / CPT® | TENECTEPLASE INJECTION |
| J3105 | 0 | HCPCS / CPT® | TERBUTALINE SULFATE INJ |
| J3110 | 0 | HCPCS / CPT® | TERIPARATIDE INJECTION |
| J3121 | 0 | HCPCS / CPT® | INJ TESTOSTERO ENANTHATE 1MG |
| J3145 | 0 | HCPCS / CPT® | TESTOSTERONE UNDECANOATE 1MG |
| J3230 | 0 | HCPCS / CPT® | CHLORPROMAZINE HCL INJECTION |
| J3240 | 0 | HCPCS / CPT® | THYROTROPIN INJECTION |
| J3243 | 0 | HCPCS / CPT® | TIGECYCLINE INJECTION |
| J3246 | 0 | HCPCS / CPT® | TIROFIBAN HCL |
| J3250 | 0 | HCPCS / CPT® | TRIMETHOBENZAMIDE HCL INJ |
| J3260 | 0 | HCPCS / CPT® | TOBRAMYCIN SULFATE INJECTION |
| J3262 | 0 | HCPCS / CPT® | TOCILIZUMAB INJECTION |
| J3265 | 0 | HCPCS / CPT® | INJECTION TORSEMIDE 10 MG/ML |
| J3280 | 0 | HCPCS / CPT® | THIETHYLPERAZINE MALEATE INJ |
| J3285 | 0 | HCPCS / CPT® | TREPROSTINIL INJECTION |
| J3300 | 0 | HCPCS / CPT® | TRIAMCINOLONE A INJ PRS-FREE |
| J3301 | 0 | HCPCS / CPT® | TRIAMCINOLONE ACET INJ NOS |
| J3302 | 0 | HCPCS / CPT® | TRIAMCINOLONE DIACETATE INJ |
| J3303 | 0 | HCPCS / CPT® | TRIAMCINOLONE HEXACETONL INJ |
| J3305 | 0 | HCPCS / CPT® | INJ TRIMETREXATE GLUCORONATE |
| J3310 | 0 | HCPCS / CPT® | PERPHENAZINE INJECITON |
| J3315 | 0 | HCPCS / CPT® | TRIPTORELIN PAMOATE |
| J3320 | 0 | HCPCS / CPT® | SPECTINOMYCN DI-HCL INJ |
| J3350 | 0 | HCPCS / CPT® | UREA INJECTION |
| J3355 | 0 | HCPCS / CPT® | UROFOLLITROPIN, 75 IU |
| J3357 | 0 | HCPCS / CPT® | USTEKINUMAB SUB CU INJ, 1 MG |
| J3360 | 11 | HCPCS / CPT® | DIAZEPAM INJECTION |
| J3364 | 0 | HCPCS / CPT® | UROKINASE 5000 IU INJECTION |
| J3365 | 0 | HCPCS / CPT® | UROKINASE 250,000 IU INJ |
| J3370 | 118 | HCPCS / CPT® | VANCOMYCIN HCL INJECTION |
| J3380 | 0 | HCPCS / CPT® | INJECTION, VEDOLIZUMAB |
| J3385 | 0 | HCPCS / CPT® | VELAGLUCERASE ALFA |
| J3396 | 0 | HCPCS / CPT® | VERTEPORFIN INJECTION |
| J3400 | 0 | HCPCS / CPT® | TRIFLUPROMAZINE HCL INJ |
| J3410 | 0 | HCPCS / CPT® | HYDROXYZINE HCL INJECTION |
| J3411 | 0 | HCPCS / CPT® | THIAMINE HCL 100 MG |
| J3415 | 0 | HCPCS / CPT® | PYRIDOXINE HCL 100 MG |
| J3420 | 0 | HCPCS / CPT® | VITAMIN B12 INJECTION |
| J3430 | 17 | HCPCS / CPT® | VITAMIN K PHYTONADIONE INJ |
| J3465 | 0 | HCPCS / CPT® | INJECTION, VORICONAZOLE |
| J3470 | 0 | HCPCS / CPT® | HYALURONIDASE INJECTION |
| J3471 | 0 | HCPCS / CPT® | OVINE, UP TO 999 USP UNITS |
| J3472 | 0 | HCPCS / CPT® | OVINE, 1000 USP UNITS |
| J3473 | 0 | HCPCS / CPT® | HYALURONIDASE RECOMBINANT |
| J3475 | 27 | HCPCS / CPT® | INJ MAGNESIUM SULFATE |
| J3480 | 7 | HCPCS / CPT® | INJ POTASSIUM CHLORIDE |
| J3485 | 0 | HCPCS / CPT® | ZIDOVUDINE |
| J3486 | 0 | HCPCS / CPT® | ZIPRASIDONE MESYLATE |
| J3489 | 0 | HCPCS / CPT® | ZOLEDRONIC ACID 1MG |
| J3490 | 65 | HCPCS / CPT® | DRUGS UNCLASSIFIED INJECTION |
| J3499 | 65 | HCPCS / CPT® | Unclassified Drugs |
| J3520 | 0 | HCPCS / CPT® | EDETATE DISODIUM PER 150 MG |
| J3530 | 0 | HCPCS / CPT® | NASAL VACCINE INHALATION |
| J3535 | 0 | HCPCS / CPT® | METERED DOSE INHALER DRUG |
| J3570 | 0 | HCPCS / CPT® | LAETRILE AMYGDALIN VIT B17 |
| J3590 | 0 | HCPCS / CPT® | UNCLASSIFIED BIOLOGICS |
| J7030 | 68 | HCPCS / CPT® | NORMAL SALINE SOLUTION INFUS |
| J7040 | 36 | HCPCS / CPT® | NORMAL SALINE SOLUTION INFUS |
| J7042 | 32 | HCPCS / CPT® | 5% DEXTROSE/NORMAL SALINE |
| J7050 | 28 | HCPCS / CPT® | NORMAL SALINE SOLUTION INFUS |
| J7060 | 38 | HCPCS / CPT® | 5% DEXTROSE/WATER |
| J7070 | 87 | HCPCS / CPT® | D5W INFUSION |
| J7100 | 0 | HCPCS / CPT® | DEXTRAN 40 INFUSION |
| J7110 | 0 | HCPCS / CPT® | DEXTRAN 75 INFUSION |
| J7120 | 96 | HCPCS / CPT® | RINGERS LACTATE INFUSION |
| J7121 | 98 | HCPCS / CPT® | 5% DEXTROSE IN LAC RINGERS |
| J7131 | 77 | HCPCS / CPT® | HYPERTONIC SALINE SOL |
| J7175 | 0 | HCPCS / CPT® | INJ, FACTOR X, (HUMAN), 1IU |
| J7178 | 0 | HCPCS / CPT® | HUMAN FIBRINOGEN CONC INJ |
| J7179 | 0 | HCPCS / CPT® | VONVENDI INJ 1 IU VWF:RCO |
| J7180 | 0 | HCPCS / CPT® | FACTOR XIII ANTI-HEM FACTOR |
| J7181 | 0 | HCPCS / CPT® | FACTOR XIII RECOMB A-SUBUNIT |
| J7182 | 0 | HCPCS / CPT® | FACTOR VIII RECOMB NOVOEIGHT |
| J7183 | 0 | HCPCS / CPT® | WILATE INJECTION |
| J7185 | 0 | HCPCS / CPT® | XYNTHA INJ |
| J7186 | 0 | HCPCS / CPT® | ANTIHEMOPHILIC VIII/VWF COMP |
| J7187 | 0 | HCPCS / CPT® | HUMATE-P, INJ |
| J7188 | 0 | HCPCS / CPT® | FACTOR VIII RECOMB OBIZUR |
| J7189 | 0 | HCPCS / CPT® | FACTOR VIIA |
| J7190 | 0 | HCPCS / CPT® | FACTOR VIII |
| J7191 | 0 | HCPCS / CPT® | FACTOR VIII (PORCINE) |
| J7192 | 0 | HCPCS / CPT® | FACTOR VIII RECOMBINANT NOS |
| J7193 | 0 | HCPCS / CPT® | FACTOR IX NON-RECOMBINANT |
| J7194 | 0 | HCPCS / CPT® | FACTOR IX COMPLEX |
| J7195 | 0 | HCPCS / CPT® | FACTOR IX RECOMBINANT NOS |
| J7196 | 0 | HCPCS / CPT® | ANTITHROMBIN RECOMBINANT |
| J7197 | 0 | HCPCS / CPT® | ANTITHROMBIN III INJECTION |
| J7198 | 0 | HCPCS / CPT® | ANTI-INHIBITOR |
| J7199 | 0 | HCPCS / CPT® | HEMOPHILIA CLOT FACTOR NOC |
| J7200 | 0 | HCPCS / CPT® | FACTOR IX RECOMBINAN RIXUBIS |
| J7201 | 0 | HCPCS / CPT® | FACTOR IX ALPROLIX RECOMB |
| J7202 | 0 | HCPCS / CPT® | FACTOR IX IDELVION INJ |
| J7205 | 0 | HCPCS / CPT® | FACTOR VIII FC FUSION RECOMB |
| J7207 | 0 | HCPCS / CPT® | FACTOR VIII PEGYLATED RECOMB |
| J7209 | 0 | HCPCS / CPT® | FACTOR VIII NUWIQ RECOMB 1IU |
| J7297 | 0 | HCPCS / CPT® | LILETTA, 52 MG |
| J7298 | 0 | HCPCS / CPT® | MIRENA, 52 MG |
| J7300 | 0 | HCPCS / CPT® | INTRAUT COPPER CONTRACEPTIVE |
| J7301 | 0 | HCPCS / CPT® | SKYLA, 13.5 MG |
| J7303 | 0 | HCPCS / CPT® | CONTRACEPTIVE VAGINAL RING |
| J7304 | 0 | HCPCS / CPT® | CONTRACEPTIVE HORMONE PATCH |
| J7306 | 0 | HCPCS / CPT® | LEVONORGESTREL IMPLANT SYS |
| J7307 | 0 | HCPCS / CPT® | ETONOGESTREL IMPLANT SYSTEM |
| J7308 | 0 | HCPCS / CPT® | AMINOLEVULINIC ACID HCL TOP |
| J7309 | 0 | HCPCS / CPT® | METHYL AMINOLEVULINATE, TOP |
| J7310 | 0 | HCPCS / CPT® | GANCICLOVIR LONG ACT IMPLANT |
| J7311 | 0 | HCPCS / CPT® | FLUOCINOLONE ACETONIDE IMPLT |
| J7312 | 65 | HCPCS / CPT® | DEXAMETHASONE INTRA IMPLANT |
| J7313 | 0 | HCPCS / CPT® | FLUOCINOL ACET INTRAVIT IMP |
| J7315 | 0 | HCPCS / CPT® | OPHTHALMIC MITOMYCIN |
| J7316 | 0 | HCPCS / CPT® | INJ, OCRIPLASMIN, 0.125 MG |
| J7320 | 0 | HCPCS / CPT® | GENVISC 850, INJ, 1MG |
| J7321 | 0 | HCPCS / CPT® | HYALGAN/SUPARTZ INJ PER DOSE |
| J7322 | 0 | HCPCS / CPT® | HYMOVIS INJECTION 1 MG |
| J7323 | 0 | HCPCS / CPT® | EUFLEXXA INJ PER DOSE |
| J7324 | 0 | HCPCS / CPT® | ORTHOVISC INJ PER DOSE |
| J7325 | 0 | HCPCS / CPT® | SYNVISC OR SYNVISC-ONE |
| J7326 | 0 | HCPCS / CPT® | GEL-ONE |
| J7327 | 0 | HCPCS / CPT® | MONOVISC INJ PER DOSE |
| J7328 | 0 | HCPCS / CPT® | GEL-SYN INJECTION 0.1 MG |
| J7330 | 0 | HCPCS / CPT® | CULTURED CHONDROCYTES IMPLNT |
| J7336 | 0 | HCPCS / CPT® | CAPSAICIN 8% PATCH |
| J7340 | 0 | HCPCS / CPT® | CARBIDOPA LEVODOPA ENT 100ML |
| J7342 | 0 | HCPCS / CPT® | CIPROFLOXACIN OTIC SUSP 6 MG |
| J7500 | 0 | HCPCS / CPT® | AZATHIOPRINE ORAL 50MG |
| J7501 | 0 | HCPCS / CPT® | AZATHIOPRINE PARENTERAL |
| J7502 | 65 | HCPCS / CPT® | CYCLOSPORINE ORAL 100 MG |
| J7503 | 0 | HCPCS / CPT® | TACROL ENVARSUS EX REL ORAL |
| J7504 | 0 | HCPCS / CPT® | LYMPHOCYTE IMMUNE GLOBULIN |
| J7505 | 0 | HCPCS / CPT® | MONOCLONAL ANTIBODIES |
| J7507 | 65 | HCPCS / CPT® | TACROLIMUS IMME REL ORAL 1MG |
| J7508 | 0 | HCPCS / CPT® | TACROL ASTAGRAF EX REL ORAL |
| J7509 | 0 | HCPCS / CPT® | METHYLPREDNISOLONE ORAL |
| J7510 | 11 | HCPCS / CPT® | PREDNISOLONE ORAL PER 5 MG |
| J7511 | 0 | HCPCS / CPT® | ANTITHYMOCYTE GLOBULN RABBIT |
| J7512 | 11 | HCPCS / CPT® | PREDNISONE IR OR DR ORAL 1MG |
| J7513 | 0 | HCPCS / CPT® | DACLIZUMAB, PARENTERAL |
| J7515 | 0 | HCPCS / CPT® | CYCLOSPORINE ORAL 25 MG |
| J7516 | 0 | HCPCS / CPT® | CYCLOSPORIN PARENTERAL 250MG |
| J7517 | 0 | HCPCS / CPT® | MYCOPHENOLATE MOFETIL ORAL |
| J7518 | 0 | HCPCS / CPT® | MYCOPHENOLIC ACID |
| J7520 | 0 | HCPCS / CPT® | SIROLIMUS, ORAL |
| J7525 | 0 | HCPCS / CPT® | TACROLIMUS INJECTION |
| J7527 | 0 | HCPCS / CPT® | ORAL EVEROLIMUS |
| J7599 | 0 | HCPCS / CPT® | IMMUNOSUPPRESSIVE DRUG NOC |
| J7604 | 0 | HCPCS / CPT® | ACETYLCYSTEINE COMP UNIT |
| J7605 | 0 | HCPCS / CPT® | ARFORMOTEROL NON-COMP UNIT |
| J7606 | 0 | HCPCS / CPT® | FORMOTEROL FUMARATE, INH |
| J7607 | 16 | HCPCS / CPT® | LEVALBUTEROL COMP CON |
| J7608 | 0 | HCPCS / CPT® | ACETYLCYSTEINE NON-COMP UNIT |
| J7609 | 0 | HCPCS / CPT® | ALBUTEROL COMP UNIT |
| J7610 | 17 | HCPCS / CPT® | ALBUTEROL COMP CON |
| J7611 | 17 | HCPCS / CPT® | ALBUTEROL NON-COMP CON |
| J7612 | 0 | HCPCS / CPT® | LEVALBUTEROL NON-COMP CON |
| J7613 | 65 | HCPCS / CPT® | ALBUTEROL NON-COMP UNIT |
| J7614 | 19 | HCPCS / CPT® | LEVALBUTEROL NON-COMP UNIT |
| J7615 | 16 | HCPCS / CPT® | LEVALBUTEROL COMP UNIT |
| J7620 | 65 | HCPCS / CPT® | ALBUTEROL IPRATROP NON-COMP |
| J7622 | 0 | HCPCS / CPT® | BECLOMETHASONE COMP UNIT |
| J7624 | 0 | HCPCS / CPT® | BETAMETHASONE COMP UNIT |
| J7626 | 0 | HCPCS / CPT® | BUDESONIDE NON-COMP UNIT |
| J7627 | 0 | HCPCS / CPT® | BUDESONIDE COMP UNIT |
| J7628 | 0 | HCPCS / CPT® | BITOLTEROL MESYLATE COMP CON |
| J7629 | 0 | HCPCS / CPT® | BITOLTEROL MESYLATE COMP UNT |
| J7631 | 0 | HCPCS / CPT® | CROMOLYN SODIUM NONCOMP UNIT |
| J7632 | 0 | HCPCS / CPT® | CROMOLYN SODIUM COMP UNIT |
| J7633 | 0 | HCPCS / CPT® | BUDESONIDE NON-COMP CON |
| J7634 | 0 | HCPCS / CPT® | BUDESONIDE COMP CON |
| J7635 | 0 | HCPCS / CPT® | ATROPINE COMP CON |
| J7636 | 0 | HCPCS / CPT® | ATROPINE COMP UNIT |
| J7637 | 65 | HCPCS / CPT® | DEXAMETHASONE COMP CON |
| J7638 | 65 | HCPCS / CPT® | DEXAMETHASONE COMP UNIT |
| J7639 | 0 | HCPCS / CPT® | DORNASE ALFA NON-COMP UNIT |
| J7640 | 0 | HCPCS / CPT® | FORMOTEROL COMP UNIT |
| J7641 | 0 | HCPCS / CPT® | FLUNISOLIDE COMP UNIT |
| J7642 | 0 | HCPCS / CPT® | GLYCOPYRROLATE COMP CON |
| J7643 | 0 | HCPCS / CPT® | GLYCOPYRROLATE COMP UNIT |
| J7644 | 28 | HCPCS / CPT® | IPRATROPIUM BROMIDE NON-COMP |
| J7645 | 0 | HCPCS / CPT® | IPRATROPIUM BROMIDE COMP |
| J7647 | 0 | HCPCS / CPT® | ISOETHARINE COMP CON |
| J7648 | 0 | HCPCS / CPT® | ISOETHARINE NON-COMP CON |
| J7649 | 0 | HCPCS / CPT® | ISOETHARINE NON-COMP UNIT |
| J7650 | 0 | HCPCS / CPT® | ISOETHARINE COMP UNIT |
| J7657 | 0 | HCPCS / CPT® | ISOPROTERENOL COMP CON |
| J7658 | 0 | HCPCS / CPT® | ISOPROTERENOL NON-COMP CON |
| J7659 | 0 | HCPCS / CPT® | ISOPROTERENOL NON-COMP UNIT |
| J7660 | 0 | HCPCS / CPT® | ISOPROTERENOL COMP UNIT |
| J7665 | 0 | HCPCS / CPT® | MANNITOL FOR INHALER |
| J7667 | 0 | HCPCS / CPT® | METAPROTERENOL COMP CON |
| J7668 | 0 | HCPCS / CPT® | METAPROTERENOL NON-COMP CON |
| J7669 | 0 | HCPCS / CPT® | METAPROTERENOL NON-COMP UNIT |
| J7670 | 0 | HCPCS / CPT® | METAPROTERENOL COMP UNIT |
| J7674 | 0 | HCPCS / CPT® | METHACHOLINE CHLORIDE, NEB |
| J7676 | 0 | HCPCS / CPT® | PENTAMIDINE COMP UNIT DOSE |
| J7680 | 0 | HCPCS / CPT® | TERBUTALINE SULF COMP CON |
| J7681 | 0 | HCPCS / CPT® | TERBUTALINE SULF COMP UNIT |
| J7682 | 0 | HCPCS / CPT® | TOBRAMYCIN NON-COMP UNIT |
| J7683 | 0 | HCPCS / CPT® | TRIAMCINOLONE COMP CON |
| J7684 | 0 | HCPCS / CPT® | TRIAMCINOLONE COMP UNIT |
| J7685 | 0 | HCPCS / CPT® | TOBRAMYCIN COMP UNIT |
| J7686 | 0 | HCPCS / CPT® | TREPROSTINIL, NON-COMP UNIT |
| J7699 | 7 | HCPCS / CPT® | INHALATION SOLUTION FOR DME |
| J7799 | 65 | HCPCS / CPT® | NON-INHALATION DRUG FOR DME |
| J7999 | 65 | HCPCS / CPT® | COMPOUNDED DRUG, NOC |
| J8498 | 0 | HCPCS / CPT® | ANTIEMETIC RECTAL/SUPP NOS |
| J8499 | 65 | HCPCS / CPT® | ORAL PRESCRIP DRUG NON CHEMO |
| J8501 | 65 | HCPCS / CPT® | ORAL APREPITANT |
| J8510 | 0 | HCPCS / CPT® | ORAL BUSULFAN |
| J8515 | 65 | HCPCS / CPT® | CABERGOLINE, ORAL 0.25MG |
| J8520 | 65 | HCPCS / CPT® | CAPECITABINE, ORAL, 150 MG |
| J8521 | 65 | HCPCS / CPT® | CAPECITABINE, ORAL, 500 MG |
| J8530 | 65 | HCPCS / CPT® | CYCLOPHOSPHAMIDE ORAL 25 MG |
| J8540 | 18 | HCPCS / CPT® | ORAL DEXAMETHASONE |
| J8560 | 65 | HCPCS / CPT® | ETOPOSIDE ORAL 50 MG |
| J8562 | 65 | HCPCS / CPT® | ORAL FLUDARABINE PHOSPHATE |
| J8565 | 65 | HCPCS / CPT® | GEFITINIB ORAL |
| J8597 | 65 | HCPCS / CPT® | ANTIEMETIC DRUG ORAL NOS |
| J8600 | 65 | HCPCS / CPT® | MELPHALAN ORAL 2 MG |
| J8610 | 65 | HCPCS / CPT® | METHOTREXATE ORAL 2.5 MG |
| J8650 | 65 | HCPCS / CPT® | NABILONE ORAL |
| J8655 | 65 | HCPCS / CPT® | NETUPITANT PALONOSETRON ORAL |
| J8670 | 65 | HCPCS / CPT® | ROLAPITANT, ORAL, 1MG |
| J8700 | 65 | HCPCS / CPT® | TEMOZOLOMIDE |
| J8705 | 0 | HCPCS / CPT® | TOPOTECAN ORAL |
| J8999 | 0 | HCPCS / CPT® | ORAL PRESCRIPTION DRUG CHEMO |
| J9000 | 65 | HCPCS / CPT® | DOXORUBICIN HCL INJECTION |
| J9015 | 65 | HCPCS / CPT® | ALDESLEUKIN INJECTION |
| J9017 | 65 | HCPCS / CPT® | ARSENIC TRIOXIDE INJECTION |
| J9019 | 65 | HCPCS / CPT® | ERWINAZE INJECTION |
| J9020 | 65 | HCPCS / CPT® | ASPARAGINASE, NOS |
| J9025 | 65 | HCPCS / CPT® | AZACITIDINE INJECTION |
| J9027 | 128 | HCPCS / CPT® | CLOFARABINE INJECTION |
| J9031 | 65 | HCPCS / CPT® | BCG LIVE INTRAVESICAL VAC |
| J9032 | 65 | HCPCS / CPT® | INJECTION, BELINOSTAT, 10MG |
| J9033 | 65 | HCPCS / CPT® | INJ., TREANDA 1 MG |
| J9034 | 65 | HCPCS / CPT® | INJ., BENDEKA 1 MG |
| J9035 | 65 | HCPCS / CPT® | BEVACIZUMAB INJECTION |
| J9039 | 65 | HCPCS / CPT® | INJECTION, BLINATUMOMAB |
| J9040 | 65 | HCPCS / CPT® | BLEOMYCIN SULFATE INJECTION |
| J9041 | 65 | HCPCS / CPT® | BORTEZOMIB INJECTION |
| J9042 | 65 | HCPCS / CPT® | BRENTUXIMAB VEDOTIN INJ |
| J9043 | 65 | HCPCS / CPT® | CABAZITAXEL INJECTION |
| J9045 | 65 | HCPCS / CPT® | CARBOPLATIN INJECTION |
| J9047 | 65 | HCPCS / CPT® | INJECTION, CARFILZOMIB, 1 MG |
| J9050 | 65 | HCPCS / CPT® | CARMUSTINE INJECTION |
| J9055 | 65 | HCPCS / CPT® | CETUXIMAB INJECTION |
| J9060 | 65 | HCPCS / CPT® | CISPLATIN 10 MG INJECTION |
| J9065 | 65 | HCPCS / CPT® | INJ CLADRIBINE PER 1 MG |
| J9070 | 65 | HCPCS / CPT® | CYCLOPHOSPHAMIDE 100 MG INJ |
| J9098 | 65 | HCPCS / CPT® | CYTARABINE LIPOSOME INJ |
| J9100 | 65 | HCPCS / CPT® | CYTARABINE HCL 100 MG INJ |
| J9120 | 65 | HCPCS / CPT® | DACTINOMYCIN INJECTION |
| J9130 | 65 | HCPCS / CPT® | DACARBAZINE 100 MG INJ |
| J9145 | 65 | HCPCS / CPT® | INJECTION, DARATUMUMAB 10 MG |
| J9150 | 65 | HCPCS / CPT® | DAUNORUBICIN INJECTION |
| J9151 | 65 | HCPCS / CPT® | DAUNORUBICIN CITRATE INJ |
| J9155 | 65 | HCPCS / CPT® | DEGARELIX INJECTION |
| J9160 | 65 | HCPCS / CPT® | DENILEUKIN DIFTITOX INJ |
| J9165 | 65 | HCPCS / CPT® | DIETHYLSTILBESTROL INJECTION |
| J9171 | 65 | HCPCS / CPT® | DOCETAXEL INJECTION |
| J9175 | 65 | HCPCS / CPT® | ELLIOTTS B SOLUTION PER ML |
| J9176 | 65 | HCPCS / CPT® | INJECTION, ELOTUZUMAB, 1MG |
| J9178 | 65 | HCPCS / CPT® | INJ, EPIRUBICIN HCL, 2 MG |
| J9179 | 65 | HCPCS / CPT® | ERIBULIN MESYLATE INJECTION |
| J9181 | 65 | HCPCS / CPT® | ETOPOSIDE INJECTION |
| J9185 | 65 | HCPCS / CPT® | FLUDARABINE PHOSPHATE INJ |
| J9190 | 65 | HCPCS / CPT® | FLUOROURACIL INJECTION |
| J9200 | 65 | HCPCS / CPT® | FLOXURIDINE INJECTION |
| J9201 | 65 | HCPCS / CPT® | GEMCITABINE HCL INJECTION |
| J9202 | 65 | HCPCS / CPT® | GOSERELIN ACETATE IMPLANT |
| J9205 | 65 | HCPCS / CPT® | INJ IRINOTECAN LIPOSOME 1 MG |
| J9206 | 65 | HCPCS / CPT® | IRINOTECAN INJECTION |
| J9207 | 65 | HCPCS / CPT® | IXABEPILONE INJECTION |
| J9208 | 65 | HCPCS / CPT® | IFOSFAMIDE INJECTION |
| J9209 | 65 | HCPCS / CPT® | MESNA INJECTION |
| J9211 | 65 | HCPCS / CPT® | IDARUBICIN HCL INJECTION |
| J9212 | 65 | HCPCS / CPT® | INTERFERON ALFACON-1 INJ |
| J9213 | 65 | HCPCS / CPT® | INTERFERON ALFA-2A INJ |
| J9214 | 65 | HCPCS / CPT® | INTERFERON ALFA-2B INJ |
| J9215 | 65 | HCPCS / CPT® | INTERFERON ALFA-N3 INJ |
| J9216 | 65 | HCPCS / CPT® | INTERFERON GAMMA 1-B INJ |
| J9217 | 65 | HCPCS / CPT® | LEUPROLIDE ACETATE SUSPNSION |
| J9218 | 65 | HCPCS / CPT® | LEUPROLIDE ACETATE INJECITON |
| J9219 | 65 | HCPCS / CPT® | LEUPROLIDE ACETATE IMPLANT |
| J9225 | 65 | HCPCS / CPT® | VANTAS IMPLANT |
| J9226 | 65 | HCPCS / CPT® | SUPPRELIN LA IMPLANT |
| J9228 | 65 | HCPCS / CPT® | IPILIMUMAB INJECTION |
| J9230 | 65 | HCPCS / CPT® | MECHLORETHAMINE HCL INJ |
| J9245 | 65 | HCPCS / CPT® | INJ MELPHALAN HYDROCHL 50 MG |
| J9250 | 65 | HCPCS / CPT® | METHOTREXATE SODIUM INJ |
| J9260 | 65 | HCPCS / CPT® | METHOTREXATE SODIUM INJ |
| J9261 | 65 | HCPCS / CPT® | NELARABINE INJECTION |
| J9262 | 65 | HCPCS / CPT® | INJ, OMACETAXINE MEP, 0.01MG |
| J9263 | 65 | HCPCS / CPT® | OXALIPLATIN |
| J9264 | 65 | HCPCS / CPT® | PACLITAXEL PROTEIN BOUND |
| J9266 | 65 | HCPCS / CPT® | PEGASPARGASE INJECTION |
| J9267 | 65 | HCPCS / CPT® | PACLITAXEL INJECTION |
| J9268 | 65 | HCPCS / CPT® | PENTOSTATIN INJECTION |
| J9270 | 65 | HCPCS / CPT® | PLICAMYCIN (MITHRAMYCIN) INJ |
| J9271 | 65 | HCPCS / CPT® | INJ PEMBROLIZUMAB |
| J9280 | 65 | HCPCS / CPT® | MITOMYCIN INJECTION |
| J9293 | 65 | HCPCS / CPT® | MITOXANTRONE HYDROCHL / 5 MG |
| J9295 | 65 | HCPCS / CPT® | INJECTION, NECITUMUMAB, 1 MG |
| J9299 | 65 | HCPCS / CPT® | INJECTION, NIVOLUMAB |
| J9300 | 65 | HCPCS / CPT® | GEMTUZUMAB OZOGAMICIN INJ |
| J9301 | 65 | HCPCS / CPT® | OBINUTUZUMAB INJ |
| J9302 | 65 | HCPCS / CPT® | OFATUMUMAB INJECTION |
| J9303 | 65 | HCPCS / CPT® | PANITUMUMAB INJECTION |
| J9305 | 65 | HCPCS / CPT® | PEMETREXED INJECTION |
| J9306 | 65 | HCPCS / CPT® | INJECTION, PERTUZUMAB, 1 MG |
| J9307 | 65 | HCPCS / CPT® | PRALATREXATE INJECTION |
| J9308 | 65 | HCPCS / CPT® | INJECTION, RAMUCIRUMAB |
| J9310 | 65 | HCPCS / CPT® | RITUXIMAB INJECTION |
| J9315 | 65 | HCPCS / CPT® | ROMIDEPSIN INJECTION |
| J9320 | 65 | HCPCS / CPT® | STREPTOZOCIN INJECTION |
| J9325 | 65 | HCPCS / CPT® | INJ TALIMOGENE LAHERPAREPVEC |
| J9328 | 65 | HCPCS / CPT® | TEMOZOLOMIDE INJECTION |
| J9330 | 65 | HCPCS / CPT® | TEMSIROLIMUS INJECTION |
| J9340 | 65 | HCPCS / CPT® | THIOTEPA INJECTION |
| J9351 | 65 | HCPCS / CPT® | TOPOTECAN INJECTION |
| J9352 | 65 | HCPCS / CPT® | INJECTION TRABECTEDIN 0.1MG |
| J9354 | 65 | HCPCS / CPT® | INJ, ADO-TRASTUZUMAB EMT 1MG |
| J9355 | 65 | HCPCS / CPT® | TRASTUZUMAB INJECTION |
| J9357 | 65 | HCPCS / CPT® | VALRUBICIN INJECTION |
| J9360 | 65 | HCPCS / CPT® | VINBLASTINE SULFATE INJ |
| J9370 | 65 | HCPCS / CPT® | VINCRISTINE SULFATE 1 MG INJ |
| J9371 | 65 | HCPCS / CPT® | INJ, VINCRISTINE SUL LIP 1MG |
| J9390 | 65 | HCPCS / CPT® | VINORELBINE TARTRATE INJ |
| J9395 | 65 | HCPCS / CPT® | INJECTION, FULVESTRANT |
| J9400 | 65 | HCPCS / CPT® | INJ, ZIV-AFLIBERCEPT, 1MG |
| J9600 | 65 | HCPCS / CPT® | PORFIMER SODIUM INJECTION |
| J9999 | 65 | HCPCS / CPT® | CHEMOTHERAPY DRUG |
| K0001 | 0 | HCPCS / CPT® | STANDARD WHEELCHAIR |
| K0002 | 0 | HCPCS / CPT® | STND HEMI (LOW SEAT) WHLCHR |
| K0003 | 0 | HCPCS / CPT® | LIGHTWEIGHT WHEELCHAIR |
| K0004 | 0 | HCPCS / CPT® | HIGH STRENGTH LTWT WHLCHR |
| K0005 | 0 | HCPCS / CPT® | ULTRALIGHTWEIGHT WHEELCHAIR |
| K0006 | 0 | HCPCS / CPT® | HEAVY DUTY WHEELCHAIR |
| K0007 | 0 | HCPCS / CPT® | EXTRA HEAVY DUTY WHEELCHAIR |
| K0008 | 0 | HCPCS / CPT® | CSTM MANUAL WHEELCHAIR/BASE |
| K0009 | 0 | HCPCS / CPT® | OTHER MANUAL WHEELCHAIR/BASE |
| K0010 | 0 | HCPCS / CPT® | STND WT FRAME POWER WHLCHR |