HCPCS Code Section: HCPCS C Codes

Injection, bendamustine hcl (belrapzo), 1 mg Short Description: Inj., belrapzo 1 mg Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: April 1, …

Injection, coagulation factor xa (recombinant), inactivated (andexxa), 10 mg Short Description: Inj, coagulation factor xa Coverage Code: Special coverage instructions apply Action Code: Add procedure or modifier code Date …

Injection, fremanezumab-vfrm, 1mg Short Description: Injection, fremanezumab-vfrm Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: April 1, 2019 Effective Date: October 1, …

Injection, plazomicin, 5 mg Short Description: Injection, plazomicin Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: January 1, 2019 Effective Date: October …

Injection, mogamulizumab-kpkc, 1 mg Short Description: Inj mogamulizumab-kpkc Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: January 1, 2019 Effective Date: October …

Injection, risperidone (perseris), 0.5 mg Short Description: Injection, risperidone Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: January 1, 2019 Effective Date: …

Injection, patisiran, 0.1 mg Short Description: Injection, patisiran Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: January 1, 2019 Effective Date: October …

Injection, aripiprazole lauroxil (aristada initio), 1 mg Short Description: Injection, aristada initio Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: January 1, …

Injection, dexamethasone 9%, intraocular, 1 mcg Short Description: Injection, dexamethasone 9% Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: October 1, 2018 …

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg Short Description: Inj, akynzeo Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: October 1, …