January 2021 Table of Drugs Questions regarding coding and billing guidance should be submitted to the insurer in whose jurisdiction a claim would be filed. For private sector health insurance systems, please contact the individual private insurance entity. For Medicaid systems, please contact the Medicaid Agency in the state in which the claim is being filed. For Medicare, contact the Medicare contractor. IA - Intra-arterial administration IV - Intravenous administration IM - Intramuscular administration IT - Intrathecal SC - Subcutaneous administration INH - Administration by inhaled solution VAR - Various routes of administration OTH - Other routes of administration ORAL - Administered orally Intravenous administration includes all methods, such as gravity infusion, injections, and timed pushes. The ‘VAR’ posting denotes various routes of administration and is used for drugs that are commonly administered into joints, cavities, tissues, or topical applications, in addition to other parenteral administrations. Listings posted with ‘OTH’ indicate other administration methods, such as suppositories or catheter injections. A Abatacept 10 mg IV J0129 Abbokinase, see Urokinase Abbokinase, Open Cath, see Urokinase Abciximab 10 mg IV J0130 Abelcet, see Amphotericin B Lipid Complex ABLC, see Amphotericin B AbobotulinumtoxintypeA 5 units IM J0586 Acetaminophen 10 mg IV J0131 Acetazolamide sodium up to 500 mg IM, IV J1120 Acetylcysteine, Injection 100 mg IV J0132 Acetylcysteine, unit dose form per gram INH J7604, J7608 Achromycin, see Tetracycline 1 Actemra, see Tocilizumab ACTH, see Corticotropin Acthar, see Corticotropin Actimmune, see Interferon gamma 1-B Activase, see Alteplase recombinant Acyclovir 5 mg J0133 Adalimumab 20 mg SC J0135 Adcetis, see Brentuximab Vedotin Adenocard, see Adenosine Adenoscan, see Adenosine Adenosine 1 mg IV J0153 Ado-trastuzumab Emtansine 1 mg IV J9354 Adrenalin Chloride, see Adrenalin, epinephrine Adrenalin, epinephrine 0.1 mg SC, IM J0171 Adriamycin PFS, see Doxorubicin HCl Adriamycin RDF, see Doxorubicin HCl Adrucil, see Fluorouracil Afamelanotide implant 1 mg IV J7352 Aflibercept 1 mg OTH J0178 Agalsidase beta 1 mg IV J0180 Aggrastat, see Tirofiban hydrochloride A-hydroCort, see Hydrocortisone sodium phosphate Akineton, see Biperiden Alatrofloxacin mesylate, Injection 100 mg IV J0200 Albuterol 0.5 mg INH J7620 Albuterol, concentrated form 1 mg INH J7610, J7611 Albuterol, unit dose form 1 mg INH J7609, J7613 Aldesleukin per single use vial IM, IV J9015 Aldomet, see Methyldopate HCl Alefacept 0.5 mg IM, IV J0215 Alferon N, see Interferon alfa-n3 Alglucerase per 10 units IV J0205 Alglucosidase alfa 10 mg IV J0220, J0221 Alkaban-AQ, see Vinblastine sulfate Alkeran, see Melphalan, oral Alpha 1-proteinase inhibitor, human 10 mg IV J0256, J0257 Alphanate J7186 Alprostadil, Injection 1.25 mcg OTH J0270 Alprostadil, urethral suppository OTH J0275 Alteplase recombinant 1 mg IV J2997 Alupent, see Metaproterenol sulfate or Metaproterenol, compounded Amcort, see Triamcinolone diacetate A-methaPred, see Methylprednisolone sodium succinate Amgen, see Interferon alphacon-1 Amifostine 500 mg IV J0207 2 Amikacin sulfate 100 mg J0278 Aminolevalinic acid Hcl unit dose (354 mg) OTH J7308 Aminolevulinic acid Hcl 10% Gel 10 mg OTH J7345 Aminolevulinate 1 gm OTH J7309 Aminophylline/Aminophyllin up to 250 mg IV J0280 Amiodarone HCl 30 mg IV J0282 Amitriptyline HCl up to 20 mg IM J1320 Amobarbital up to 125 mg IM, IV J0300 Amphocin, see Amphotericin B Amphotericin B 50 mg IV J0285 Amphotericin B, lipid complex 10 mg IV J0287-J0289 Ampicillin sodium up to 500 mg IM, IV J0290 Ampicillin sodium/sulbactam sodium per 1.5 gm IM, IV J0295 Amygdalin, see Laetrile, Amygdalin, vitamin B-17 Amytal, see Amobarbital Anabolin LA 100, see Nandrolone decanoate Anadulafungin 1 mg IV J0348 Anascorp, see Centruroides Immune F(ab) Ancef, see Cefazolin sodium Andrest 90-4, see Testosterone enanthate and estradiol valerate Andro-Cyp, see Testosterone cypionate Andro-Cyp 200, see Testosterone cypionate Andro L.A. 200, see Testosterone enanthate Andro-Estro 90-4, see Testosterone enanthate and estradiol valerate Andro/Fem, see Testosterone cypionate and estradiol cypionate Androgyn L.A., see Testosterone enanthate and estradiol valerate Androlone-50, see Nandrolone phenpropionate Androlone-D 100, see Nandrolone decanoate Andronaq-50, see Testosterone suspension Andronaq-LA, see Testosterone cypionate Andronate-200, see Testosterone cypionate Andronate-100, see Testosterone cypionate Andropository 100, see Testosterone enanthate Andryl 200, see Testosterone enanthate Anectine, see Succinylcholine chloride Anergan 25, see Promethazine HCl Anergan 50, see Promethazine HCl Anistreplase 30 units IV J0350 Anti-Inhibitor per IU IV J7198 Antispas, see Dicyclomine HCl Antithrombin III (human) per IU IV J7197 Antithrombin recombinant 50 IU IV J7196 Anzemet, see Dolasetron mesylate Injection A.P.L., see Chorionic gonadotropin Apomorphine Hydrochloride 1 mg SC J0364 3 Aprepitant 1 mg IV J0185 Apresoline, see Hydralazine HCl Aprotinin 10,000 kiu J0365 AquaMEPHYTON, see Vitamin K Aralen, see Chloroquine HCl Aramine, see Metaraminol Aranesp, see Darbepoetin Alfa IV Arbutamine 1 mg J0395 Arcalyst, see Rilanocept Aredia, see Pamidronate disodium Arfonad, see Trimethaphan camsylate 15 mcg INH J7605 Arformoterol tartrate Argatroban (for non-esrd use) 1 mg IV J0883 (for esrd use) 1 mg IV J0884 Aridol, see Mannitol Aripiprazole 0.25 mg IM J0400 Aripiprazole, extended release 1 mg IV J0401 Aripiprazole lauroxil (aristada) 1 mg IV J1944 Aripiprazole lauroxil (aristada initio) 1 mg IV J1943 Aripiprazole lauroxil 1 mg IV J1942 Aristocort Forte, see Triamcinolone diacetate Aristocort Intralesional, see Triamcinolone diacetate Aristospan Intra-Articular, see Triamcinolone hexacetonide Aristospan Intralesional, see Triamcinolone hexacetonide Arrestin, see Trimethobenzamide HCl Arsenic trioxide 1 mg IV J9017 Arzerra, see Ofatumumab Asparaginase 1,000 units IV, IM J9019 10,000 units IV, IM J9020 Astramorph PF, see Morphine sulfate Atezolizumab 10 mg IV J9022 Atgam, see Lymphocyte immune globulin Ativan, see Lorazepam Atropine, concentrated form per mg INH J7635 Atropine, unit dose form per mg INH J7636 Atropine sulfate 0.01 mg IV, IM, SC J0461 Atrovent, see Ipratropium bromide Atryn, see Antithrombin recombinant Aurothioglucose up to 50 mg IM J2910 Autologous cultured chondrocytes implant OTH J7330 Autoplex T, see Hemophilia clotting factors Avelumab 10 mg IV J9023 Avonex, see Interferon beta-1a Azacitidine 1 mg SC J9025 Azathioprine 50 mg ORAL J7500 Azathioprine, parenteral 100 mg IV J7501 4 Azithromycin, dihydrate 1 gm ORAL Q0144 Azithromycin, injection 500 mg IV J0456 B Baclofen 10 mg IT J0475 Baclofen for intrathecal trial 50 mcg OTH J0476 Bactocill, see Oxacillin sodium BAL in oil, see Dimercaprol Banflex, see Orphenadrine citrate Basiliximab 20 mg J0480 BCG live intravesical instillation 1 mg OTH J9030 BCG (Bacillus Calmette and Guérin), live per vial IV J9031 instillation Beclomethasone inhalation solution, unit dose form per mg INH J7622 Belatacept 1 mg IV J0485 Belimumab 10 mg IV J0490 Belinostat 10 mg IV J9032 Bena-D 10, see Diphenhydramine HCl Bena-D 50, see Diphenhydramine HCl Benadryl, see Diphenhydramine HCl Benahist 10, see Diphenhydramine HCl Benahist 50, see Diphenhydramine HCl Ben-Allergin-50, see Diphenhydramine HCl Bendamustine HCl (Treanda) 1 mg IV J9033 Bendamustine HCl (Bendeka) 1 mg IV J9034 Bendamustine HCl (Belrapzo/bendamustine) 1 mg IV J9036 Benefix, see Factor IX, recombinant Benlysta, see Belimumab Benoject-10, see Diphenhydramine HCl Benoject-50, see Diphenhydramine HCl Bentyl, see Dicyclomine Benralizumab 1 mg IV J0517 Benztropine mesylate per 1 mg IM, IV J0515 Berinert, see C-1 esterase inhibitor Berubigen, see Vitamin B-12 cyanocobalamin Beta amyloid per study dose OTH A9599 Betalin 12, see Vitamin B-12 cyanocobalamin Betameth, see Betamethasone sodium phosphate Betamethasone acetate & betamethasone sodium phosphate per 3 mg IM J0702 Betamethasone inhalation solution, unit dose form per mg INH J7624 Betaseron, see Interferon beta-1b Bethanechol chloride up to 5 mg SC J0520 Bevacizumab 10 mg IV J9035 Bevacizumab-awwb 10 mg IV Q5107 Bevacizumab- bvzr (Zirabev) 10 mg IV Q5118 5 Beziotoxumab 10 mg IV J0565 Bicillin L-A, see Penicillin G benzathine Bicillin C-R 900/300, see Penicillin G procaine and penicillin G benzathine Bicillin C-R, see Penicillin G benzathine and penicillin G procaine BiCNU, see Carmustine Bimatoprost 1 microgram IV J7351 Biperiden lactate per 5 mg IM, IV J0190 Bitolterol mesylate,concentrated form per mg INH J7628 Bitolterol mesylate,unit dose form per mg INH J7629 Bivalirudin 1 mg IV J0583 Blenoxane, see Bleomycin sulfate Bleomycin sulfate 15 units IM, IV, SC J9040 Blinatumomab 1 microgram IV J9039 Bortezomib 0.1 mg IV J9041 Bortezomib, not otherwise specified 0.1 mg IV J9044 Botox, see OnabotulinumtoxinA Brentuximab Vedotin 1 mg IV J9042 Brethine, see Terbutaline sulfate or Terbutaline, compounded Brexanolone 1 mg IV J1632 Bricanyl Subcutaneous, see Terbutaline sulfate Brolucizumab- dbll 1 mg OTH J0179 Brompheniramine maleate per 10 mg IM, SC, IV J0945 Bronkephrine, see Ethylnorepinephrine HCl Bronkosol, see Isoetharine HCl Budesonide inhalation solution, concentrated form0.25 mg INH J7633, J7634 Budesonide inhalation solution, unit dose form 0.5 mg INH J7626, J7627 Buprenorphine Hydrochloride 0.1 mg IM J0592 Buprenorphine/Naloxone 1 mg ORAL J0571 <=3 mg ORAL J0572 >3 mg but <=6 mg ORAL J0573 >6 mg but <=10 mg ORAL