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Enrollment in the Health Benefits for Immigrant Adults (HBIA) program will be temporarily paused effective July 1, 2023.

Renal Dialysis Injectable Drugs

Covered Injectable Drugs Provided in Conjunction with Renal Dialysis

The department allows an add-on payment for certain injectable drugs billed on institutional outpatient renal dialysis claims. The most current rates for these injectable drugs are identified in the Practitioner Fee Schedule.

The dosage for the drug as defined in the Healthcare Common Procedure Coding System (HCPCS) is considered one unit. If the dosage is one plus a portion of the amount listed, the dosage must be rounded up to the nearest whole number.

HCPCS Code Drug Coverage Begin Date Coverage End Date
​J0606 Etelcalcetide (Parsabiv) 08/01/20
J0636 Calcitriol (Calcijex) 01/01/03  
J0690 Cefazolin Sodium 06/01/96  
J0694 Cefoxitin Sodium 06/01/96  
J0882 Aranesp 01/01/06  
​J0887 ​Mircera ​07/01/19
J1270 Doxercalciferol (Hectoral) 01/01/02  
J1580 Gentamicin Sulfate 06/01/96  
J1750 Iron Dextran 01/01/09  
J1751​ ​Iron Dextran 165 ​01/01/06 ​ 03/31/08
​J1756 ​Iron Dextran 267 ​01/01/06 ​ 03/31/08
J1756 Venofer 01/01/03  
J2501 Paricalcitol (Zemplar) 01/01/03  
J2916 Sodium Ferric Gluconate Complex in Sucrose (Ferrlecit) 01/01/03  
J2997 Cathflo Activase 07/01/02  
J3260 Tobramycin Sulfate 06/01/96  
J3370 Vancomycin 06/01/96  
J3430 Vitamin K/Aquamephyton 06/01/96  
Q0139 Ferumoxytol 01/01/10  
Q4081 Epoetin Alfa (Epogen) *HCPCS code Q4081 required for dates of service on and after 1/1/2007   
Q4098​ ​ Iron Dextran ​04/01/08 ​12/31/08