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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 |