DOCSLIB.ORG

Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM Code Short Description Modifier Age Range Non Fac Fee Fac Fee Effective Date** 0054T Bone Srgry Cmptr Fluor Image NA $78.63 0055T Bone Srgry Cmptr Ct/Mri Imag NA $78.63 0099T Implant Corneal Ring M M 0178T 64 Lead Ecg W/I&R M M 0179T 64 Lead Ecg W/Tracing M M 0180T 64 Lead Ecg W/I&R Only M M 0182T Hdr Elect Brachytherapy M NA 0182T Hdr Elect Brachytherapy 26 M M 0182T Hdr Elect Brachytherapy TC M NA 0190T Place Intraoc Radiation Src M M 0191T Insert Ant Segment Drain Int M M 0195T Prescrl Fuse W/O Instr L5/S1 M M 0196T Prescrl Fuse W/O Instr L4/L5 M M 0198T Ocular Blood Flow Measure M M 0200T Perq Sacral Augmt Unilat Inj NA $322.66 0201T Perq Sacral Augmt Bilat Inj $484.00 $484.00 0202T Post Vert Arthrplst 1 Lumbar NA $854.70 0205T Inirs Each Vessel Add-On NA $63.19 0206T Cptr Dbs Alys Car Elec Dta $10.89 $10.89 0207T Clear Eyelid Gland W/Heat $136.47 $68.53 0208T Audiometry Air Only $17.23 NA 0209T Audiometry Air & Bone $20.60 NA 0210T Speech Audiometry Threshold $12.88 NA 0211T Speech Audiom Thresh & Recog $20.80 NA 0212T Compre Audiometry Evaluation $20.80 $18.03 0213T Njx Paravert W/Us Cer/Thor $107.17 $61.01 0214T Njx Paravert W/Us Cer/Thor $52.69 $34.27 0215T Njx Paravert W/Us Cer/Thor $53.09 $34.67 0216T Njx Paravert W/Us Lumb/Sac $96.67 $51.70 0217T Njx Paravert W/Us Lumb/Sac $48.73 $29.52 0218T Njx Paravert W/Us Lumb/Sac $48.93 $29.91 0219T Plmt Post Facet Implt Cerv NA $410.61 0220T Plmt Post Facet Implt Thor NA $410.61 0221T Plmt Post Facet Implt Lumb NA $410.61 0222T Plmt Post Facet Implt Addl NA $93.29 0223T Acoustic/Electr Cardgraphy M M 0224T Acstic/Elec Cardgrphy Av/Vv M M 0225T Acstic/Elec Cardgrphy Av + Vv M M 0228T Us Tfrml Edrl Inj Crv/T 1lvl M M 0229T Njx Tfrml Eprl W/Us Cer/Thor M M 0230T Us Tfrml Edrl Inj L/S 1 Lvl M M 0231T Njx Tfrml Eprl W/Us Lumb/Sac M M 0232T Njx Platelet Plasma M M **Effective Date will only be populated when the rate begins after the published fee schedule date Page 1 of 248 Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM Code Short Description Modifier Age Range Non Fac Fee Fac Fee Effective Date** 0233T Skn Age Meas Spctrscpy M M 0234T Trluml Perip Athrc Renal Art M M 0235T Trluml Perip Athrc Visceral M M 0236T Trluml Perip Athrc Abd Aorta M M 0237T Trluml Perip Athrc Brchiocph M M 0238T Trluml Perip Athrc Iliac Art M M 0240T Esoph Motility 3d Topography M NA 0240T Esoph Motility 3d Topography 26 M M 0240T Esoph Motility 3d Topography TC M NA 0241T Esoph Motility W/Stim/Perf M NA 0241T Esoph Motility W/Stim/Perf 26 M M 0241T Esoph Motility W/Stim/Perf TC M NA 0243T Intm Msr Bronchodil Wheeze M NA 0243T Intm Msr Bronchodil Wheeze 26 M M 0243T Intm Msr Bronchodil Wheeze TC M NA 0244T Cont Msr Bronchodil Wheeze M NA 0244T Cont Msr Bronchodil Wheeze 26 M M 0244T Cont Msr Bronchodil Wheeze TC M NA 0249T Ligation Hemorrhoid W/Us M M 0253T Insert Aqueous Drain Device M M 0254T Evasc Rpr Iliac Art Bifur M M 0255T Evasc Rpr Iliac Art Bifr S&I M NA 0255T Evasc Rpr Iliac Art Bifr S&I 26 M M 0255T Evasc Rpr Iliac Art Bifr S&I TC M NA 10021 Fna W/O Image $83.60 $39.62 10022 Fna W/Image $79.44 $37.64 10030 Guide Cathet Fluid Drainage $440.38 $91.32 10040 Acne Surgery $56.85 $49.72 10060 Drainage Of Skin Abscess $65.57 $54.48 10061 Drainage Of Skin Abscess $115.69 $101.23 10080 Drainage Of Pilonidal Cyst $100.83 $58.44 10081 Drainage Of Pilonidal Cyst $150.56 $95.68 10120 Remove Foreign Body $85.38 $58.44 10121 Remove Foreign Body $153.53 $104.60 10140 Drainage Of Hematoma/Fluid $91.52 $66.96 10160 Puncture Drainage Of Lesion $72.90 $54.28 10180 Complex Drainage Wound $138.47 $101.23 11000 Debride Infected Skin $30.51 $16.24 11001 Debride Infected Skin Add-On $11.69 $7.92 11004 Debride Genitalia & Perineum NA $330.43 11005 Debride Abdom Wall NA $446.12 11006 Debride Genit/Per/Abdom Wall NA $400.16 11008 Remove Mesh From Abd Wall NA $156.90 **Effective Date will only be populated when the rate begins after the published fee schedule date Page 2 of 248 Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM Code Short Description Modifier Age Range Non Fac Fee Fac Fee Effective Date** 11010 Debride Skin At Fx Site $275.76 $158.68 11011 Debride Skin Musc At Fx Site $295.76 $168.58 11012 Deb Skin Bone At Fx Site $398.78 $241.68 11042 Deb Subq Tissue 20 Sq Cm/< $65.37 $34.87 11043 Deb Musc/Fascia 20 Sq Cm/< $127.77 $87.96 11044 Deb Bone 20 Sq Cm/< $177.10 $131.54 11045 Deb Subq Tissue Add-On $22.98 $14.86 11046 Deb Musc/Fascia Add-On $41.20 $31.89 11047 Deb Bone Add-On $69.53 $56.26 11055 Trim Skin Lesion $26.55 $9.11 11056 Trim Skin Lesions 2 To 4 $32.49 $12.88 11057 Trim Skin Lesions Over 4 $36.65 $16.84 11100 Biopsy Skin Lesion $57.45 $27.34 11101 Biopsy Skin Add-On $18.23 $14.07 11200 Removal Of Skin Tags <W/15 $49.13 $41.01 11201 Remove Skin Tags Add-On $10.50 $9.31 11300 Shave Skin Lesion 0.5 Cm/< $54.28 $19.81 11301 Shave Skin Lesion 0.6-1.0 Cm $66.56 $30.11 11302 Shave Skin Lesion 1.1-2.0 Cm $78.45 $35.26 11303 Shave Skin Lesion >2.0 Cm $87.16 $42.20 11305 Shave Skin Lesion 0.5 Cm/< $55.07 $21.99 11306 Shave Skin Lesion 0.6-1.0 Cm $67.75 $29.12 11307 Shave Skin Lesion 1.1-2.0 Cm $79.64 $37.24 11308 Shave Skin Lesion >2.0 Cm $83.80 $41.40 11310 Shave Skin Lesion 0.5 Cm/< $63.19 $26.55 11311 Shave Skin Lesion 0.6-1.0 Cm $62.40 $37.44 11312 Shave Skin Lesion 1.1-2.0 Cm $89.34 $44.18 11313 Shave Skin Lesion >2.0 Cm $103.41 $56.66 11400 Exc Tr-Ext B9+Marg 0.5 Cm< $69.14 $45.17 11401 Exc Tr-Ext B9+Marg 0.6-1 Cm $83.40 $58.64 11402 Exc Tr-Ext B9+Marg 1.1-2 Cm $92.71 $64.38 11403 Exc Tr-Ext B9+Marg 2.1-3cm/< $107.17 $83.00 11404 Exc Tr-Ext B9+Marg 3.1-4 Cm $121.63 $91.32 11406 Exc Tr-Ext B9+Marg >4.0 Cm $175.71 $139.66 11420 Exc H-F-Nk-Sp B9+Marg 0.5/< $68.34 $45.76 11421 Exc H-F-Nk-Sp B9+Marg 0.6-1 $87.76 $62.20 11422 Exc H-F-Nk-Sp B9+Marg 1.1-2 $98.26 $76.66 11423 Exc H-F-Nk-Sp B9+Marg 2.1-3 $113.31 $88.95 11424 Exc H-F-Nk-Sp B9+Marg 3.1-4 $131.34 $102.22 11426 Exc H-F-Nk-Sp B9+Marg >4 Cm $187.01 $155.71 11440 Exc Face-Mm B9+Marg 0.5 Cm/< $75.08 $57.85 11441 Exc Face-Mm B9+Marg 0.6-1 Cm $93.90 $74.09 11442 Exc Face-Mm B9+Marg 1.1-2 Cm $104.99 $82.01 **Effective Date will only be populated when the rate begins after the published fee schedule date Page 3 of 248 Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM Code Short Description Modifier Age Range Non Fac Fee Fac Fee Effective Date** 11443 Exc Face-Mm B9+Marg 2.1-3 Cm $125.20 $100.44 11444 Exc Face-Mm B9+Marg 3.1-4 Cm $157.89 $128.77 11446 Exc Face-Mm B9+Marg >4 Cm $219.10 $184.23 11450 Removal Sweat Gland Lesion $214.94 $143.23 11451 Removal Sweat Gland Lesion $271.20 $183.24 11462 Removal Sweat Gland Lesion $207.81 $135.90 11463 Removal Sweat Gland Lesion $276.35 $184.63 11470 Removal Sweat Gland Lesion $230.39 $158.48 11471 Removal Sweat Gland Lesion $284.27 $195.92 11600 Exc Tr-Ext Mal+Marg 0.5 Cm/< $107.77 $67.55 11601 Exc Tr-Ext Mal+Marg 0.6-1 Cm $127.77 $84.19 11602 Exc Tr-Ext Mal+Marg 1.1-2 Cm $138.27 $92.31 11603 Exc Tr-Ext Mal+Marg 2.1-3 Cm $157.89 $110.34 11604 Exc Tr-Ext Mal+Marg 3.1-4 Cm $176.11 $121.83 11606 Exc Tr-Ext Mal+Marg >4 Cm $252.18 $181.26 11620 Exc H-F-Nk-Sp Mal+Marg 0.5/< $108.96 $68.54 11621 Exc S/N/H/F/G Mal+Mrg 0.6-1 $128.37 $84.59 11622 Exc S/N/H/F/G Mal+Mrg 1.1-2 $143.03 $96.87 11623 Exc S/N/H/F/G Mal+Mrg 2.1-3 $168.19 $120.25 11624 Exc S/N/H/F/G Mal+Mrg 3.1-4 $189.58 $136.09 11626 Exc S/N/H/F/G Mal+Mrg >4 Cm $228.81 $167.00 11640 Exc F/E/E/N/L Mal+Mrg 0.5cm< $111.93 $70.72 11641 Exc F/E/E/N/L Mal+Mrg 0.6-1 $132.93 $88.35 11642 Exc F/E/E/N/L Mal+Mrg 1.1-2 $151.55 $104.00 11643 Exc F/E/E/N/L Mal+Mrg 2.1-3 $179.28 $130.75 11644 Exc F/E/E/N/L Mal+Mrg 3.1-4 $220.68 $161.45 11646 Exc F/E/E/N/L Mal+Mrg >4 Cm $289.23 $224.84 11720 Debride Nail 1-5 $18.03 $8.32 11721 Debride Nail 6 Or More $25.16 $14.07 11730 Removal Of Nail Plate $55.27 $28.53 11732 Remove Nail Plate Add-On $20.01 $11.49 11740 Drain Blood From Under Nail $27.73 $18.42 11750 Removal Of Nail Bed $125.40 $97.86 11752 Remove Nail Bed/Tip $182.25 $148.77 11755 Biopsy Nail Unit $74.49 $43.78 11760 Repair Of Nail Bed $128.17 $74.29 11762 Reconstruction Of Nail Bed $158.48 $104.99 11770 Remove Pilonidal Cyst Simple $155.11 $104.40 11771 Remove Pilonidal Cyst Exten $322.11 $246.04 11772 Remove Pilonidal Cyst Compl $391.45 $326.47 11900 Inject Skin Lesions </W 7 $30.90 $17.63 11901 Inject Skin Lesions >7 $38.83 $27.14 11920 Correct Skin Color 6.0 Cm/< $95.29 $64.38 **Effective Date will only be populated when the rate begins after the published fee schedule date Page 4 of 248 Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule July - 2015 Revised: 09/30/2015 9:58:24 AM Code Short Description Modifier Age Range Non Fac Fee Fac Fee Effective Date** 11921 Corect Skin Color 6.1-20.0cm $110.94 $76.07 11922 Correct Skin Color Ea 20.0cm $34.27 $16.84 11950 Tx Contour Defects 1 Cc/< $43.78 $30.51 11951 Tx Contour Defects 1.1-5.0cc $59.23 $42.39 11952 Tx Contour Defects 5.1-10cc $71.91 $54.08 11954 Tx Contour Defects >10.0 Cc $88.75 $65.17 11960 Insert Tissue Expander(S) NA $533.29 11970 Replace Tissue Expander NA $344.30 11971 Remove Tissue Expander(S) $263.87 $180.27 11976 Remove Contraceptive Capsule $80.23 $53.49 11980 Implant Hormone
Load more

Recommended publications
  • The Activation of the Glucagon-Like Peptide-1 (GLP-1) Receptor by Peptide and Non-Peptide Ligands
    The Activation of the Glucagon-Like Peptide-1 (GLP-1) Receptor by Peptide and Non-Peptide Ligands Clare Louise Wishart Submitted in accordance with the requirements for the degree of Doctor of Philosophy of Science University of Leeds School of Biomedical Sciences Faculty of Biological Sciences September 2013 I Intellectual Property and Publication Statements The candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. The right of Clare Louise Wishart to be identified as Author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. © 2013 The University of Leeds and Clare Louise Wishart. II Acknowledgments Firstly I would like to offer my sincerest thanks and gratitude to my supervisor, Dr. Dan Donnelly, who has been nothing but encouraging and engaging from day one. I have thoroughly enjoyed every moment of working alongside him and learning from his guidance and wisdom. My thanks go to my academic assessor Professor Paul Milner whom I have known for several years, and during my time at the University of Leeds he has offered me invaluable advice and inspiration. Additionally I would like to thank my academic project advisor Dr. Michael Harrison for his friendship, help and advice. I would like to thank Dr. Rosalind Mann and Dr. Elsayed Nasr for welcoming me into the lab as a new PhD student and sharing their experimental techniques with me, these techniques have helped me no end in my time as a research student.
    [Show full text]
  • List of Approved Ndas for Biological Products That Were Deemed to Be Blas on March 23, 2020
    List of Approved NDAs for Biological Products That Were Deemed to be BLAs on March 23, 2020 On March 23, 2020, an approved application for a biological product under section 505 of the Federal Food, Drug, and Cosmetic Act (FD&C Act) was deemed to be a license for the biological product under section 351 of the Public Health Service Act (PHS Act) (see section 7002(e)(4)(A) of the Biologics Price Competition and Innovation Act of 2009). To enhance transparency and facilitate planning for the March 23, 2020, transition date, FDA compiled a preliminary list of approved applications for biological products under the FD&C Act that were listed in FDA’s Approved Drug Products with Therapeutic Equivalence Evaluations (the Orange Book) and that would be affected by this transition provision. FDA posted this list on the FDA website in December 2018, and periodically updated this list before the March 23, 2020, transition date. The September 2019 update to this preliminary list added certain administratively closed applications related to approved applications for biological products that were on the December 2018 version of this list. The January 2020 update to the preliminary list reflected a change to the definition of “biological product” made by the Further Consolidated Appropriations Act, 2020, which was enacted on December 20, 2019. Section 605 of this Act further amended the definition of a “biological product” in section 351(i) of the PHS Act to remove the parenthetical “(except any chemically synthesized polypeptide)” from the statutory category of “protein.” FDA has provided below a list of each approved application for a biological product under the FD&C Act that was deemed to be a license (i.e., an approved biologics license application (BLA)) for the biological product on March 23, 2020.
    [Show full text]
  • Corticorelin Acetate, a Synthetic Corticotropin-Releasing Factor with Preclinical Antitumor Activity, Alone and with Bevacizumab, Against Human Brain Tumor Models
    ANTICANCER RESEARCH 30: 5037-5042 (2010) Corticorelin Acetate, a Synthetic Corticotropin-releasing Factor with Preclinical Antitumor Activity, alone and with Bevacizumab, against Human Brain Tumor Models IDOIA GAMEZ1, ROBERT P. RYAN1 and STEPHEN T. KEIR2 1Celtic Pharmaceutical Development Services America, Inc., New York, NY 10022, U.S.A.; 2The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC 27710, U.S.A. Abstract. Background: Corticorelin acetate (CrA) is a brain tumors. The cause of PBE is believed to result in part synthetic form of corticotropin-releasing factor that is from the leakage of edematous brain tumor fluid from currently undergoing clinical trials in the treatment of abnormal tumor vasculature into the surrounding tissue (1, peritumoral brain edema (PBE). This study preclinically 2). The mechanism(s) of action by which CrA exerts its investigated its potential as an antitumor agent against beneficial effect in the therapy of PBE has not been human brain tumor xenografts. Materials and Methods: The elucidated, but two factors appear to be relevant: decreased in vivo efficacy of CrA as a single agent and in combination vascular leakage and preserved integrity of the endothelial with the antiangiogenic agent, bevacizumab, was examined cells, which ultimately helps to maintain the blood-brain in three different patient-derived human brain tumor barrier (3, 4). xenografts implanted orthotopically (intracranially) or CrA appears to mediate its activity through two subtypes subcutaneously in athymic mice. Results: CrA significantly of G-protein coupled receptors: CRF receptor-1 (CRFR1) increased the lifespan of mice implanted orthotopically with and CRF receptor-2 (CRFR2) (5). These CRFRs are widely two different pediatric brain tumor xenograft models.
    [Show full text]
  • BCBSVT Specialty Drug List Effective 2021.07.01.Xlsx
    Effective Date: 07/01/2021 SPECIALTY DRUG LIST Revised Date: 05/07/2021 DOSAGE EXCLUDED ON NATIONAL DRUG CLASS DRUG NAME GENERIC NAME FORM PERFORMANCE FORMULARY ANEMIA ARANESP SOLN DARBEPOETIN ALFA SOLN INJ ANEMIA ARANESP SOSY DARBEPOETIN ALFA SOLN PREFILLED SYRINGE ANEMIA EPOGEN SOLN EPOETIN ALFA INJ X ANEMIA PROCRIT SOLN EPOETIN ALFA INJ X ANEMIA REBLOZYL SOLR LUSPATERCEPT-AAMT FOR SUBCUTANEOUS INJ ANEMIA RETACRIT SOLN EPOETIN ALFA-EPBX INJ ANTI-GOUT AGENT KRYSTEXXA SOLN PEGLOTICASE INJ (FOR IV INFUSION) ANTI-INFECTIVE PREVYMIS SOLN LETERMOVIR IV SOLN ANTI-INFECTIVE PREVYMIS TABS LETERMOVIR TAB ASTHMA CINQAIR SOLN RESLIZUMAB IV INFUSION SOLN ASTHMA FASENRA SOSY BENRALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE ASTHMA FASENRA PEN SOAJ BENRALIZUMAB SUBCUTANEOUS SOLN AUTO-INJECTOR ASTHMA NUCALA SOAJ MEPOLIZUMAB SUBCUTANEOUS SOLUTION AUTO-INJECTOR ASTHMA NUCALA SOLR MEPOLIZUMAB FOR INJ ASTHMA NUCALA SOSY MEPOLIZUMAB SUBCUTANEOUS SOLUTION PREF SYRINGE ASTHMA XOLAIR SOLR OMALIZUMAB FOR INJ ASTHMA XOLAIR SOSY OMALIZUMAB SUBCUTANEOUS SOLN PREFILLED SYRINGE CARDIOVASCULAR VYNDAMAX CAPS TAFAMIDIS CAP CARDIOVASCULAR VYNDAQEL CAPS TAFAMIDIS MEGLUMINE (CARDIAC) CAP CENTRAL NERVOUS SYSTEM AGENTS AUSTEDO TABS DEUTETRABENAZINE TAB CENTRAL NERVOUS SYSTEM AGENTS ENSPRYNG SOSY SATRALIZUMAB-MWGE SUBCUTANEOUS SOLN PREF SYRINGE CENTRAL NERVOUS SYSTEM AGENTS HETLIOZ CAPS TASIMELTEON CAPSULE CENTRAL NERVOUS SYSTEM AGENTS HETLIOZ LQ SUSP TASIMELTEON ORAL SUSP CHEMOTHERAPY PROTECTANT AMIFOSTINE SOLR AMIFOSTINE CRYSTALLINE FOR INJ CHEMOTHERAPY PROTECTANT ELITEK
    [Show full text]
  • Preferred Drug List (Formulary)
    January 2020 Molina Healthcare of Michigan Preferred Drug List (Formulary) 1 Molina Healthcare of Michigan Preferred Drug List (Formulary) (01/01/2020) INTRODUCTION ..........................................................................................................................................................................................................................................5 PREFACE .....................................................................................................................................................................................................................................................5 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE ..........................................................................................................................................................................5 DRUG LIST PRODUCT DESCRIPTIONS ...................................................................................................................................................................................................5 GENERIC SUBSTITUTION ..........................................................................................................................................................................................................................5 PLAN DESIGN .............................................................................................................................................................................................................................................6
    [Show full text]
  • September 2017 ~ Resource #330909
    −This Clinical Resource gives subscribers additional insight related to the Recommendations published in− September 2017 ~ Resource #330909 Medications Stored in the Refrigerator (Information below comes from current U.S. and Canadian product labeling and is current as of date of publication) Proper medication storage is important to ensure medication shelf life until the manufacturer expiration date and to reduce waste. Many meds are recommended to be stored at controlled-room temperature. However, several meds require storage in the refrigerator or freezer to ensure stability. See our toolbox, Medication Storage: Maintaining the Cold Chain, for helpful storage tips and other resources. Though most meds requiring storage at temperatures colder than room temperature should be stored in the refrigerator, expect to see a few meds require storage in the freezer. Some examples of medications requiring frozen storage conditions include: anthrax immune globulin (Anthrasil [U.S. only]), carmustine wafer (Gliadel [U.S. only]), cholera (live) vaccine (Vaxchora), dinoprostone vaginal insert (Cervidil), dinoprostone vaginal suppository (Prostin E2 [U.S.]), varicella vaccine (Varivax [U.S.]; Varivax III [Canada] can be stored in the refrigerator or freezer), zoster vaccine (Zostavax [U.S.]; Zostavax II [Canada] can be stored in the refrigerator or freezer). Use the list below to help identify medications requiring refrigerator storage and become familiar with acceptable temperature excursions from recommended storage conditions. Abbreviations: RT = room temperature Abaloparatide (Tymlos [U.S.]) Aflibercept (Eylea) Amphotericin B (Abelcet, Fungizone) • Once open, may store at RT (68°F to 77°F • May store at RT (77°F [25°C]) for up to Anakinra (Kineret) [20°C to 25°C]) for up to 30 days.
    [Show full text]
  • Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule Revised: 04/06/2016 January - 2016
    Michigan Department of Health and Human Services Practitioner and Medical Clinic Fee Schedule Revised: 04/06/2016 January - 2016 Code Short Description Modifier Age Range Non Fac Fee Fac Fee Effective Date** 0054T Bone Srgry Cmptr Fluor Image NA $84.39 0055T Bone Srgry Cmptr Ct/Mri Imag NA $84.39 0178T 64 Lead Ecg W/I&R M M 0179T 64 Lead Ecg W/Tracing M M 0180T 64 Lead Ecg W/I&R Only M M 0190T Place Intraoc Radiation Src M M 0191T Insert Ant Segment Drain Int $379.27 $379.27 0195T Prescrl Fuse W/O Instr L5/S1 NA M 0196T Prescrl Fuse W/O Instr L4/L5 NA M 0198T Ocular Blood Flow Measure M M 0200T Perq Sacral Augmt Unilat Inj $987.92 $243.46 0201T Perq Sacral Augmt Bilat Inj $553.69 $120.64 0202T Post Vert Arthrplst 1 Lumbar $4,128.40 $288.24 0205T Inirs Each Vessel Add-On NA $63.19 0206T Cptr Dbs Alys Car Elec Dta $14.66 $14.66 0207T Clear Eyelid Gland W/Heat $136.47 $68.53 0208T Audiometry Air Only $17.43 NA 0209T Audiometry Air & Bone $20.80 NA 0210T Speech Audiometry Threshold $13.07 NA 0211T Speech Audiom Thresh & Recog $20.80 NA 0212T Compre Audiometry Evaluation $21.00 $18.42 0213T Njx Paravert W/Us Cer/Thor $107.57 $60.82 0214T Njx Paravert W/Us Cer/Thor $53.09 $34.47 0215T Njx Paravert W/Us Cer/Thor $53.29 $34.87 0216T Njx Paravert W/Us Lumb/Sac $97.66 $52.10 0217T Njx Paravert W/Us Lumb/Sac $48.93 $29.72 0218T Njx Paravert W/Us Lumb/Sac $49.13 $30.11 0219T Plmt Post Facet Implt Cerv $238.91 $129.56 0220T Plmt Post Facet Implt Thor $238.91 $129.56 0221T Plmt Post Facet Implt Lumb $236.14 $127.77 0222T Plmt Post Facet Implt Addl
    [Show full text]
  • Pharmaceutical Appendix to the Harmonized Tariff Schedule
    Harmonized Tariff Schedule of the United States Basic Revision 3 (2021) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States Basic Revision 3 (2021) Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names INN which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service CAS registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known.
    [Show full text]
  • CDER List of Licensed Biological Products With
    Center for Drug Evaluation and Research List of Licensed Biological Products with (1) Reference Product Exclusivity and (2) Biosimilarity or Interchangeability Evaluations to Date DATE OF FIRST REFERENCE PRODUCT DATE OF LICENSURE LICENSURE EXCLUSIVITY EXPIRY DATE INTERCHANGEABLE (I)/ BLA STN PRODUCT (PROPER) NAME PROPRIETARY NAME (mo/day/yr) (mo/day/yr) (mo/day/yr) BIOSIMILAR (B) WITHDRAWN 125118 abatacept Orencia 12/23/05 NA NA 103575 abciximab ReoPro 12/22/94 NA NA Yes 125274 abobotulinumtoxinA Dysport 04/29/09 125057 adalimumab Humira 12/31/02 NA NA 761071 adalimumab-adaz Hyrimoz 10/30/18 B 761058 adalimumab-adbm Cyltezo 08/25/17 B 761118 adalimumab-afzb Abrilada 11/15/19 B 761024 adalimumab-atto Amjevita 09/23/16 B 761059 adalimumab-bwwd Hadlima 07/23/19 B 125427 ado-trastuzumab emtansine Kadcyla 02/22/13 125387 aflibercept Eylea 11/18/11 103979 agalsidase beta Fabrazyme 04/24/03 NA NA 125431 albiglutide Tanzeum 04/15/14 017835 albumin chromated CR-51 serum Chromalbin 02/23/76 103293 aldesleukin Proleukin 05/05/92 NA NA 103948 alemtuzumab Campath, Lemtrada 05/07/01 NA NA 125141 alglucosidase alfa Myozyme 04/28/06 NA NA 125291 alglucosidase alfa Lumizyme 05/24/10 125559 alirocumab Praluent 07/24/15 103172 alteplase, cathflo activase Activase 11/13/87 NA NA 103950 anakinra Kineret 11/14/01 NA NA 020304 aprotinin Trasylol 12/29/93 125513 asfotase alfa Strensiq 10/23/15 101063 asparaginase Elspar 01/10/78 NA NA 125359 asparaginase erwinia chrysanthemi Erwinaze 11/18/11 761034 atezolizumab Tecentriq 05/18/16 761049 avelumab Bavencio 03/23/17
    [Show full text]
  • Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DIX to the HTSUS—Continued
    20558 Federal Register / Vol. 60, No. 80 / Wednesday, April 26, 1995 / Notices DEPARMENT OF THE TREASURY Services, U.S. Customs Service, 1301 TABLE 1.ÐPHARMACEUTICAL APPEN- Constitution Avenue NW, Washington, DIX TO THE HTSUSÐContinued Customs Service D.C. 20229 at (202) 927±1060. CAS No. Pharmaceutical [T.D. 95±33] Dated: April 14, 1995. 52±78±8 ..................... NORETHANDROLONE. A. W. Tennant, 52±86±8 ..................... HALOPERIDOL. Pharmaceutical Tables 1 and 3 of the Director, Office of Laboratories and Scientific 52±88±0 ..................... ATROPINE METHONITRATE. HTSUS 52±90±4 ..................... CYSTEINE. Services. 53±03±2 ..................... PREDNISONE. 53±06±5 ..................... CORTISONE. AGENCY: Customs Service, Department TABLE 1.ÐPHARMACEUTICAL 53±10±1 ..................... HYDROXYDIONE SODIUM SUCCI- of the Treasury. NATE. APPENDIX TO THE HTSUS 53±16±7 ..................... ESTRONE. ACTION: Listing of the products found in 53±18±9 ..................... BIETASERPINE. Table 1 and Table 3 of the CAS No. Pharmaceutical 53±19±0 ..................... MITOTANE. 53±31±6 ..................... MEDIBAZINE. Pharmaceutical Appendix to the N/A ............................. ACTAGARDIN. 53±33±8 ..................... PARAMETHASONE. Harmonized Tariff Schedule of the N/A ............................. ARDACIN. 53±34±9 ..................... FLUPREDNISOLONE. N/A ............................. BICIROMAB. 53±39±4 ..................... OXANDROLONE. United States of America in Chemical N/A ............................. CELUCLORAL. 53±43±0
    [Show full text]
  • Injectable Medication Hcpcs/Dofr Crosswalk
    INJECTABLE MEDICATION HCPCS/DOFR CROSSWALK HCPCS DRUG NAME GENERIC NAME PRIMARY CATEGORY SECONDARY CATEGORY J0287 ABELCET Amphotericin B lipid complex THERAPEUTIC INJ HOME HEALTH/INFUSION** J0400 ABILIFY Aripiprazole, intramuscular, 0.25 mg THERAPEUTIC INJ J0401 ABILIFY MAINTENA Apriprazole 300mg, IM injection THERAPEUTIC INJ J9264 ABRAXANE paclitaxel protein-bound particles, 1 mg J1120 ACETAZOLAMIDE SODIUM Acetazolamide sodium injection THERAPEUTIC INJ J0132 ACETYLCYSTEINE INJ Acetylcysteine injection, 10 mg THERAPEUTIC INJ ACTEMRA INJECTION (50242-0136-01, J3262 50242-0137-01) Tocilizumab 200mg, 400mg THERAPEUTIC INJ ACTEMRA 162mg/0.9ml Syringe (50242- J3262 SELF-INJECTABLE 0138-01) Tocilizumab, 1 mg J0800 ACTHAR HP Corticotropin injection THERAPEUTIC INJ Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4- 90648 ACTHIB dose schedule), for intramuscular use THERAPEUTIC INJ IMMUNIZATIONS J0795 ACTHREL Corticorelin ovine triflutal THERAPEUTIC INJ J9216 ACTIMMUNE Interferon gamma 1-b 3 miillion units SELF-INJECTABLE CHEMO ADJUNCT* J2997 ACTIVASE Alteplase recombinant, 1mg THERAPEUTIC INJ HOME HEALTH/INFUSION** J0133 ACYCLOVIR SODIUM Acyclovir, 5 mg THERAPEUTIC INJ HOME HEALTH/INFUSION** 90715 ADACEL Tdap vaccine, > 7 yrs, IM THERAPEUTIC INJ IMMUNIZATIONS J2504 ADAGEN Pegademase bovine, 25 IU THERAPEUTIC INJ HOME HEALTH/INFUSION** J9042 ADCETRIS Brentuximab vedotin Injection THERAPEUTIC INJ CHEMOTHERAPY J0153 ADENOCARD Adenosine 6 MG THERAPEUTIC INJ J0171 ADRENALIN Adrenalin (epinephrine) inject THERAPEUTIC INJ J9000 ADRIAMYCIN Doxorubicin
    [Show full text]
  • Stembook 2018.Pdf
    The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances FORMER DOCUMENT NUMBER: WHO/PHARM S/NOM 15 WHO/EMP/RHT/TSN/2018.1 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances. Geneva: World Health Organization; 2018 (WHO/EMP/RHT/TSN/2018.1). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data.
    [Show full text]