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2020 Table of DrugsQuestions regarding coding and billing guidance should be submitted to the insurer in whosejurisdiction a claim would be filed. For private sector health insurance systems, please contactthe individual private insurance entity. For Medicaid systems, please contact the MedicaidAgency in the state in which the claim is being filed. For Medicare, contact the Medicarecontractor.IA - Intra-arterial administrationIV - Intravenous administrationIM - Intramuscular administrationIT - IntrathecalSC - Subcutaneous administrationINH - Administration by inhaled solutionVAR - Various routes of administrationOTH - Other routes of administrationORAL - Administered orallyIntravenous administration includes all methods, such as gravity infusion, injections, and timedpushes. The ‘VAR’ posting denotes various routes of administration and is used for drugs thatare commonly administered into joints, cavities, tissues, or topical applications, in addition toother parenteral administrations. Listings posted with ‘OTH’ indicate other administrationmethods, such as suppositories or catheter injections.AAbataceptAbbokinase, see UrokinaseAbbokinase, Open Cath, see UrokinaseAbciximabAbelcet, see Amphotericin B Lipid ComplexABLC, see Amphotericin BAbobotulinumtoxintypeAAcetaminophenAcetazolamide sodiumAcetylcysteine, InjectionAcetylcysteine, unit dose form10 mgIVJ012910 mgIVJ01305 units10 mgup to 500 mg100 mgper gramIMIVIM, IVIVINHJ0586J0131J1120J0132J7604, J7608Achromycin, see Tetracycline1
Actemra, see TocilizumabACTH, see CorticotropinActhar, see CorticotropinActimmune, see Interferon gamma 1-BActivase, see Alteplase recombinantAcyclovir5 mgAdalimumab20 mgAdcetis, see Brentuximab VedotinAdenocard, see AdenosineAdenoscan, see AdenosineAdenosine1 mgAdo-trastuzumab Emtansine1 mgAdrenalin Chloride, see Adrenalin, epinephrineAdrenalin, epinephrine0.1 mgAdriamycin PFS, see Doxorubicin HClAdriamycin RDF, see Doxorubicin HClAdrucil, see FluorouracilAflibercept1 mgAgalsidase beta1 mgAggrastat, see Tirofiban hydrochlorideA-hydroCort, see Hydrocortisone sodium phosphateAkineton, see BiperidenAlatrofloxacin mesylate, Injection100 mgAlbuterol0.5 mgAlbuterol, concentrated form1 mgAlbuterol, unit dose form1 mgAldesleukinper single use vialAldomet, see Methyldopate HClAlefacept0.5 mgAlferon N, see Interferon alfa-n3Algluceraseper 10 unitsAlglucosidase alfa10 mgAlkaban-AQ, see Vinblastine sulfateAlkeran, see Melphalan, oralAlpha 1-proteinase inhibitor, human10 mgAlphanateAlprostadil, Injection1.25 mcgAlprostadil, urethral suppositoryAlteplase recombinant1 mgAlupent, see Metaproterenol sulfate or Metaproterenol, compoundedAmcort, see Triamcinolone diacetateA-methaPred, see Methylprednisolone sodium succinateAmgen, see Interferon alphacon-1Amifostine500 mg2SCJ0133J0135IVIVJ0153J9354SC, IMJ0171OTHIVJ0178J0180IVINHINHINHIM, IVJ0200J7620J7610, J7611J7609, J7613J9015IM, IVJ0215IVIVJ0205J0220, J0221IVOTHOTHIVJ0256, J0257J7186J0270J0275J2997IVJ0207
Amikacin sulfateAminolevalinic acid HclAminolevulinic acid Hcl 10% rone HClAmitriptyline HCl100 mgunit dose (354 mg)10 mg1 gmup to 250 mg30 mgup to 20 mgAmobarbitalup to 125 mgAmphocin, see Amphotericin BAmphotericin B50 mgAmphotericin B, lipid complex10 mgAmpicillin sodiumup to 500 mgAmpicillin sodium/sulbactam sodiumper 1.5 gmAmygdalin, see Laetrile, Amygdalin, vitamin B-17Amytal, see AmobarbitalAnabolin LA 100, see Nandrolone decanoateAnadulafungin1 mgAnascorp, see Centruroides Immune F(ab)Ancef, see Cefazolin sodiumAndrest 90-4, see Testosterone enanthate and estradiol valerateAndro-Cyp, see Testosterone cypionateAndro-Cyp 200, see Testosterone cypionateAndro L.A. 200, see Testosterone enanthateAndro-Estro 90-4, see Testosterone enanthate and estradiol valerateAndro/Fem, see Testosterone cypionate and estradiol cypionateAndrogyn L.A., see Testosterone enanthate and estradiol valerateAndrolone-50, see Nandrolone phenpropionateAndrolone-D 100, see Nandrolone decanoateAndronaq-50, see Testosterone suspensionAndronaq-LA, see Testosterone cypionateAndronate-200, see Testosterone cypionateAndronate-100, see Testosterone cypionateAndropository 100, see Testosterone enanthateAndryl 200, see Testosterone enanthateAnectine, see Succinylcholine chlorideAnergan 25, see Promethazine HClAnergan 50, see Promethazine HClAnistreplase30 unitsAnti-Inhibitorper IUAntispas, see Dicyclomine HClAntithrombin III (human)per IUAntithrombin recombinant50 IUAnzemet, see Dolasetron mesylate InjectionA.P.L., see Chorionic gonadotropinApomorphine Hydrochloride1 mgAprepitant1 320IM, IVJ0300IVIVIM, IVIM, VIVJ7197J7196SCIVJ0364J0185
Apresoline, see Hydralazine HClAprotininAquaMEPHYTON, see Vitamin KAralen, see Chloroquine HClAramine, see MetaraminolAranesp, see Darbepoetin AlfaArbutamine10,000 kiu1 mgArcalyst, see RilanoceptAredia, see Pamidronate disodiumArfonad, see Trimethaphan camsylate15 mcgArformoterol tartrateArgatroban (for non-esrd use)1 mg(for esrd use)1 mgAridol, see MannitolAripiprazole0.25 mgAripiprazole, extended release1 mgAripiprazole lauroxil (aristada)1 mgAripiprazole lauroxil (aristada initio)1 mgAripiprazole lauroxil1 mgAristocort Forte, see Triamcinolone diacetateAristocort Intralesional, see Triamcinolone diacetateAristospan Intra-Articular, see Triamcinolone hexacetonideAristospan Intralesional, see Triamcinolone hexacetonideArrestin, see Trimethobenzamide HClArsenic trioxide1 mgArzerra, see OfatumumabAsparaginase1,000 units10,000 unitsAstramorph PF, see Morphine sulfateAtezolizumab10 mgAtgam, see Lymphocyte immune globulinAtivan, see LorazepamAtropine, concentrated formper mgAtropine, unit dose formper mgAtropine sulfate0.01 mgAtrovent, see Ipratropium bromideAtryn, see Antithrombin recombinantAurothioglucoseup to 50 mgAutologous cultured chondrocytes implantAutoplex T, see Hemophilia clotting factorsAvelumab10 mgAvonex, see Interferon beta-1aAzacitidine1 mgAzathioprine50 mgAzathioprine, parenteral100 mgAzithromycin, dihydrate1 gmAzithromycin, injection500 00J0401J1944J1943J1942IVJ9017IV, IMIV, IMJ9019J9020IVJ9022INHINHIV, IM, LIVJ9025J7500J7501Q0144J0456
BBaclofenBaclofen for intrathecal trialBactocill, see Oxacillin sodiumBAL in oil, see DimercaprolBanflex, see Orphenadrine citrateBasiliximabBCG live intravesical instillationBCG (Bacillus Calmette and Guérin), live10 mg50 mcgITOTHJ0475J047620 mg1 mgOTHper vialIVinstillationBeclomethasone inhalation solution, unit dose form per mgINHBelatacept1 mgIVBelimumab10 mgIVBelinostat10 mgIVBena-D 10, see Diphenhydramine HClBena-D 50, see Diphenhydramine HClBenadryl, see Diphenhydramine HClBenahist 10, see Diphenhydramine HClBenahist 50, see Diphenhydramine HClBen-Allergin-50, see Diphenhydramine HClBendamustine HCl (Treanda)1 mgIVBendamustine HCl (Bendeka)1 mgIVBendamustine HCl (Belrapzo/bendamustine)1 mgIVBenefix, see Factor IX, recombinantBenlysta, see BelimumabBenoject-10, see Diphenhydramine HClBenoject-50, see Diphenhydramine HClBentyl, see DicyclomineBenralizumab1 mgIVBenztropine mesylateper 1 mgIM, IVBerinert, see C-1 esterase inhibitorBerubigen, see Vitamin B-12 cyanocobalaminBeta amyloidper study doseOTHBetalin 12, see Vitamin B-12 cyanocobalaminBetameth, see Betamethasone sodium phosphateBetamethasone acetate& betamethasone sodium phosphateper 3 mgIMBetamethasone inhalation solution, unit dose form per mgINHBetaseron, see Interferon beta-1bBethanechol chlorideup to 5 mgSCBevacizumab10 mgIVBevacizumab-awwb10 mgIVBevacizumab- bvzr (Zirabev)10 mgIVBeziotoxumab10 mgIVBicillin L-A, see Penicillin G benzathineBicillin C-R 900/300, see Penicillin G procaine and penicillin G benzathineBicillin C-R, see Penicillin G benzathine and penicillin G 5118J0565
BiCNU, see CarmustineBiperiden lactateper 5 mgIM, IVJ0190INHINHIVJ7628J7629J0583IM, IV, SCIVIVIVJ9040J9039J9041J9044IVJ9042OTHIM, SC, IVORALJ7633, J7634J7626, J0594J8510J059510 units1 mg.25 mgIVIVORALJ0596-J0599J9043J85155 mgIVJ0706Bitolterol mesylate,concentrated formper mgBitolterol mesylate,unit dose formper mgBivalirudin1 mgBlenoxane, see Bleomycin sulfateBleomycin sulfate15 unitsBlinatumomab1 microgramBortezomib0.1 mgBortezomib, not otherwise specified0.1 mgBotox, see OnabotulinumtoxinABrentuximab Vedotin1 mgBrethine, see Terbutaline sulfate or Terbutaline, compoundedBricanyl Subcutaneous, see Terbutaline sulfateBrolucizumab- dbll1 mgBrompheniramine maleateper 10 mgBronkephrine, see Ethylnorepinephrine HClBronkosol, see Isoetharine HClBudesonide inhalation solution, concentrated form0.25 mgBudesonide inhalation solution, unit dose form0.5 mgBuprenorphine Hydrochloride0.1 mgBuprenorphine/Naloxone1 mg 3 mg 3 mg but 6 mg 6 mg but 10 mg 10 mgBurenorphine extended release 100 mg 100 mgBurosumab-twza1 mgBusulfan1 mgBusulfan2 mgButorphanol tartrate1 mgCC1 Esterase InhibitorCabazitaxelCabergolineCafcit, see Caffeine citrateCaffeine citrateCaine-1, see Lidocaine HclCaine-2, see Lidocaine HClCalaspargase pegol – mknlCalcijex, see CalcitriolCalcimar, see Calcitonin-salmonCalcitonin-salmon10 unitsIVup to 400 units6SC, IMJ9118J0630
Calcitriol0.1 mcgCalcium Disodium Versenate, see Edetate calcium disodiumCalcium gluconateper 10 mlCalcium glycerophosphate & calcium lactateper 10 mlCaldolor, see IbuprofenCalphosan, see Calcium glycerophosphate and calcium lactateCamptosar, see IrinotecanCanakinumabCapecitabine1 mg150 mg500 mgCapsaicin patchper sq cmCarbidopa 5 mg/levodopa 20 mg enteral suspensionCarbocaine with Neo-Cobefrin, see MepivacaineCarbocaine, see MepivacaineCarboplatin50 mgCarfilzomib1 mgCarmustine100 mgCarnitor, see LevocarnitineCarticel, see Autologous cultured chondrocytesCaspofungin acetate5 mgCayston, see AztreonamCefadyl, see Cephapirin SodiumCefazolin sodium500 mgCefepime hydrochloride500 mgCefizox, see Ceftizoxime sodiumCefotaxime sodiumper 1 gCefoxitin sodium1gCeftaroline fosamil1 mgCeftazidimeper 500 mgCeftazidime and avibactam0.5 g/0.125 gCeftizoxime sodiumper 500 mgCeftriaxone sodiumper 250 mgCeftolozane 50 mg and tazobactam 25 mgCefuroxime sodium, sterileper 750 mgCelestone Soluspan, see Betamethasone acetateand betamethasone sodium phosphateCellCept, see Mycophenolate mofetilCel-U-Jec, see Betamethasone sodium phosphateCenacort Forte, see Triamcinolone diacetateCenacort A-40, see Triamcinolone acetonideCentruroides Immune F(ab)up to 120 mgCephalothin sodiumup to 1 gCephapirin sodiumup to 1 gCeredase, see AlgluceraseCerliponase alfa1 mgCertolizumab pegol1 mgCerubidine, see Daunorubicin HCl7IMJ0636IVIM, 40IVIVIVJ9045J9047J9050IVJ0637IV, IMIVJ0690J0692IV, IMIV, IMIM, IVIVIV, IMIV, IMIVIM, M, IVIV, IMJ0716J1890J0710IVSCJ0567J0717
Cetuximab10 mgIVChealamide, see Endrate ethylenediamine-tetra-acetic acidChloramphenicol sodium succinateup to 1 gIVChlordiazepoxide HClup to 100 mgIM, IVChloromycetin Sodium Succinate, see Chloramphenicol sodium succinateChloroprocaine HClper 30 mlVARChlorpromazine5 mgORALChloroquine HClup to 250 mgIMChlorothiazide sodiumper 500 mgIVChlorpromazine HClup to 50 mgIM, IVChorex-5, see Chorionic gonadotropinChorex-10, see Chorionic gonadotropinChorignon, see Chorionic gonadotropinChorionic gonadotropinper 1,000 USP unitsIMChoron 10, see Chorionic gonadotropinCidofovir375 mgIVCilastatin sodium, imipenemper 250 mgIV, IMCimzia, see Certolizumab pegolORALCinacacetCinryze, see C1 Esterase InhibitorCipro IV, see CiprofloxacinCiprofloxacin200 mgIVoctic suspension6 mgOTHCisplatin, powder or solutionper 10 mgIVCladribineper mgIVClaforan, see Cefotaxime sodiumClofarabine1 mgIVClonidine Hydrochloride1 mgepiduralCobex, see Vitamin B-12 cyanocobalaminCodeine phosphateper 30 mgIM, IV, SCCodimal-A, see Brompheniramine maleateCogentin, see Benztropine mesylateCollagenase, Clostridium Histolyticum0.01 mgOTHColistimethate sodiumup to 150 mgIM, IVColy-Mycin M, see Colistimethate sodiumCompa-Z, see ProchlorperazineCopanlisib1 mgIVCompazine, see ProchlorperazineCompounded drug, not otherwise classifiedCophene-B, see Brompheniramine maleateCopper contraceptive, intrauterineOTHCordarone, see Amiodarone HClCorgonject-5, see Chorionic gonadotropinCorticorelin ovine triflutate1 mcgCorticotropinup to 40 unitsIV, IM, SCCortrosyn, see CosyntropinCosmegen, see DactinomycinCotranzine, see 27J0735J0745J0775J0770J9057J7999J7300J0795J0800
Crofab, see Crotalidae Polyvalent Immune FabCromolyn sodium, unit dose formper 10 mgCrotalidae immune f(ab’)2 (equine)120 mgCrotalidae Polyvalent Immune Fabup to 1 gramCrysticillin 300 A.S., see Penicillin G procaineCrysticillin 600 A.S., see Penicillin G procaineCyclophosphamide100 mgCyclophosphamide, oralCyclosporine, oral25 mg25 mg100 mgCyclosporine, parenteral250 mgCytarabine100 mgCytarabine liposome10 mgCytomegalovirus immune globulin intravenous(human)per vialCytosar-U, see CytarabineCytovene, see Ganciclovir sodiumCytoxan, see Cyclophosphamide; cyclophosphamide, lyophilized; andcyclophosphamide, oralINHIVIVJ7631, J7632J0841J0840IVJ9070ORALORALORALIVSC, 7070J9130J7513J9120IVSCIVIVIV, SCIVIVJ0875J1645J0878J9145J0881, J0882J9151J9150DD-5-W, infusion1000 ccDacarbazine100 mgDaclizumab25 mgDactinomycin0.5 mgDalalone, see Dexamethasone sodium phosphateDalalone L.A., see Dexamethasone acetateDalbavancin5 mgDalteparin sodiumper 2500 IUDaptomycin1 mgDaratumumab10 mgDarbepoetin Alfa1 mcgDaunorubicin citrate, liposomal formulation10 mgDaunorubicin HCl10 mgDaunoxome, see Daunorubicin citrateDDAVP, see Desmopressin acetateDecadron Phosphate, see Dexamethasone sodium phosphateDecadron, see Dexamethasone sodium phosphateDecadron-LA, see Dexamethasone acetateDeca-Durabolin, see Nandrolone decanoateDecaject, see Dexamethasone sodium phosphateDecaject-L.A., see Dexamethasone acetateDecitabine1 mgDecolone-50, see Nandrolone decanoateDecolone-100, see Nandrolone decanoateDe-Comberol, see Testosterone cypionate and estradiol cypionate9IVJ0894
Deferoxamine mesylateDegarelix500 mg1 mgIM, SC, IVSCDehist, see Brompheniramine maleateDeladumone OB, see Testosterone enanthate and estradiol valerateDeladumone, see Testosterone enanthate and estradiol valerateDelatest, see Testosterone enanthateDelatestadiol, see Testosterone enanthate and estradiol valerateDelatestryl, see Testosterone enanthateDelta-Cortef, see Prednisolone, oralDelestrogen, see Estradiol valerateDemadex, see TorsemideDemerol HCl, see Meperidine HClDenileukin diftitox300 mcgIVDenosumab1 mgSCDepAndro 100, see Testosterone cypionateDepAndro 200, see Testosterone cypionateDepAndrogyn, see Testosterone cypionate and estradiol cypionateDepGynogen, see Depo-estradiol cypionateDepMedalone 40, see Methylprednisolone acetateDepMedalone 80, see Methylprednisolone acetateDepo-estradiol cypionateup to 5 mgIMDepogen, see Depo-estradiol cypionateDepoject, see Methyprednisolone acetateDepo-Medrol, see Methylprednisolone acetateDepopred-40, see Methylprednisolone acetateDepopred-80, see Methylprednisolone acetateDepo-Provera, see Medroxyprogesterone acetateDepotest, see Testosterone cypionateDepo-Testadiol, see Testosterone cypionate and estradiol cypionateDepotestogen, see Testosterone cypionate and estradiol cypionateDepo-Testosterone, see Testosterone cypionateDesferal Mesylate, see Deferoxamine mesylateDesmopressin acetate1 mcgIV, SCDexacen LA-8, see Dexamethasone acetateDexacen-4, see Dexamethasone sodium phosphateDexamethasone, concentrated formper mgINHDexamethasone,unit formper mgINHDexamethasone, intravitreal implant0.1 mgOTHDexamethasone, lacrimal ophthalmic insert0.1 mgOTHDexamethasone, oral0.25 mgORALDexamethasone acetate1 mgIMDexamethasone sodium phosphate1 mgIM, IV, OTHDexasone, see Dexamethasone sodium phosphateDexasone L.A., see Dexamethasone acetateDexferrum, see Iron DextranDexone, see Dexamethasone sodium phosphateDexone LA, see Dexamethasone 7312J1096J8540J1094J1100
Dexrazoxane hydrochloride250 mgDextran 40500 mlDextran 75500 mlDextrose 5%/normal saline solution500 ml 1 unitDextrose/water (5%)500 ml 1 unitD.H.E. 45, see DihydroergotamineDiamox, see Acetazolamide sodiumDiazepamup to 5 mgDiazoxideup to 300 mgDibent, see Dicyclomine HClDiclofenac sodium37.5Dicyclomine HClup to 20 mgDidronel, see Etidronate disodiumDiethylstilbestrol diphosphate250 mgDiflucan, see FluconazoleDigoxinup to 0.5 mgDigoxin immune fab (ovine)per vialDihydrex, see Diphenhydramine HclDihydroergotamine mesylateper 1 mgDilantin, see Phenytoin sodiumDilaudid, see Hydromorphone HClDilocaine, see Lidocaine HClDilomine, see Dicyclomine HClDilor, see DyphyllineDimenhydrinateup to 50 mgDimercaprolper 100 mgDimethyl sulfoxide, see DMSO,Dimethylsulfoxide Dinate, see DimenhydrinateDioval, see Estradiol valerateDioval 40, see Estradiol valerateDioval XX, see Estradiol valerateDiphenacen-50, see Diphenhydramine HClDiphenhydramine HCl, Injectionup to 50 mgDiphenhydramine HCl, oral50 mgDipyridamoleper 10 mgDisotate, see Endrate ethylenediamine-tetra-acetic acidDi-Spaz, see Dicyclomine HClDitate-DS, see Testosterone enanthate and estradiol valerateDiuril Sodium, see Chlorothiazide sodiumD-Med 80, see Methylprednisolone acetateDMSO, Dimethyl sulfoxide50%, 50 mlDobutamine HClper 250 mgDobutrex, see Dobutamine HclDocetaxel20 mgDolasetron mesylate, Injection10 mgDolasetron mesylate, tablets100 mgDolophine HCl, see Methadone HclDommanate, see 0IM, IVIVJ3360J1730IVIMJ1130J0500IVJ9165IM, IVJ1160J1162IM, IVJ1110IM, IVIMJ1240J0470IV, 0J1260Q0180
Donbax, see DoripenemDopamine HCl40 mgDoribax, see DoripenemDoripenem10 mgIVDornase alpha, unit dose formper mgINHDoxercalciferol1 mcgIVDoxil, see Doxorubicin HCL, lipidDoxorubicin HCL10 mgIVDramamine, see DimenhydrinateDramanate, see DimenhydrinateDramilin, see DimenhydrinateDramocen, see DimenhydrinateDramoject, see DimenhydrinateDronabinol, oral2.5 mgORALDroperidolup to 5 mgIM, IVDrug administered through a metered dose inhalerINHDroperidol and fentanyl citrateup to 2 ml ampuleIM,IVDTIC-Dome, see DacarbazineDua-Gen L.A., see Testosterone enanthate and estradiol valerate cypionateDuoval P.A., see Testosterone enanthate and estradiol valerateDurabolin, see Nandrolone phenpropionateDuraclon, see Clonidine HydrochlorideDura-Estrin, see Depo-estradiol cypionateDuracillin A.S., see Penicillin G procaineDuragen-10, see Estradiol valerateDuragen-20, see Estradiol valerateDuragen-40, see Estradiol valerateDuralone-40, see Methylprednisolone acetateDuralone-80, see Methylprednisolone acetateDuralutin, see Hydroxyprogesterone CaproateDuramorph, see Morphine sulfateDuratest-100, see Testosterone cypionateDuratest-200, see Testosterone cypionateDuratestrin, see Testosterone cypionate and estradiol cypionateDurathate-200, see Testosterone enanthateDurvalumab10 mgIVDymenate, see DimenhydrinateDyphyllineup to 500 mgIMDysport, see daravoneEdetate calcium disodiumEdetate disodium1 mg10 mg1 mgup to 1000 mgper 150 mg12SCIVIVIV, SC, IMIVJ1290J1300J1301J0600J3520
Elavil, see Amitriptyline HClEllence, see Epirubicin HClElliotts b solution1 mlElosulfase alfa1 mgElotuzumab1 mgElspar, see AsparaginaseEmapalunab – lzsg1 mgEmend, see FosaprepitantEmete-Con, see BenzquinamideEminase, see AnistreplaseEnbrel, see EtanerceptEndrate ethylenediamine-tetra-acetic acid, see Edeta
Oct 22, 2019 · Carfilzomib 1 mg IV J9047 Carmustine 100 mg IV J9050 Carnitor, see Levocarnitine Carticel, see Autologous cultured chondrocytes Caspofungin acetate 5 mg IV J0637 Cayston, see Aztreonam Cefadyl, see Cephapirin Sodium Cefazolin sodium 500 mg IV, IM J0690 Cefepime hydrochloride 500 mg IV J0692 .File Size: 638KB
