HCPCS Code |
HCPCS Description |
Prior Approval |
APL Code |
APL CPT Code Description |
J0129 |
Injection, Abatacept, 10 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
J0490 |
Injection, Belimumab, 10 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
J0585 |
Injection, Onabotulinumtoxina, 1 unit |
Yes - HFS 3082 Drug Prior Authorization Request Form |
64612 |
Chemodenervation of muscle(s); muscle innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64616 |
Chemodenervation of muscle(s); neck muscles, excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64642 |
Chemodenervation of one extremity; 1-4 muscle(s) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64643 |
Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64644 |
Chemodenervation of one extremity; 5 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64645 |
Chemodenervation of one extremity; each additional extremity, 5 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64646 |
Chemodenervation of trunk muscle(s); 1-5 muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64647 |
Chemodenervation of trunk muscles; 6 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64650 |
Chemodenervation of eccrine glands; both axillae |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64653 |
Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, neck), per day |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64999 |
Unlisted procedure, nervous system |
J0586 |
Injection, Abobotulinumtoxina, 5 units |
Yes - HFS 3082 Drug Prior Authorization Request Form |
64612 |
Chemodenervation of muscle(s); muscle innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64616 |
Chemodenervation of muscle(s); neck muscles, excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64642 |
Chemodenervation of one extremity; 1-4 muscle(s) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64643 |
Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64644 |
Chemodenervation of one extremity; 5 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64645 |
Chemodenervation of one extremity; each additional extremity, 5 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64646 |
Chemodenervation of trunk muscle(s); 1-5 muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64647 |
Chemodenervation of trunk muscle(s); 6 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64650 |
Chemodenervation of eccrine glands; both axillae |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64653 |
Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, neck), per day |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64999 |
Unlisted procedure, nervous system |
J0587 |
Injection, Rimabotulinumtoxinb, 100 units |
Yes - HFS 3082 Drug Prior Authorization Request Form |
64612 |
Chemodenervation of muscle(s); muscle innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64616 |
Chemodenervation of muscle(s); neck muscles, excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64642 |
Chemodenervation of one extremity; 1-4 muscle(s) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64643 |
Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64644 |
Chemodenervation of one extremity; 5 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64645 |
Chemodenervation of one extremity; each additional extremity, 5 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64646 |
Chemodenervation of trunk muscle(s); 1-5 muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64647 |
Chemodenervation of trunk muscle(s); 6 or more muscles |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64650 |
Chemodenervation of eccrine glands; both axillae |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64653 |
Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, neck), per day |
|
|
Yes - HFS 3082 Drug Prior Authorization Request Form |
64999 |
Unlisted procedure, nervous system |
J0588 |
Injection, Incobotulinumtoxin A, 1 unit |
No |
64612 |
Chemodenervation of muscle(s); muscle innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm) |
|
|
No |
64616 |
Chemodenervation of muscle(s); neck muscles, excluding muscles of the larynx, unilateral (e.g., for cervical dystonia, spasmodic torticollis) |
|
|
No |
64642 |
Chemodenervation of one extremity; 1-4 muscle(s) |
|
|
No |
64643 |
Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) |
|
|
No |
64644 |
Chemodenervation of one extremity; 5 or more muscles |
|
|
No |
64645 |
Chemodenervation of one extremity; each additional extremity, 5 or more muscles |
|
|
No |
64646 |
Chemodenervation of trunk muscle(s); 1-5 muscles |
|
|
No |
64647 |
Chemodenervation of trunk muscle(s); 6 or more muscles |
|
|
No |
64650 |
Chemodenervation of eccrine glands; both axillae |
|
|
No |
64653 |
Chemodenervation of eccrine glands; other area(s) (e.g., scalp, face, neck), per day |
|
|
No |
64999 |
Unlisted procedure, nervous system |
J0597 |
Berinert, 10 units |
No |
96374 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
|
96375 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (list separately in addition to code for primary procedure) |
|
|
|
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (list separately in addition to primary procedure) |
J0850 |
Injection, Cytomegalovirus Immune Globulin intravenous (human), per vial |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96369 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s). |
|
|
No |
96370 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug; each additional hour). List separately in addition to code for primary procedure. |
J1300 |
Injection, Eculizumab, 10 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
J1459 |
Injection, Immune Globulin (Privigen), Intravenous, Non-Lyophilized (e.g., liquid), 500 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour). |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
J1561 |
Injection, Immune Globulin (Gamunex), Intravenous, Non-Lyophilized (e.g., liquid), 500 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour). |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96369 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s). |
|
|
No |
96370 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug; each additional hour). List separately in addition to code for primary procedure. |
J1562 |
Injection, Immune Globulin (Vivaglobin), 100 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour). |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96369 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s). |
|
|
No |
96370 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug; each additional hour). List separately in addition to code for primary procedure. |
J1566 |
Injection, Immune Globulin, Intravenous, Lyophilized (e.g., powder), not otherwise specified |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour). |
|
|
|
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
|
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
|
96369 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s). |
|
|
|
96370 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug; each additional hour). List separately in addition to code for primary procedure. |
J1568 |
Injection, Immune Globulin, (Octagam), Intravenous, Non-Lyophilized (e.g., liquid), 500 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96369 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s). |
|
|
No |
96370 |
Subcutaneous infusion for therapy or prophylaxis, (specify substance or drug) each additional hour). List separately in addition to code for primary procedure. |
J1569 |
Injection, Immune Globulin, (Gammagard Liquid), Intravenous, Non-Lyophilized (e.g., liquid), 500 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96369 |
Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s). |
|
|
No |
96370 |
Subcutaneous infusion for therapy or prophylaxis, (specify substance or drug) each additional hour). List separately in addition to code for primary procedure. |
J1745 |
Injection, Infliximab, 10 mg. - Remicade |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour). |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
J3262 |
Injection, Tocilizumab, 1 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour. |
|
|
|
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour. List separately in addition to code for primary procedure. |
|
|
|
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion, up to 1 hour. List separately in addition to code for primary procedure. |
J3364 |
Injection, Urokinase, 5000 IU Vial - Abbokinase |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour). |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
J3365 |
Injection, Urokinase, 250,000 IU Vial - Abbokinase |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
J7185 |
Injection, Factor VIII (Antihemophilic Factor, Recombinant) (Xyntha), Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7186 |
Injection, Antihemophilic Factor VIII/Von Willebrand Factor Complex (Human), Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7187 |
Injection, Von Willebrand Factor Complex (Humate-P), Per I.U. VWF:RCO |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7189 |
Factor VIIA (Antihemophilic Factor, Recombinant), Per 1 mcg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7190 |
Factor VIII (Antihemophilic Factor, Human) Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7191 |
Factor VIII (Antihemophilic Factor (Porcine), Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7192 |
Factor VIII (Antihemophilic Factor, Recombinant) Per I.U., Not Otherwise Specified |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7193 |
Factor IX (Antihemophilic Factor, Purified, Non-Recombinant) per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7194 |
Factor IX, Complex, Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7195 |
Factor IX (Antihemophilic Factor, Recombinant), Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7197 |
Antithrombin III (Human), Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7198 |
Anti-Inhibitor, Per I.U. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7199 |
Hemophilia Clotting Factor, Not Otherwise Classified |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
No |
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
No |
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
No |
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
No |
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
No |
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
J7310 |
Ganciclovir, 4.5 mg., long-acting implant - Vitrasert |
No |
67027 |
Implantation of intravitreal drug delivery system (eg., ganciclovir, implant), includes concomitant removal of vitreous |
J9226 |
Histrelin Implant (Supprelin LA), 50 mg. |
No |
11980 |
Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) |
|
|
No |
11981 |
Insertion, non-biodegradable drug delivery implant |
|
|
No |
11983 |
Removal with reinsertion, non-biodegradable drug delivery implant |
Q2041 |
Injection, Von Willebrand Factor, complex (human) Wilate 1 IU |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |
|
|
|
96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, each additional hour). List separately in addition to code for primary procedure. |
|
|
|
96367 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; additional sequential infusion, up to 1 hour). List separately in addition to code for primary procedure. |
|
|
|
96374 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug |
|
|
|
96375 |
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug. List separately in addition to code for primary procedure. |
|
|
|
96376 |
Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility. List separately in addition to primary procedure. |
Q2051 |
Injection, Zoledronic Acid (Reclast), 1 mg. |
No |
96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug; initial, up to 1 hour) |