3Q26 → 4Q26

New and dropped codes

Codes in the 4Q26 file that were not in the 3Q26 file, and the other way round. A code can leave the file for many reasons, such as being replaced by a new code. This page does not say why.

New in 4Q26 (38)

Code	Drug	Billing unit	Payment limit
90616	Flu vacc trivalent mRNA IM		$171.211
J0014	Cocaine hcl nasal (goprelto)	1 MG	$1.825
J0528	Inj fosfomycin disodium 20mg	20 MG	$0.633
J0643	Inj leucovorin calcium 1 mg	1 MG	$0.054
J0644	Inj, leucovorin cal (avyxa)	1 MG	$2.625
J0716	Centruroides immune f(ab)	UP TO 120MG	$5,449.649
J0841	Inj crotalidae im f(ab')2 eq	120 MG	$1,084.909
J0871	Inj, daptomycin (endo) 1mg	1 MG	$0.541
J1289	Narsoplimab-wuug, 1 mg	1 MG	$105.441
J1577	Inj, qivigy, 100mg	100 MG	$29.28
J1737	Inj meloxicam (azurity) 1mg	1 MG	$1.06
J1957	Injection levetiracetam 5 mg	5 MG	$0.013
J1958	Inj levetirac sodi chlo 5 mg	5 MG	$0.033
J2361	Inj depemokimab-ulaa 1 mg	1 MG	$275.391
J2374	Apraclonidine hcl opht 0.1ml	0.1 ML	$28.804
J2789	Riboflavin epioxa/hd<=2ml	UP TO 2 ML	$41,359.618
J3268	Injection, delafloxacin	1 MG	$0.478
J3404	Inj zopapogene per ther dose	Per Therapeutic Dose	$119,675.512
J3405	Inj onase abepar-brve treat	Per treatment	$2,729,937.922
J7524	Mycophenol mofetil oral 5 mg	5 MG	$0.002
J7526	Inj mycophenola mofetil 5 mg	5 MG	$0.20
J7529	Mycop mofetil susp oral 5 mg	5 MG	$0.034
J7530	Mycophenolat (myhibbin) 5 mg	5 MG	$0.115
J8541	Oral, hemady, 0.25 mg	0.25 MG	$0.375
J9186	Inj etoposide (avyxa), 1 mg	1 MG	$4.24
J9187	Inj, etoposide, 1 mg	1 MG	$0.094
J9191	Inj fluorouracil (avyxa)10mg	10 MG	$14.84
J9192	Inj, fluorouracil, 10 mg	10 MG	$0.039
J9275	Inj cosibelimab-ipdl, 2 mg	2 MG	$21.989
J9318	Inj romidepsin non-lyo 0.1mg	0.1 MG	$32.864
J9361	Inj, efbemalenograstim alfa-	0.5 MG	$121.429
J9362	Inj, trabectedin, 0.01 mg	0.01 MG	$41.844
Q0166	Granisetron hcl 1 mg oral	1 MG	$0.774
Q2058	Obecbtge autol up to 400 mil	Per Therapeutic Dose	$293,725.702
Q5161	Inj, denosumab-kyqq, 1 mg	1 MG	$27.509
Q5167	Inj, denosumab-qbde, 1 mg	1 MG	$7.681
Q5168	Inj. nufymco, 0.1 mg	0.1 MG	$26.384
Q5169	Inj, armlupeg, 0.5 mg	0.5 MG	$519.481

Dropped since 3Q26 (10)

Code	Drug	Billing unit	3Q26 limit
J0640	Leucovorin calcium injection	50 MG	$2.932
J1953	Levetiracetam injection	10 MG	$0.032
J7514	Mycophenol (myhibbin) 100 mg	100 MG	$2.296
J7517	Mycophenolate mofetil oral	250 MG	$0.131
J7519	Inj. mycophenolate mofetil	10 MG	$0.399
J7528	Mycophen mofetil for susp	100 MG	$0.164
J9181	Etoposide injection	10 MG	$1.018
J9190	Fluorouracil injection	500 MG	$2.024
J9352	Injection trabectedin 0.1mg	0.1 MG	$410.479
J9394	Inj, fulvestrant (fresenius)	25 MG	$27.112