All codes

1,205 codes

• 90371 Hep b ig im
• 90375 Rabies ig im/sc
• 90376 Rabies ig heat treated not in 4Q26
• 90377 Rabies ig ht&sol human im/sc
• 90586 Bcg vaccine intravesical not in 4Q26
• 90616 Flu vacc trivalent mRNA IM
• 90632 Hepa vaccine adult im
• 90653 Iiv adjuvant vaccine im
• 90656 IIV3 VACC NO PRSV 0.5 ML IM
• 90657 IIV3 VACCINE SPLT 0.25 ML IM
• 90658 IIV3 VACCINE SPLT 0.5 ML IM
• 90660 LAIV3 Vaccine Intranasal
• 90661 CCIIV3 VACCINE NO PRSC 0.5ML IM
• 90662 Iiv no prsv increased ag im
• 90670 Pcv13 vaccine im not in 4Q26
• 90671 PCV15 vaccine IM
• 90672 Laiv4 vaccine intranasal not in 4Q26
• 90673 Riv3 vaccine no preserv im
• 90674 Cciiv4 vac no prsv 0.5 ml im not in 4Q26
• 90675 Rabies vaccine im
• 90677 Pcv20 vaccine im
• 90682 Riv4 vacc recombinant dna im not in 4Q26
• 90684 PCV21 VACCINE IM
• 90685 Iiv4 vacc no prsv 0.25 ml im not in 4Q26
• 90686 Iiv4 vacc no prsv 0.5 ml im not in 4Q26
• 90687 Iiv4 vaccine splt 0.25 ml im not in 4Q26
• 90688 Iiv4 vaccine splt 0.5 ml im not in 4Q26
• 90691 Typhoid vaccine im not in 4Q26
• 90694 Vacc AIIV4 no prsrv 0.5ML IM not in 4Q26
• 90714 Td vacc no presv 7 yrs+ im
• 90715 Tdap vaccine 7 yrs/> im
• 90732 Ppsv23 vacc 2 yrs+ subq/im
• 90739 Hepb vacc 2 dose adult im
• 90740 Hepb vacc 3 dose immunsup im
• 90743 Hep b vacc, adol, 2 dose, im
• 90744 Hepb vacc 3 dose ped/adol im
• 90746 Hepb vaccine 3 dose adult im
• 90747 Hepb vacc 4 dose immunsup im
• 90756 Cciiv4 vacc abx free im not in 4Q26
• 90759 Hep b vac 3ag 10mcg 3 dos im not in 4Q26
• 91304 SARSCOV2 VAC 5MCG/0.5ML IM
• 91318 SARSCOV2 VAC 3MCG TRS-SUC IM not in 4Q26
• 91319 SARSCV2 VAC 10MCG TRS-SUC IM
• 91320 SARSCV2 VAC 30MCG TRS-SUC IM
• 91321 SARSCOV2 VAC 25 MCG/.25ML IM
• 91322 SARSCOV2 VAC 50 MCG/0.5ML IM
• 91323 SARSCOV2 VAC 10 MCG/0.2ML IM
• A9573 Inj, gadopiclenol, 1 ml
• A9575 Inj gadoterate meglumi 0.1ml
• A9576 Inj prohance multipack
• A9577 Inj multihance
• A9578 Inj multihance multipack
• A9579 Gad-base mr contrast nos,1ml
• A9581 Gadoxetate disodium inj
• A9585 Gadobutrol injection
• A9589 Insti hexaminolevulinate hcl
• A9606 Radium ra223 dichloride ther
• J0014 Cocaine hcl nasal (goprelto)
• J0121 Inj., omadacycline, 1 mg
• J0122 Inj., eravacycline, 1 mg
• J0129 Abatacept injection
• J0131 Inj, acetaminophen (nos)
• J0132 Acetylcysteine injection
• J0133 Acyclovir injection
• J0134 Inj acetaminophen -fresenius
• J0136 Inj, acetaminophen (b braun)
• J0137 Inj, acetaminophen (hikma)
• J0138 Inj acetaminoph 10mg/ibu 3mg
• J0153 Adenosine inj 1mg
• J0162 Inj epinephrine (fresenius)
• J0163 Epinephrine in nacl (endo)
• J0164 Epinephrine in nacl (baxter)
• J0165 Inj epinephrine nos 0.1 mg
• J0166 Inj epinephrine (bpi)
• J0167 Inj epinephrine (hospira)
• J0168 Epinephrine (intl med sys)
• J0169 Inj epinephrine (adrenalin)
• J0171 Adrenalin epinephrine inject not in 4Q26
• J0172 Inj, aducanumab-avwa, 2 mg not in 4Q26
• J0173 Inj, epinephrine (belcher) not in 4Q26
• J0174 Lecanemab-irmb, for iv inj
• J0175 Inj, donanemab-azbt, 2 mg
• J0177 Inj, aflibercept hd, 1 mg
• J0178 Aflibercept injection
• J0179 Inj, brolucizumab-dbll, 1 mg
• J0180 Agalsidase beta injection
• J0185 Inj., aprepitant, 1 mg
• J0202 Injection, alemtuzumab
• J0206 Inj allopurinol sodium 1 mg
• J0207 Amifostine not in 4Q26
• J0216 Inj, alfentanil hcl, 500mcg not in 4Q26
• J0217 Inj velmanase alfa-tycv 1 mg
• J0218 Inj olipudase alfa-rpcp 1mg
• J0219 Inj aval alfa-nqpt 4mg
• J0221 Lumizyme injection
• J0222 Inj., patisiran, 0.1 mg
• J0223 Inj givosiran 0.5 mg
• J0224 Inj. lumasiran, 0.5 mg
• J0225 Inj, vutrisiran, 1 mg
• J0248 Inj, remdesivir, 1 mg
• J0256 Alpha 1 proteinase inhibitor
• J0257 Glassia injection
• J0278 Amikacin sulfate injection
• J0280 Aminophyllin 250 mg inj
• J0281 Inj aminocaproic acid 1 gram
• J0282 Amiodarone hcl
• J0283 Inj, amiodarone (nexterone)
• J0285 Amphotericin b
• J0287 Amphotericin b lipid complex not in 4Q26
• J0289 Amphotericin b liposome inj
• J0290 Ampicillin 500 mg inj
• J0291 Inj., plazomicin, 5 mg
• J0295 Ampicillin sulbactam 1.5 gm
• J0348 Anidulafungin injection
• J0349 Inj, rezafungin, 1 mg
• J0360 Hydralazine hcl injection
• J0401 Inj, abilify maintena, 1 mg
• J0402 Inj, abilify asimtufii, 1 mg
• J0456 Azithromycin
• J0457 Injection, aztreonam, 100 mg
• J0458 Aztreonam/avibactam 10 mg
• J0461 Atropine sulfate injection
• J0462 Atropine sulf, nte, 0.01 mg
• J0463 Inj atropine (fresenius te)
• J0475 Baclofen 10 mg injection
• J0476 Baclofen intrathecal trial
• J0480 Basiliximab
• J0485 Belatacept injection
• J0490 Belimumab injection
• J0491 Inj anifrolumab-fnia 1mg
• J0500 Dicyclomine injection
• J0515 Inj benztropine mesylate
• J0517 Inj., benralizumab, 1 mg
• J0528 Inj fosfomycin disodium 20mg
• J0558 Peng benzathine/procaine inj
• J0561 Penicillin g benzathine inj
• J0565 Inj, bezlotoxumab, 10 mg not in 4Q26
• J0570 Buprenorphine implant 74.2mg not in 4Q26
• J0577 Inj, brixadi, 7 days or less
• J0578 Inj brixadi, more than 7 day
• J0582 Bivalirudin (endo) 1 mg
• J0583 Bivalirudin
• J0584 Injection, burosumab-twza 1m
• J0585 Injection,onabotulinumtoxina
• J0586 Abobotulinumtoxina
• J0587 Inj, rimabotulinumtoxinb
• J0588 Incobotulinumtoxin a
• J0589 Inj daxibotulinumtoxina-lanm
• J0592 Buprenorphine hydrochloride
• J0593 Inj., lanadelumab-flyo, 1 mg
• J0594 Busulfan injection
• J0595 Butorphanol tartrate 1 mg
• J0596 Injection, ruconest
• J0597 C-1 esterase, berinert
• J0598 C-1 esterase, cinryze
• J0600 Edetate calcium disodium inj
• J0610 Calcium glucon (fresenius) not in 4Q26
• J0611 Calcium glucon (wg critical) not in 4Q26
• J0612 Inj, calcium gluconate, nos
• J0613 Calcium glucon (wg critical)
• J0614 Inj, treosulfan, 50 mg
• J0616 Inj metoprolol tartrate 1 mg
• J0630 Calcitonin salmon injection not in 4Q26
• J0636 Inj calcitriol per 0.1 mcg not in 4Q26
• J0637 Caspofungin acetate
• J0638 Canakinumab injection
• J0640 Leucovorin calcium injection not in 4Q26
• J0641 Inj levoleucovorin nos 0.5mg
• J0642 Injection, khapzory, 0.5 mg
• J0643 Inj leucovorin calcium 1 mg
• J0644 Inj, leucovorin cal (avyxa)
• J0650 Inj, levothyroxine nos 10mcg
• J0651 Inj, levothyroxine, freskabi
• J0652 Inj, levothyroxine, hikma
• J0665 Inj, bupivacaine, nos, 0.5mg
• J0666 Inj, bupivacaine liposome
• J0670 Inj mepivacaine hcl/10 ml
• J0681 Inj ceftobipole medocarl 3mg
• J0687 Inj cefazolin (wg crit care)
• J0688 Inj cefazolin sodium, hikma
• J0689 Inj cefazolin sodium, baxter
• J0690 Cefazolin sodium injection
• J0691 Inj lefamulin 1 mg not in 4Q26
• J0692 Cefepime hcl for injection
• J0694 Cefoxitin sodium injection
• J0695 Inj ceftolozane tazobactam
• J0696 Ceftriaxone sodium injection
• J0697 Sterile cefuroxime injection
• J0698 Cefotaxime sodium injection not in 4Q26
• J0699 Inj, cefiderocol, 10 mg
• J0701 Inj. cefepime hcl (baxter)
• J0702 Betamethasone acet&sod phosp
• J0703 Inj, cefepime hcl (b braun)
• J0712 Ceftaroline fosamil inj
• J0713 Inj ceftazidime per 500 mg
• J0714 Ceftazidime and avibactam
• J0716 Centruroides immune f(ab)
• J0717 Certolizumab pegol inj 1mg
• J0720 Chloramphenicol sodium injec not in 4Q26
• J0725 Chorionic gonadotropin/1000u
• J0735 Clonidine hydrochloride
• J0736 Inj, clindamycin phosp 300mg
• J0737 Inj, clindamycin (baxter)
• J0738 Hiv prep, inj, lenacapavir
• J0739 Hiv prep, inj, cabotegravir
• J0740 Cidofovir injection
• J0741 Inj, cabote rilpivir 2mg 3mg
• J0742 Inj imip 4 cilas 4 releb 2mg
• J0743 Cilastatin sodium injection
• J0744 Ciprofloxacin iv
• J0750 Hiv prep, ftc/tdf 200/300mg
• J0751 Hiv prep, ftc/taf 200/25mg
• J0752 Hiv prep, oral lenacapavir
• J0759 Inj, clevidipine, 1 mg
• J0770 Colistimethate sodium inj
• J0775 Collagenase, clost hist inj
• J0780 Prochlorperazine injection
• J0791 Inj crizanlizumab-tmca 5mg
• J0795 Corticorelin ovine triflutal not in 4Q26
• J0800 Corticotropin injection not in 4Q26
• J0801 Inj. acthar gel to 40 units
• J0802 Inj. (ani), up to 40 units
• J0834 Inj., cosyntropin, 0.25 mg
• J0840 Crotalidae poly immune fab
• J0841 Inj crotalidae im f(ab')2 eq
• J0850 Cytomegalovirus imm iv /vial
• J0870 Injection, imetelstat, 1 mg
• J0871 Inj, daptomycin (endo) 1mg
• J0872 Daptomycin (xellia) unrefrig
• J0873 Inj daptomycin (xellia)
• J0874 Inj, daptomycin (baxter)
• J0875 Injection, dalbavancin
• J0877 Inj, daptomycin (hospira)
• J0878 Daptomycin injection
• J0881 Darbepoetin alfa, non-esrd
• J0882 Darbepoetin alfa, esrd use
• J0883 Argatroban nonesrd use 1mg
• J0884 Argatroban esrd dialysis 1mg
• J0885 Epoetin alfa, non-esrd
• J0887 Epoetin beta esrd use
• J0888 Epoetin beta non esrd
• J0891 Argatroban nonesrd (accord) not in 4Q26
• J0892 Argatroban dialysis (accord) not in 4Q26
• J0893 Inj, decitabine (sun pharma) not in 4Q26
• J0894 Decitabine injection
• J0895 Deferoxamine mesylate inj
• J0896 Inj luspatercept-aamt 0.25mg
• J0897 Denosumab injection
• J0898 Argatroban nonesrd (auromed)
• J0899 Argatroban dialysis, auromed
• J0901 Vadadustat oral 1mg for esrd
• J1000 Depo-estradiol cypionate inj
• J1010 Inj, methylpred acetate 1 mg
• J1020 Methylprednisolone 20 mg inj not in 4Q26
• J1030 Methylprednisolone 40 mg inj not in 4Q26
• J1040 Methylprednisolone 80 mg inj not in 4Q26
• J1050 Medroxyprogesterone acetate not in 4Q26
• J1071 Inj testosterone cypionate
• J1072 Inj, testosterone, azmiro
• J1096 Dexametha opth insert 0.1 mg
• J1100 Dexamethasone sodium phos
• J1110 Inj dihydroergotamine mesylt
• J1120 Acetazolamid sodium injectio
• J1160 Digoxin injection
• J1162 Digoxin immune fab (ovine)
• J1163 Inj, diltiazem hcl, 0.5 mg
• J1164 Inj diltiazem in 0.72% nacl
• J1165 Phenytoin sodium injection
• J1170 Hydromorphone injection not in 4Q26
• J1171 Inj, hydromorphone, 0.1 mg
• J1190 Dexrazoxane hcl injection
• J1200 Diphenhydramine hcl injectio
• J1201 Inj. cetirizine hcl 0.5mg
• J1203 Inj, cipaglucosidase, 5 mg
• J1205 Chlorothiazide sodium inj
• J1212 Dimethyl sulfoxide 50% 50 ml
• J1230 Methadone injection
• J1240 Dimenhydrinate injection
• J1245 Dipyridamole injection
• J1250 Inj dobutamine hcl/250 mg
• J1265 Dopamine injection
• J1270 Injection, doxercalciferol
• J1271 Inj doxycycline hyclate 1 mg
• J1289 Narsoplimab-wuug, 1 mg
• J1290 Ecallantide injection
• J1299 Inj, eculizumab, 2 mg
• J1300 Eculizumab injection not in 4Q26
• J1301 Injection, edaravone, 1 mg
• J1302 Inj, sutimlimab-jome, 10 mg
• J1303 Inj., ravulizumab-cwvz 10 mg
• J1304 Inj tofersen intrathec 1 mg
• J1305 Inj, evinacumab-dgnb, 5mg
• J1306 Injection, inclisiran, 1 mg
• J1307 Inj, crovalimab-akkz, 10 mg
• J1308 Inj, famotidine, 0.25 mg
• J1322 Elosulfase alfa, injection
• J1323 Inj, elranatamab-bcmm, 1 mg
• J1325 Epoprostenol injection
• J1326 Inj, zolbetuximab-clzb, 2 mg
• J1335 Ertapenem injection
• J1364 Erythro lactobionate /500 mg
• J1380 Estradiol valerate 10 mg inj
• J1410 Inj estrogen conjugate 25 mg
• J1430 Ethanolamine oleate 100 mg
• J1434 Inj, focinvez, 1mg
• J1437 Inj. fe derisomaltose 10 mg
• J1439 Inj ferric carboxymaltos 1mg
• J1440 Fecal microbiota jslm 1 ml
• J1442 Inj filgrastim excl biosimil
• J1447 Inj tbo filgrastim 1 microg
• J1448 Injection, trilaciclib, 1mg
• J1449 Inj eflapegrastim-xnst 0.1mg
• J1450 Fluconazole
• J1453 Fosaprepitant injection
• J1454 Inj fosnetupitant, palonoset
• J1455 Foscarnet sodium injection
• J1456 Inj, fosaprepitant (teva)
• J1458 Galsulfase injection
• J1459 Inj ivig privigen 500 mg
• J1460 Gamma globulin 1 cc inj
• J1551 Inj cutaquig 100 mg
• J1552 Inj, alyglo, 500 mg
• J1553 Inj yimmugo 100 mg
• J1554 Inj. asceniv
• J1555 Inj cuvitru, 100 mg
• J1556 Inj, imm glob bivigam, 500mg
• J1557 Gammaplex injection
• J1558 Inj. xembify, 100 mg
• J1559 Hizentra injection
• J1560 Gamma globulin > 10 cc inj
• J1561 Gamunex-c/gammaked
• J1566 Immune globulin, powder
• J1568 Octagam injection
• J1569 Gammagard liquid/erc inj
• J1570 Ganciclovir sodium injection
• J1571 Hepagam b im injection
• J1572 Flebogamma injection not in 4Q26
• J1573 Hepagam b intravenous, inj
• J1575 Hyqvia 100mg immuneglobulin
• J1576 Inj, panzyga, 500 mg
• J1577 Inj, qivigy, 100mg
• J1580 Garamycin gentamicin inj
• J1596 Inj, glycopyrrolate, 0.1 mg
• J1597 Inj glycopyrrolate, glyrx-pf
• J1598 Inj glycopyrrolate fres kabi
• J1602 Golimumab for iv use 1mg
• J1610 Glucagon hydrochloride/1 mg
• J1611 Inj glucagon hcl, fresenius
• J1612 Inj glucagon (gvoke) 0.01 mg
• J1626 Granisetron hcl injection
• J1627 Inj, granisetron, xr, 0.1 mg
• J1628 Inj., guselkumab, 1 mg
• J1630 Haloperidol injection
• J1631 Haloperidol decanoate inj
• J1640 Hemin, 1 mg
• J1642 Inj heparin sodium per 10 u
• J1643 Inj heparin, pfizer, 1000u
• J1644 Inj heparin sodium per 1000u
• J1645 Dalteparin sodium
• J1650 Inj enoxaparin sodium
• J1652 Fondaparinux sodium
• J1670 Tetanus immune globulin inj
• J1720 Hydrocortisone sodium succ i
• J1737 Inj meloxicam (azurity) 1mg
• J1738 Inj. meloxicam 1 mg not in 4Q26
• J1740 Ibandronate sodium injection
• J1741 Ibuprofen injection
• J1742 Ibutilide fumarate injection not in 4Q26
• J1743 Idursulfase injection
• J1744 Icatibant injection not in 4Q26
• J1745 Infliximab not biosimil 10mg
• J1746 Inj., ibalizumab-uiyk, 10 mg
• J1747 Inj, spesolimab-sbzo, 1 mg
• J1748 Inj, zymfentra, 10 mg not in 4Q26
• J1749 Inj, iloprost, 0.1 mcg
• J1750 Inj iron dextran
• J1756 Iron sucrose injection
• J1786 Imuglucerase injection
• J1790 Droperidol injection
• J1800 Propranolol injection not in 4Q26
• J1805 Inj, esmolol hcl, 10mg
• J1806 Inj esmolol hcl wg crit care
• J1808 Inj, folic acid, 0.1 mg
• J1809 Inj, fosdenopterin, 0.1mg
• J1811 Fiasp for insulin pump use
• J1813 Lyumjev for insulin pump use
• J1815 Insulin injection not in 4Q26
• J1817 Insulin for insulin pump use
• J1823 Inj. inebilizumab-cdon, 1 mg
• J1836 Inj, metronidazole, 10 mg
• J1837 Inj, posaconazole, 1 mg
• J1885 Ketorolac tromethamine inj
• J1920 Inj, labetalol hcl, 5mg
• J1921 Inj labetalol hcl hikma, 5mg
• J1930 Lanreotide injection
• J1931 Laronidase injection
• J1932 Inj, lanreotide, (cipla) 1mg
• J1938 Inj, furosemide, 1 mg
• J1939 Inj, bumetanide, 0.5 mg
• J1940 Furosemide injection not in 4Q26
• J1943 Inj., aristada initio, 1 mg
• J1944 Aripiprazole lauroxil 1 mg
• J1950 Leuprolide acetate /3.75 mg
• J1951 Inj fensolvi 0.25 mg
• J1952 Leuprolide inj, camcevi, 1mg
• J1953 Levetiracetam injection not in 4Q26
• J1954 Inj leu acet lutr dpt 7.5 mg
• J1955 Inj levocarnitine per 1 gm
• J1956 Levofloxacin injection
• J1957 Injection levetiracetam 5 mg
• J1958 Inj levetirac sodi chlo 5 mg
• J1961 Inj lenacapavir (hiv tx) 1mg
• J1980 Hyoscyamine sulfate inj not in 4Q26
• J2001 Lidocaine injection not in 4Q26
• J2002 Inj, lidocaine in d5w, 1 mg
• J2010 Lincomycin injection
• J2020 Linezolid injection
• J2021 Inj, linezolid (hospira)
• J2060 Lorazepam injection
• J2150 Mannitol injection not in 4Q26
• J2151 Inj, mannitol, 250 mg
• J2175 Meperidine hydrochl /100 mg
• J2182 Injection, mepolizumab, 1mg
• J2183 Inj meropenem (wg crit care)
• J2184 Inj, meropenem (b. braun)
• J2185 Meropenem
• J2210 Methylergonovin maleate inj
• J2246 Inj, micafungin (baxter)
• J2247 Inj, micafungin (par pharm)
• J2248 Micafungin sodium injection
• J2250 Inj midazolam hydrochloride
• J2251 Inj midazolam in 0.9% nacl
• J2260 Inj milrinone lactate / 5 mg
• J2267 Inj, mirikizumab-mrkz, 1 mg
• J2270 Morphine sulfate injection
• J2272 Inj, morphine (fresenius)
• J2274 Inj morphine pf epid ithc
• J2277 Inj, motixafortide, 0.25 mg
• J2278 Ziconotide injection
• J2280 Inj, moxifloxacin 100 mg
• J2281 Inj moxifloxacin (fres kabi)
• J2290 Inj, nafcillin sodium, 20 mg
• J2291 Inj, nafcillin (baxter) 20mg
• J2300 Inj nalbuphine hydrochloride
• J2305 Inj, nitroglycerin, 5 mg
• J2310 Inj naloxone hydrochloride not in 4Q26
• J2311 Inj, naloxone hcl (zimhi) not in 4Q26
• J2312 Inj naloxone hcl nos, 0.01mg
• J2313 Inj, naloxone (zimhi) 0.01mg not in 4Q26
• J2315 Naltrexone, depot form
• J2323 Natalizumab injection
• J2327 Inj risankizumab-rzaa 1 mg
• J2329 Inj ublituximab-xiiy, 1 mg
• J2350 Injection, ocrelizumab, 1 mg
• J2351 Inj ocrelizumab 1mg hya-ocsq
• J2353 Octreotide injection, depot
• J2354 Octreotide inj, non-depot
• J2356 Inj tezepelumab-ekko, 1mg
• J2357 Omalizumab injection
• J2358 Olanzapine long-acting inj
• J2359 Inj. olanzapine, 0.5mg
• J2360 Orphenadrine injection
• J2361 Inj depemokimab-ulaa 1 mg
• J2371 Inj phenylephrine hcl 20 mcg
• J2372 Inj, biorphen, 20 micrograms
• J2373 Inj, immphentiv, 20 mcg
• J2374 Apraclonidine hcl opht 0.1ml
• J2400 Chloroprocaine hcl injection not in 4Q26
• J2401 Chloroprocaine hcl injection
• J2403 Chloroprocaine opht gel, 1mg
• J2404 Inj, nicardipine 0.1 mg
• J2405 Ondansetron hcl injection
• J2406 Injection, oritavancin 10 mg
• J2407 Injection, oritavancin
• J2425 Palifermin injection
• J2426 Inj, invega sustenna, 1 mg
• J2427 Inj, invega hafyera/trinza
• J2428 Inj, erzofri, 1 mg
• J2430 Pamidronate disodium /30 mg
• J2468 Inj, palonosetron (posfrea)
• J2469 Palonosetron hcl
• J2501 Paricalcitol
• J2502 Inj, pasireotide long acting
• J2503 Pegaptanib sodium injection not in 4Q26
• J2505 Injection, pegfilgrastim 6mg not in 4Q26
• J2506 Inj pegfilgrast ex bio 0.5mg
• J2507 Pegloticase injection
• J2508 Pegunigalsidase alfa-iwxj
• J2510 Penicillin g procaine inj not in 4Q26
• J2515 Pentobarbital sodium inj not in 4Q26
• J2516 Inj, pentamidine isethionate
• J2540 Penicillin g potassium inj
• J2543 Piperacillin/tazobactam
• J2545 Pentamidine non-comp unit
• J2550 Promethazine hcl injection
• J2560 Phenobarbital sodium inj
• J2562 Plerixafor injection
• J2596 Vasopressin (long grove) 1 u
• J2597 Inj desmopressin acetate
• J2598 Inj, vasopressin, 1 unit
• J2599 Inj vasopressin (am reg) 1 u
• J2601 Inj, vasopressin (baxter)
• J2675 Inj progesterone per 50 mg
• J2679 Inj fluphenazine hcl 1.25 mg
• J2680 Fluphenazine decanoate 25 mg
• J2690 Procainamide hcl injection
• J2700 Oxacillin sodium injeciton
• J2704 Inj, propofol, 10 mg
• J2720 Inj protamine sulfate/10 mg
• J2724 Protein c concentrate
• J2760 Phentolaine mesylate inj
• J2765 Metoclopramide hcl injection
• J2770 Quinupristin/dalfopristin not in 4Q26
• J2777 Inj, faricimab-svoa, 0.1mg
• J2778 Ranibizumab injection
• J2779 Inj, susvimo 0.1 mg
• J2780 Ranitidine hydrochloride inj not in 4Q26
• J2781 Inj, pegcetacoplan, 1mg
• J2782 Inj avacincaptad pegol 0.1mg
• J2783 Rasburicase
• J2785 Regadenoson injection
• J2786 Injection, reslizumab, 1mg
• J2788 Rho d immune globulin 50 mcg
• J2789 Riboflavin epioxa/hd<=2ml
• J2790 Rho d immune globulin inj
• J2791 Rhophylac injection
• J2792 Rho(d) immune globulin h, sd
• J2794 Inj risperdal consta, 0.5 mg
• J2795 Ropivacaine hcl injection
• J2796 Romiplostim injection not in 4Q26
• J2798 Inj., perseris, 0.5 mg
• J2799 Inj, uzedy, 1 mg
• J2800 Methocarbamol injection
• J2802 Inj, romiplostim 1 microgram
• J2804 Inj, rifampin, 1 mg
• J2805 Sincalide injection
• J2820 Sargramostim injection
• J2860 Injection, siltuximab
• J2865 Inj sulfameth/trim 5 mg/1 mg
• J2916 Na ferric gluconate complex
• J2919 Inj, methylpred sod succ 5mg
• J2920 Methylprednisolone injection not in 4Q26
• J2930 Methylprednisolone injection not in 4Q26
• J2997 Alteplase recombinant
• J2998 Inj plasminogen tvmh 1mg not in 4Q26
• J3000 Streptomycin injection
• J3010 Fentanyl citrate injection
• J3032 Inj. eptinezumab-jjmr 1 mg
• J3055 Inj talquetamab-tgvs 0.25 mg
• J3060 Inj, taliglucerase alfa 10 u
• J3090 Inj tedizolid phosphate
• J3095 Telavancin injection
• J3101 Tenecteplase injection
• J3105 Terbutaline sulfate inj
• J3111 Inj. romosozumab-aqqg 1 mg
• J3121 Inj testostero enanthate 1mg
• J3145 Testosterone undecanoate 1mg
• J3230 Chlorpromazine hcl injection
• J3240 Thyrotropin injection
• J3241 Inj. teprotumumab-trbw 10 mg
• J3243 Tigecycline injection
• J3244 Inj. tigecycline (accord) not in 4Q26
• J3245 Inj., tildrakizumab, 1 mg
• J3246 Tirofiban hcl
• J3247 Inj secukinumab intrav 1mg
• J3250 Trimethobenzamide hcl inj
• J3260 Tobramycin sulfate injection
• J3262 Tocilizumab injection
• J3263 Inj, toripalimab-tpzi, 1 mg
• J3268 Injection, delafloxacin
• J3285 Treprostinil injection
• J3299 Inj xipere 1 mg
• J3300 Triamcinolone a inj prs-free
• J3301 Triamcinolone acet inj nos
• J3304 Inj triamcinolone ace xr 1mg
• J3315 Triptorelin pamoate
• J3316 Inj., triptorelin xr 3.75 mg
• J3357 Ustekinumab sub cu inj, 1 mg not in 4Q26
• J3358 Ustekinumab, iv inject, 1 mg
• J3360 Diazepam injection
• J3370 Vancomycin hcl injection not in 4Q26
• J3371 Inj, vancomycin hcl (mylan) not in 4Q26
• J3372 Inj, vancomycin hcl (xellia) not in 4Q26
• J3373 Inj, vancomycin hcl, 10 mg
• J3374 Inj, vancomycin (mylan) 10mg
• J3375 Inj, vanco (tyzavan) 10mg
• J3376 Inj vancomycin (hikma) 10mg
• J3379 Inj, valproate sod, 5 mg
• J3380 Inj vedolizumab iv 1 mg
• J3385 Velaglucerase alfa
• J3396 Verteporfin injection
• J3401 Vyjuvek 5x10^9pfu/ml, 0.1 ml
• J3402 Inj. remestemcel-l-rknd/ td
• J3404 Inj zopapogene per ther dose
• J3405 Inj onase abepar-brve treat
• J3410 Hydroxyzine hcl injection
• J3411 Thiamine hcl 100 mg
• J3415 Pyridoxine hcl 100 mg
• J3420 Vitamin b12 injection
• J3425 Hydroxocobalamin im 10mcg
• J3430 Vitamin k phytonadione inj
• J3465 Injection, voriconazole
• J3470 Hyaluronidase injection
• J3471 Ovine, up to 999 usp units not in 4Q26
• J3473 Hyaluronidase recombinant
• J3475 Inj magnesium sulfate
• J3480 Inj potassium chloride
• J3485 Zidovudine
• J3486 Ziprasidone mesylate
• J3489 Zoledronic acid 1mg
• J7030 Normal saline solution infus
• J7040 Normal saline solution infus
• J7042 5% dextrose/normal saline
• J7050 Normal saline solution infus
• J7060 5% dextrose/water
• J7070 D5w infusion
• J7120 Ringers lactate infusion
• J7170 Inj., emicizumab-kxwh 0.5 mg
• J7171 Inj, adzynma, 10 iu
• J7172 Inj marstacim-hncq, 0.5 mg
• J7173 Inj. concizumab-mtci, 0.5 mg
• J7174 Injection fitusiran 0.04 mg
• J7175 Inj, factor x, (human), 1iu
• J7177 Inj., fibryga, 1 mg
• J7178 Inj human fibrinogen con nos
• J7179 Vonvendi inj 1 iu vwf:rco
• J7180 Factor xiii anti-hem factor
• J7181 Factor xiii recomb a-subunit
• J7182 Factor viii recomb novoeight
• J7183 Wilate injection
• J7185 Xyntha inj
• J7186 Antihemophilic viii/vwf comp
• J7187 Humate-p, inj
• J7188 Factor viii recomb obizur
• J7189 Factor viia recomb novoseven
• J7190 Factor viii
• J7192 Factor viii recombinant nos
• J7193 Factor ix non-recombinant
• J7194 Factor ix complex
• J7195 Factor ix recombinant nos
• J7197 Antithrombin iii injection
• J7198 Anti-inhibitor
• J7200 Factor ix recombinan rixubis
• J7201 Factor ix alprolix recomb
• J7202 Factor ix idelvion inj
• J7203 Factor ix recomb gly rebinyn
• J7204 Inj recombin esperoct per iu
• J7205 Factor viii fc fusion recomb
• J7207 Factor viii pegylated recomb
• J7208 Inj. jivi 1 iu
• J7209 Factor viii nuwiq recomb 1iu
• J7210 Inj, afstyla, 1 i.u.
• J7211 Inj, kovaltry, 1 i.u.
• J7212 Factor viia recomb sevenfact
• J7213 Inj, ixinity, 1 i.u.
• J7214 Altuviiio per factor viii iu
• J7308 Aminolevulinic acid hcl top
• J7311 Inj., retisert, 0.01 mg
• J7312 Dexamethasone intra implant
• J7313 Inj., iluvien, 0.01 mg
• J7314 Inj., yutiq, 0.01 mg not in 4Q26
• J7316 Inj, ocriplasmin, 0.125 mg not in 4Q26
• J7318 Inj, durolane 1 mg
• J7320 Genvisc 850, inj, 1mg
• J7321 Hyalgan supartz visco-3 dose
• J7322 Hyaluronan, hymo or hymo one
• J7323 Euflexxa inj per dose
• J7324 Orthovisc inj per dose
• J7325 Synvisc or synvisc-one
• J7326 Gel-one
• J7327 Monovisc inj per dose
• J7328 Gelsyn-3 injection 0.1 mg
• J7329 Inj, trivisc 1 mg
• J7331 Synojoynt, inj., 1 mg
• J7332 Inj., triluron, 1 mg
• J7336 Capsaicin 8% patch
• J7340 Carbidopa levodopa ent 100ml
• J7342 Ciprofloxacin otic susp 6 mg not in 4Q26
• J7345 Aminolevulinic acid, 10% gel
• J7351 Inj bimatoprost itc imp1mcg
• J7354 Cantharidin top, applicator
• J7355 Inj travoprost intra impl
• J7356 Inj foscarb/foslevodopa 5 mg
• J7402 Mometasone sinus sinuva
• J7500 Azathioprine oral 50mg
• J7502 Cyclosporine oral 100 mg
• J7503 Tacrol envarsus ex rel oral
• J7504 Lymphocyte immune globulin
• J7507 Tacrolimus imme rel oral 1mg
• J7508 Tacrol astagraf ex rel oral
• J7509 Methylprednisolone oral
• J7510 Prednisolone oral per 5 mg
• J7511 Antithymocyte globuln rabbit
• J7512 Prednisone ir or dr oral 1mg
• J7514 Mycophenol (myhibbin) 100 mg not in 4Q26
• J7515 Cyclosporine oral 25 mg
• J7516 Inj, cyclosporine 250mg
• J7517 Mycophenolate mofetil oral not in 4Q26
• J7518 Mycophenolic acid
• J7519 Inj. mycophenolate mofetil not in 4Q26
• J7520 Sirolimus, oral
• J7521 Tacrolim granules oral susp
• J7524 Mycophenol mofetil oral 5 mg
• J7525 Tacrolimus injection
• J7526 Inj mycophenola mofetil 5 mg
• J7527 Oral everolimus
• J7528 Mycophen mofetil for susp not in 4Q26
• J7529 Mycop mofetil susp oral 5 mg
• J7530 Mycophenolat (myhibbin) 5 mg
• J7601 Ensifentrine inh 3 mg
• J7605 Arformoterol non-comp unit
• J7606 Formoterol fumarate, inh
• J7608 Acetylcysteine non-comp unit
• J7611 Albuterol non-comp con
• J7612 Levalbuterol non-comp con
• J7613 Albuterol non-comp unit
• J7614 Levalbuterol non-comp unit
• J7620 Albuterol ipratrop non-comp
• J7626 Budesonide non-comp unit
• J7631 Cromolyn sodium noncomp unit
• J7639 Dornase alfa non-comp unit
• J7644 Ipratropium bromide non-comp
• J7674 Methacholine chloride, neb
• J7677 Revefenacin inh non-com 1mcg
• J7682 Tobramycin non-comp unit
• J7686 Treprostinil, non-comp unit
• J8501 Oral aprepitant
• J8502 Inj, aponvie, 1 mg
• J8515 Cabergoline, oral 0.25mg
• J8520 Capecitabine, oral, 150 mg not in 4Q26
• J8521 Capecitabine, oral, 500 mg not in 4Q26
• J8522 Capecitabine, oral, 50 mg
• J8530 Cyclophosphamide oral 25 mg
• J8540 Oral dexamethasone
• J8541 Oral, hemady, 0.25 mg
• J8560 Etoposide oral 50 mg
• J8610 Methotrexate oral 2.5 mg
• J8611 Oral methotrexate (jylamvo)
• J8612 Oral methotrexate (xatmep)
• J8655 Oral netupitant, palonosetro
• J8670 Rolapitant, oral, 1mg not in 4Q26
• J8700 Temozolomide
• J8705 Topotecan oral
• J9000 Doxorubicin hcl injection
• J9011 Datopotamab deruxtecan, 1 mg
• J9017 Arsenic trioxide injection
• J9019 Erwinaze injection not in 4Q26
• J9021 Inj, aspara, rylaze, 0.1 mg
• J9022 Inj, atezolizumab,10 mg
• J9023 Injection, avelumab, 10 mg
• J9024 Inj atezolizumb 5mg hya-tqjs
• J9025 Azacitidine injection
• J9026 Inj, tarlatamab-dlle, 1 mg
• J9027 Clofarabine injection
• J9028 Inj, nogapendekin pmln, 1mcg
• J9029 Instill adstiladrin, tx dose
• J9030 Bcg live intravesical 1mg
• J9032 Injection, belinostat, 10mg
• J9033 Inj, bendamustine (nos) 1mg
• J9034 Inj., bendeka 1 mg
• J9035 Bevacizumab injection
• J9036 Inj. belrapzo/bendamustine
• J9037 Inj belantamab mafodot blmf not in 4Q26
• J9038 Inj axatilimab-csfr 0.1 mg
• J9039 Injection, blinatumomab
• J9040 Bleomycin sulfate injection
• J9041 Injection, bortezomib, 0.1mg
• J9042 Brentuximab vedotin inj
• J9043 Cabazitaxel injection
• J9044 Inj, bortezomib, nos, 0.1 mg not in 4Q26
• J9045 Carboplatin injection
• J9046 Inj, bortezomib, dr. reddy's not in 4Q26
• J9047 Injection, carfilzomib, 1 mg
• J9048 Inj, bortezomib freseniuskab not in 4Q26
• J9049 Inj, bortezomib, hospira
• J9050 Carmustine injection
• J9052 Inj, carmustine (accord) not in 4Q26
• J9053 Inj belantamab mafodot blmf
• J9054 Inj bortezomib boruzu 0.1 mg
• J9055 Cetuximab injection
• J9056 Inj, vivimusta, 1 mg
• J9058 Inj apotex/bendamustine 1 mg not in 4Q26
• J9059 Inj bendamustine, baxter 1mg not in 4Q26
• J9060 Cisplatin 10 mg injection
• J9061 Inj, amivantamab-vmjw
• J9062 Inj amivantamab 5mg hyaluron
• J9063 Inj, elahere, 1 mg
• J9065 Inj cladribine per 1 mg
• J9070 Cyclophosphamide 100 mg inj not in 4Q26
• J9071 Inj cyclophosphamd auromedic
• J9072 Inj cyclophos frindovyx 5 mg
• J9073 Inj cyclophos dr reddys 5 mg
• J9074 Inj, cyclophosphamd, sandoz
• J9075 Inj, cyclophosphamide, nos
• J9076 Inj, cyclophos (baxter) 5mg
• J9100 Cytarabine hcl 100 mg inj
• J9118 Inj. calaspargase pegol-mknl
• J9119 Inj., cemiplimab-rwlc, 1 mg
• J9120 Dactinomycin injection
• J9130 Dacarbazine 100 mg inj
• J9144 Daratumumab, hyaluronidase
• J9145 Injection, daratumumab 10 mg
• J9150 Daunorubicin injection
• J9153 Inj daunorubicin, cytarabine
• J9155 Degarelix injection
• J9161 Inj denileuk difti-cxdl 1mcg
• J9171 Docetaxel injection
• J9172 Docetaxel (docivyx), 1 mg
• J9173 Inj., durvalumab, 10 mg
• J9174 Inj, docetaxel (beizray) 1mg
• J9176 Injection, elotuzumab, 1mg
• J9177 Inj enfort vedo-ejfv 0.25mg
• J9178 Inj, epirubicin hcl, 2 mg
• J9179 Eribulin mesylate injection
• J9181 Etoposide injection not in 4Q26
• J9183 Gemcitabine intravesical sys
• J9184 Inj gemcitabin (avyxa) 200mg
• J9185 Fludarabine phosphate inj
• J9186 Inj etoposide (avyxa), 1 mg
• J9187 Inj, etoposide, 1 mg
• J9190 Fluorouracil injection not in 4Q26
• J9191 Inj fluorouracil (avyxa)10mg
• J9192 Inj, fluorouracil, 10 mg
• J9196 Inj gemcitabine hcl (accord) not in 4Q26
• J9198 Inj. infugem, 100 mg not in 4Q26
• J9200 Floxuridine injection
• J9201 In gemcitabine hcl nos 200mg
• J9202 Goserelin acetate implant not in 4Q26
• J9203 Gemtuzumab ozogamicin 0.1 mg
• J9204 Inj mogamulizumab-kpkc, 1 mg
• J9205 Inj irinotecan liposome 1 mg
• J9206 Irinotecan injection
• J9207 Ixabepilone injection
• J9208 Ifosfamide injection
• J9209 Mesna injection
• J9210 Inj., emapalumab-lzsg, 1 mg
• J9211 Idarubicin hcl injection
• J9214 Interferon alfa-2b inj not in 4Q26
• J9217 Leuprolide acetate suspnsion
• J9218 Leuprolide acetate injeciton not in 4Q26
• J9223 Inj. lurbinectedin, 0.1 mg
• J9225 Vantas implant not in 4Q26
• J9226 Supprelin la implant
• J9227 Inj. isatuximab-irfc 10 mg
• J9228 Ipilimumab injection
• J9229 Inj inotuzumab ozogam 0.1 mg
• J9232 Inj docetaxel (hospira) 1 mg
• J9245 Inj melpha hydroch nos 50 mg
• J9246 Inj., evomela, 1 mg
• J9247 Inj, melphalan flufenami 1mg not in 4Q26
• J9248 Inj melphalan (hepzato) 1 mg
• J9250 Methotrexate sodium inj not in 4Q26
• J9256 Inj, nipocalimab-aahu, 3 mg
• J9259 Paclitaxel (american regent) not in 4Q26
• J9260 Inj methotrexate sodium 50mg
• J9261 Nelarabine injection
• J9262 Inj, omacetaxine mep, 0.01mg not in 4Q26
• J9263 Oxaliplatin
• J9264 Paclitaxel protein bound
• J9266 Pegaspargase injection
• J9267 Paclitaxel injection
• J9268 Pentostatin injection
• J9269 Inj. tagraxofusp-erzs 10 mcg
• J9271 Inj pembrolizumab
• J9272 Inj, dostarlimab-gxly, 10 mg
• J9273 Inj tisotu vedotin-tftv, 1mg
• J9274 Inj, tebentafusp-tebn, 1 mcg
• J9275 Inj cosibelimab-ipdl, 2 mg
• J9276 Inj zanidatamab-hrii, 2 mg
• J9277 Pembrolizumab 1mg berahyalur
• J9278 Inj, carboplatin (avyxa)
• J9280 Mitomycin injection
• J9281 Mitomycin instillation
• J9282 Mitomycin intravesical inst
• J9285 Inj, olaratumab, 10 mg not in 4Q26
• J9286 Inj glofitamab gxbm, 2.5 mg
• J9289 Inj nivolumab 2 mg hyaluron
• J9292 Inj, pemetrexed dipotassium
• J9293 Mitoxantrone hydrochl / 5 mg
• J9294 Inj pemetrexed, hospira 10mg
• J9295 Injection, necitumumab, 1 mg not in 4Q26
• J9296 Inj pemetrexed (accord) 10mg not in 4Q26
• J9297 Inj pemetrexed (sandoz) 10mg
• J9298 Inj nivol relatlimab 3mg/1mg
• J9299 Injection, nivolumab
• J9301 Obinutuzumab inj
• J9302 Ofatumumab injection not in 4Q26
• J9303 Panitumumab injection
• J9304 Inj. pemetrexed, 10 mg
• J9305 Inj. pemetrexed nos 10mg
• J9306 Injection, pertuzumab, 1 mg
• J9307 Pralatrexate injection
• J9308 Injection, ramucirumab
• J9309 Inj, polatuzumab vedotin 1mg
• J9311 Inj rituximab, hyaluronidase
• J9312 Inj., rituximab, 10 mg
• J9313 Inj., lumoxiti, 0.01 mg not in 4Q26
• J9314 Inj pemetrexed (teva) 10mg
• J9315 Romidepsin injection not in 4Q26
• J9316 Pertuzu, trastuzu, 10 mg
• J9317 Sacituzumab govitecan-hziy
• J9318 Inj romidepsin non-lyo 0.1mg
• J9319 Inj romidepsin lyophil 0.1mg
• J9320 Streptozocin injection not in 4Q26
• J9321 Inj epcoritamab-bysp 0.16 mg
• J9323 Inj pemetrexed ditromethamin not in 4Q26
• J9324 Inj, pemrydi rtu, 10 mg
• J9325 Inj talimogene laherparepvec
• J9326 Telisotuzumab vedotin-tllv
• J9328 Temozolomide injection
• J9329 Inj, tislelizumab-jsgr
• J9330 Temsirolimus injection
• J9331 Inj sirolimus prot part 1 mg
• J9332 Inj efgartigimod 2mg
• J9333 Inj rozanolixizum-noli 1 mg
• J9334 Inj efgart-alfa 2mg hya-qvfc
• J9340 Thiotepa injection not in 4Q26
• J9341 Inj thiotepa (tepylute) 1 mg
• J9342 Inj thiotepa nos 1 mg
• J9345 Inj, retifanlimab-dlwr, 1 mg
• J9347 Inj, tremelimumab-actl, 1 mg
• J9348 Inj. naxitamab-gqgk, 1 mg
• J9349 Inj., tafasitamab-cxix
• J9350 Inj mosunetuzumab-axgb, 1 mg
• J9351 Topotecan injection
• J9352 Injection trabectedin 0.1mg not in 4Q26
• J9353 Inj. margetuximab-cmkb, 5 mg
• J9354 Inj, ado-trastuzumab emt 1mg
• J9355 Inj trastuzumab excl biosimi
• J9356 Inj. herceptin hylecta, 10mg
• J9357 Valrubicin injection
• J9358 Inj fam-trastu deru-nxki 1mg
• J9359 Inj lon tesirin-lpyl 0.075mg
• J9360 Vinblastine sulfate inj
• J9361 Inj, efbemalenograstim alfa-
• J9362 Inj, trabectedin, 0.01 mg
• J9370 Vincristine sulfate 1 mg inj
• J9371 Inj, vincristine sul lip 1mg not in 4Q26
• J9380 Inj teclistamab cqyv 0.5 mg
• J9381 Inj teplizumab mzwv 5 mcg
• J9382 Inj zenocutuzumab-zbco 1 mg
• J9390 Vinorelbine tartrate inj
• J9393 Inj, fulvestrant (teva) not in 4Q26
• J9394 Inj, fulvestrant (fresenius) not in 4Q26
• J9395 Injection, fulvestrant
• J9400 Inj, ziv-aflibercept, 1mg
• J9601 Inj linvoseltamab-gcpt 1 mg
• P9041 Albumin (human),5%, 50ml
• P9045 Albumin (human), 5%, 250 ml
• P9046 Albumin (human), 25%, 20 ml
• P9047 Albumin (human), 25%, 50ml
• Q0138 Ferumoxytol, non-esrd
• Q0139 Ferumoxytol, esrd use
• Q0162 Ondansetron oral
• Q0164 Prochlorperazine maleate 5mg not in 4Q26
• Q0166 Granisetron hcl 1 mg oral
• Q0167 Dronabinol 2.5mg oral
• Q0222 Bebtelovimab 175 mg not in 4Q26
• Q0224 Inj, pemivibart, 4500 mg
• Q0234 Inj, tocilizumab-bavi, 1mg
• Q0237 Inj, tocilizumab-anoh, hospi
• Q0238 Inj, tocilizumab-aazg, hospi
• Q0249 Tocilizumab for covid-19
• Q2041 Axicabtagene ciloleucel car+
• Q2042 Tisagenlecleucel car-pos t
• Q2043 Sipuleucel-t auto cd54+
• Q2050 Doxorubicin inj 10mg
• Q2053 Brexucabtagene car pos t
• Q2054 Lisocabtagene mara car pos t
• Q2055 Idecabtagene vicleucel car
• Q2056 Ciltacabtagene car-pos t
• Q2057 Afamitresgene autoleucel
• Q2058 Obecbtge autol up to 400 mil
• Q3027 Inj beta interferon im 1 mcg not in 4Q26
• Q4074 Iloprost non-comp unit dose not in 4Q26
• Q4081 Epoetin alfa, 100 units esrd
• Q4101 Apligraf not in 4Q26
• Q4102 Oasis wound matrix not in 4Q26
• Q4103 Oasis burn matrix not in 4Q26
• Q4104 Integra bmwd not in 4Q26
• Q4105 Integra drt or omnigraft not in 4Q26
• Q4106 Dermagraft not in 4Q26
• Q4108 Integra matrix not in 4Q26
• Q4110 Primatrix not in 4Q26
• Q4111 Gammagraft not in 4Q26
• Q4114 Integra flowable wound matri not in 4Q26
• Q4115 Alloskin not in 4Q26
• Q4117 Hyalomatrix not in 4Q26
• Q4118 Matristem micromatrix not in 4Q26
• Q4121 Theraskin not in 4Q26
• Q4123 Alloskin not in 4Q26
• Q4124 Oasis tri-layer wound matrix not in 4Q26
• Q4126 Memoderm/derma/tranz/integup not in 4Q26
• Q4127 Talymed not in 4Q26
• Q4128 Flexhd/allopatchhd/sq cm not in 4Q26
• Q4132 Grafix core, grafixpl core not in 4Q26
• Q4133 Grafix stravix prime pl sqcm not in 4Q26
• Q4134 Hmatrix not in 4Q26
• Q4137 Amnioexcel biodexcel 1sq cm not in 4Q26
• Q4138 Biodfence dryflex, 1cm not in 4Q26
• Q4140 Biodfence 1cm not in 4Q26
• Q4141 Alloskin ac, 1 cm not in 4Q26
• Q4143 Repriza, 1cm not in 4Q26
• Q4145 Epifix, inj, 1mg not in 4Q26
• Q4147 Architect ecm px fx 1 sq cm not in 4Q26
• Q4148 Neox neox rt or clarix cord not in 4Q26
• Q4150 Allowrap ds or dry 1 sq cm not in 4Q26
• Q4151 Amnioband, guardian 1 sq cm not in 4Q26
• Q4152 Dermapure 1 square cm not in 4Q26
• Q4153 Dermavest, plurivest sq cm not in 4Q26
• Q4154 Biovance 1 square cm not in 4Q26
• Q4155 Neoxflo or clarixflo 1 mg not in 4Q26
• Q4156 Neox 100 or clarix 100 not in 4Q26
• Q4158 Kerecis omega3, per sq cm not in 4Q26
• Q4159 Affinity1 square cm not in 4Q26
• Q4160 Nushield 1 square cm not in 4Q26
• Q4161 Bio-connekt per square cm not in 4Q26
• Q4163 Woundex, bioskin, per sq cm not in 4Q26
• Q4164 Helicoll, per square cm not in 4Q26
• Q4166 Cytal, per square centimeter not in 4Q26
• Q4168 Amnioband, 1 mg not in 4Q26
• Q4169 Artacent wound, per sq cm not in 4Q26
• Q4170 Cygnus, per sq cm not in 4Q26
• Q4171 Interfyl, 1 mg not in 4Q26
• Q4173 Palingen or palingen xplus not in 4Q26
• Q4174 Palingen or promatrx not in 4Q26
• Q4175 Miroderm not in 4Q26
• Q4176 Neopatch or therion, 1 sq cm not in 4Q26
• Q4178 Floweramniopatch, per sq cm not in 4Q26
• Q4180 Revita, per sq cm not in 4Q26
• Q4184 Cellesta or duo per sq cm not in 4Q26
• Q4186 Epifix 1 sq cm not in 4Q26
• Q4187 Epicord 1 sq cm not in 4Q26
• Q4188 Amnioarmor 1 sq cm not in 4Q26
• Q4190 Artacent ac 1 sq cm not in 4Q26
• Q4191 Restorigin 1 sq cm not in 4Q26
• Q4193 Coll-e-derm 1 sq cm not in 4Q26
• Q4194 Novachor 1 sq cm not in 4Q26
• Q4195 Puraply 1 sq cm not in 4Q26
• Q4196 Puraply am 1 sq cm not in 4Q26
• Q4197 Puraply xt 1 sq cm not in 4Q26
• Q4199 Cygnus matrix, per sq cm not in 4Q26
• Q4201 Matrion 1 sq cm not in 4Q26
• Q4203 Derma-gide, 1 sq cm not in 4Q26
• Q4204 Xwrap 1 sq cm not in 4Q26
• Q4205 Membrane graft or wrap sq cm not in 4Q26
• Q4210 Axolotl graf dualgraf sq cm not in 4Q26
• Q4217 Woundfix biowound plus xplus not in 4Q26
• Q4221 Amniowrap2 per sq cm not in 4Q26
• Q4222 Progenamatrix, per sq cm not in 4Q26
• Q4225 Amnio or derma tl, per sq cm not in 4Q26
• Q4226 Myown harv prep proc sq cm not in 4Q26
• Q4227 Amniocore per sq cm not in 4Q26
• Q4229 Cogenex amnio memb per sq cm not in 4Q26
• Q4231 Corplex p, per cc not in 4Q26
• Q4232 Corplex, per sq cm not in 4Q26
• Q4234 Xcellerate, per sq cm not in 4Q26
• Q4235 Amniorepair or altiply sq cm not in 4Q26
• Q4236 Carepatch per sq cm not in 4Q26
• Q4238 Derm-maxx, per sq cm not in 4Q26
• Q4239 Amnio-maxx or lite per sq cm not in 4Q26
• Q4246 Coretext or protext, per cc not in 4Q26
• Q4247 Amniotext patch, per sq cm not in 4Q26
• Q4248 Dermacyte amn mem allo sq cm not in 4Q26
• Q4249 Amniply, per sq cm not in 4Q26
• Q4250 Amnioamp-mp per sq cm not in 4Q26
• Q4252 Vendaje, per square centimet not in 4Q26
• Q4253 Zenith amniotic membrane psc not in 4Q26
• Q4256 Mlg complet, per sq cm not in 4Q26
• Q4257 Relese, per sq cm not in 4Q26
• Q4258 Enverse, per sq cm not in 4Q26
• Q4259 Celera per sq cm not in 4Q26
• Q4262 Dual layer impax, per sq cm not in 4Q26
• Q4263 Surgraft tl, per sq cm not in 4Q26
• Q4264 Cocoon membrane, per sq cm not in 4Q26
• Q4265 Neostim tl per sq cm not in 4Q26
• Q4266 Neostim per sq cm not in 4Q26
• Q4267 Neostim dl per sq cm not in 4Q26
• Q4268 Surgraft ft per sq cm not in 4Q26
• Q4269 Surgraft xt per sq cm not in 4Q26
• Q4270 Complete sl per sq cm not in 4Q26
• Q4271 Complete ft per sq cm not in 4Q26
• Q4274 Esano ac, per sq cm not in 4Q26
• Q4275 Esano aca, per sq cm not in 4Q26
• Q4276 Orion, per sq cm not in 4Q26
• Q4278 Epieffect, per sq cm not in 4Q26
• Q4279 Vendaje ac, per sq cm not in 4Q26
• Q4280 Xcell amnio matrix per sq cm not in 4Q26
• Q4281 Barrera slor dl per sq cm not in 4Q26
• Q4282 Cygnus dual per sq cm not in 4Q26
• Q4283 Biovance tri or 3l, sq cm not in 4Q26
• Q4289 Revoshield+ amnio, per sq cm not in 4Q26
• Q4290 Membrane wrap hydr per sq cm not in 4Q26
• Q4293 Acesso dl, per sq cm not in 4Q26
• Q4294 Amnio quad-core, per sq cm not in 4Q26
• Q4295 Amnio tri-core, per sq cm not in 4Q26
• Q4296 Rebound matrix, per sq cm not in 4Q26
• Q4297 Emerge matrix, per sq cm not in 4Q26
• Q4298 Amnicore pro, per sq cm not in 4Q26
• Q4299 Amnicore pro+, per sq cm not in 4Q26
• Q4300 Acesso tl, per sq cm not in 4Q26
• Q4301 Activate matrix, per sq cm not in 4Q26
• Q4302 Complete aca, per sq cm not in 4Q26
• Q4303 Complete aa, per sq cm not in 4Q26
• Q4304 Grafix plus, per sq cm not in 4Q26
• Q4309 Via matrix, per sq cm not in 4Q26
• Q4310 Procenta, per 100 mg not in 4Q26
• Q4312 Acesso ac, per sq cm not in 4Q26
• Q4313 Dermabind fm, per sq cm not in 4Q26
• Q4314 Reeva, per sq cm not in 4Q26
• Q4316 Amchoplast, per sq cm not in 4Q26
• Q4317 Vitograft, per sq cm not in 4Q26
• Q4319 Sanograft, per sq cm not in 4Q26
• Q4320 Pellograft, per sq cm not in 4Q26
• Q4321 Renograft, per sq cm not in 4Q26
• Q4322 Caregraft, per sq cm not in 4Q26
• Q4323 Alloply, per sq cm not in 4Q26
• Q4325 Acapatch, per sq cm not in 4Q26
• Q4326 Woundplus, per sq cm not in 4Q26
• Q4328 Most, per sq cm not in 4Q26
• Q4331 Axolotl graft, per sq cm not in 4Q26
• Q4332 Axolotl dualgraft, per sq cm not in 4Q26
• Q4339 Artacent vericlen, per sq cm not in 4Q26
• Q4340 Simpligraft, per sq cm not in 4Q26
• Q4341 Simplimax, per sq cm not in 4Q26
• Q4342 Theramend, per sq cm not in 4Q26
• Q4343 Dermacyte ac matrx per sq cm not in 4Q26
• Q4344 Tri membrane wrap, per sq cm not in 4Q26
• Q4345 Matrix hd allogrft per sq cm not in 4Q26
• Q4346 Shelter dm matrix per sq cm not in 4Q26
• Q4347 Rampart dl matrix per sq cm not in 4Q26
• Q4348 Sentry sl matrix per sq cm not in 4Q26
• Q4350 Palisade dm matrix per sq cm not in 4Q26
• Q4353 Xceed tl matrix per sq cm not in 4Q26
• Q4355 Abio xpl abio xpl hy p sq cm not in 4Q26
• Q4357 Xwrap plus, per sq cm not in 4Q26
• Q4358 Xwrap dual, per sq cm not in 4Q26
• Q4359 Choriply, per sq cm not in 4Q26
• Q4361 Epixpress, per sq cm not in 4Q26
• Q4367 Amniocore sl, per sq cm not in 4Q26
• Q5098 Inj ustekinumab-srlf, 1 mg
• Q5099 Inj ustekinumab-stba, 1 mg
• Q5100 Inj ustekinumab-kfce, 1 mg
• Q5101 Injection, zarxio
• Q5103 Injection, inflectra
• Q5104 Injection, renflexis
• Q5105 Inj retacrit esrd on dialysi
• Q5106 Inj retacrit non-esrd use
• Q5107 Inj mvasi 10 mg
• Q5108 Injection, fulphila
• Q5110 Nivestym
• Q5111 Injection, udenyca 0.5 mg
• Q5112 Inj ontruzant 10 mg
• Q5113 Inj herzuma 10 mg
• Q5114 Inj ogivri 10 mg
• Q5115 Inj truxima 10 mg
• Q5116 Inj., trazimera, 10 mg
• Q5117 Inj., kanjinti, 10 mg
• Q5118 Inj., zirabev, 10 mg
• Q5119 Inj ruxience, 10 mg
• Q5120 Inj pegfilgrastim-bmez 0.5mg
• Q5121 Inj. avsola, 10 mg
• Q5122 Inj, nyvepria
• Q5123 Inj. riabni, 10 mg
• Q5124 Inj. byooviz, 0.1 mg
• Q5125 Inj, releuko 1 mcg
• Q5126 Inj alymsys 10 mg
• Q5127 Inj, stimufend, 0.5 mg
• Q5128 Inj, cimerli, 0.1 mg
• Q5129 Inj, vegzelma, 10 mg
• Q5130 Inj, fylnetra, 0.5 mg
• Q5133 Inj, tofidence, 1 mg
• Q5134 Inj, tyruko, 1 mg
• Q5135 Inj, tyenne, 1 mg
• Q5136 Inj. denosumab-bbdz, 1 mg
• Q5138 Inj, wezlana, iv, 1 mg
• Q5146 Inj, hercessi, 10 mg
• Q5147 Inj, aflibercept-ayyh, 1 mg
• Q5148 Inj, nyposi 1 mcg
• Q5151 Inj, eculizumab-aagh, 2 mg
• Q5152 Inj, eculizumab-aeeb, 2 mg
• Q5156 Inj, tocilizumab-anoh, 1 mg
• Q5157 Inj, denosumab-bmwo, 1 mg
• Q5158 Inj, denosumab-bnht, 1 mg
• Q5160 Inj, jobevne, 10 mg
• Q5161 Inj, denosumab-kyqq, 1 mg
• Q5162 Inj, denosumab-nxxp, 1 mg
• Q5167 Inj, denosumab-qbde, 1 mg
• Q5168 Inj. nufymco, 0.1 mg
• Q5169 Inj, armlupeg, 0.5 mg
• Q9950 Inj sulf hexa lipid microsph
• Q9956 Inj octafluoropropane mic,ml
• Q9957 Inj perflutren lip micros,ml
• Q9958 Hocm <=149 mg/ml iodine, 1ml
• Q9960 Hocm 200-249mg/ml iodine,1ml not in 4Q26
• Q9961 Hocm 250-299mg/ml iodine,1ml
• Q9963 Hocm 350-399mg/ml iodine,1ml
• Q9965 Locm 100-199mg/ml iodine,1ml
• Q9966 Locm 200-299mg/ml iodine,1ml
• Q9967 Locm 300-399mg/ml iodine,1ml
• Q9991 Buprenorph xr 100 mg or less
• Q9992 Buprenorphine xr over 100 mg
• Q9997 Ustekinumab-ttwe iv inj 1 mg
• Q9998 Inj ustekinumab-aekn, 1 mg
• Q9999 Inj ustekinumab-aauz 1 mg