HCPCS Code Medication Name 90651 Gardasil9 A4261 Cervical Cap A4266 Diaphragm for contraceptive use A4269 Contraceptive Supply, Spermicide J0278 INJECTION, AMIKACIN SULFATE, 100 MG J0290 INJECTION, AMPICILLIN SODIUM, UP TO 500MG J0295 INJECTION; AMPICILLIN J0456 INJECTION, AZITHROMYCIN, 500 MG J0558 PenG benzathine/procaine inj J0561 Penicillin g benzathine inj J0690 INJECTION, CEFAZOLIN SODIUM, UP TO 500 MG J0692 INJECTION, CEFEPIME HYDROCHLORIDE, 500 MG J0694 INJECTION, CEFOXITIN SODIUM, 1 GM J0695 INJ CEFTOLOZANE TAZOBACTAM J0696 INJECTION, CEFTRIAXONE SODIUM, PER 250 MG (ROCEPHIN) J0697 INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG J0698 CEFOTAXIME SODIUM, PER GM J0710 INJECTION, CEPHAPIRIN SODIUM, UP TO 1 GM J0713 INJ CEFTAZIDIME PER 500 MG J0714 CEFTAZIDIME AND AVIBACTAM J0715 INJECTION; CEFTIZOXIME SODIUM-500MG J0744 INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG J1000 INJECTION, DEPO-ESTRADIOL CYPIONATE, UP TO 5 MG J1050 INJECTION, MEDROXYPROGESTERONE ACETATE, 100 MG(DEPO PROVERA) J1364 INJECTION; ERYTHROMYCIN LACTOBIONA J1450 INJECTION FLUCONAZOLE, 200 MG J1580 INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG J1956 INJECTION, LEVOFLOXACIN, 250 MG J2265 Minocycline hydrochloride J2280 INJECTION, MOXIFLOXACIN, 100 MG J2510 INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS J2540 INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS J2543 INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1. J3260 INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG J7296 Levonorgestrel-releasing intrauterine contraceptive system (Kyleena) 19.5mg J7297 LEVONORGESTREL IU 52MG 3 YR J7298 LEVONORGESTREL IU 52MG 5 YR J7300 IUD COPPER J7301 SKYLA 13.5MG J7303 CONTRACEPTIVE SUPPLY, HORMONE CONTAINING VAGINAL RING, EACH J7304 CONTRACEPTIVE SUPPLY, HORMONE CONTAINING PATCH, EACH J7306 LEVONORGESTREL (CONTRACEPTIVE) IMPLANT SYSTEM, INCLUDING IMP J7307 Etonogestrel implant system Q0144 AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM S0030 INJECTION, METRONIDAZOLE, 500 MG S0032 INJECTION, NAFCILLIN SODIUM, 2 GRAMS S0039 INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML S0073 INJECTION, AZTREONAM, 500 MG S0074 INJECTION, CEFOTETAN DISODIUM, 500 MG S0077 INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG S4981 Insertion of levonorgestrel-releasing intrauterine system S4989 Contraceptive Intrauterine Device S4993 Contraceptive Pills for Birth Control 11981 Insertion and/or removal (Nexplanon) 11982 Insertion (Nexplanon) 11983 Same day removal with reinsertion of implant (Nexplanon) 58300 Insertion of IUD (copper IUD and the hormonal IUDs) 58301 Removal of IUD (copper IUD and the hormonal IUDs)