HCPCS Code Section: HCPCS C Codes

Injection, tedizolid phosphate, 1 mg Short Description: Inj, tedizolid phosphate Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2015 Effective …

Injection, c-1 esterase inhibitor (recombinant), ruconest, 10 units Short Description: C-1 esterase, ruconest Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: April …

Injection, oritavancin, 10 mg Short Description: Injection, oritavancin Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2015 Effective Date: January …

Injection, dalbavancin, 10 mg Short Description: Injection, dalbavancin Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2015 Effective Date: January …

Injection, belinostat, 10 mg Short Description: Injection, belinostat Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2015 Effective Date: January …

Injection, sulfur hexafluoride lipid microsphere, per ml Short Description: Lumason contrast agent Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: October 1, …

Injection, ferric carboxymaltose, 1 mg Short Description: Inj, ferric carboxymaltose Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: January 1, 2014 Effective …

Injection, isavuconazonium sulfate, 1 mg Short Description: Inj, isavuconazonium sulfate Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: October 1, 2015 Effective …

Iodine i-131 iobenguane, therapeutic, 1 millicurie Short Description: Iodine i-131 iobenguane, tx Coverage Code: Special coverage instructions apply Action Code: Discontinue procedure or modifier code Date Added: January 1, …

Injection, siltuximab, 10 mg Short Description: Injection, siltuximab Coverage Code: Special coverage instructions apply Action Code: No maintenance for this code Date Added: July 1, 2015 Effective Date: January …