IVIG Products
with J-Code (HCPCS) Reference

Specialty Products
with J-Code (HCPCS) Reference

Actemra	J3262
Actemra	J3262
Actemra	J3262
Aduhelm	J3590
Aduhelm	J3590
Avastin	J9035
Avastin	J9035
Avsola	Q5121
Benlysta	J0490
Benlysta	J0490
Botox 100U (Allergan)	J0585
Botox 200U (Allergan)	J0585
Cimzia	J0717
Cinrize 500U	J0598
Dysport 300U	J0586
Dysport 500U	J0586
Entyvio	J3380
Fabrazyme	J0180
Fabrazyme	J0180
Fasenra	J0517
Inflectra	Q5103
Keytruda	J9271
Krystexxa	J2507
Novoseven	J7189
Nucala	J2182
Ocrevus	J2350
Orencia	J0129
Prolia	J0897
Radicava (per carton)	J1301
Radicava (per carton) - Direct Contract	J1301
Remicade	J1745
Renflexis	Q5104
Rituxan	J9312
Rituxan	J9312
Simponi	J1602
Soliris	J1300
Spinraza	J2326
Stelara IV	J3358
Stelara	J3357
Trogarzo	J1746
Truxima	Q5115
Tysabri DRPSHP	J2323
Xolair	J2357

Volumat MC Agila Infusion Pump
VL ST10-0
VL ST10-X0
VL ST02-0
VL ST02-X0
VL PN02-1
VL SP22-0
VL SP62-1
VL ON72-1
VL ON72-X1
VL PA92-1
VL PA92-2
VL PR40-11
VL SP40-11
VL PR42-11
VL PR42-12
VL PR44-12
VL PR72-11
VL SL00-X0
VL SL00-XP
Sodium Chloride 0.45% Freeflex Inj. Solution 50mL	J7030
Sodium Chloride 0.45% Freeflex Inj. Solution 100mL	J7030
Sodium Chloride 0.45% Freeflex Inj. Solution 250mL	J7030
Sodium Chloride 0.45% Freeflex Inj. Solution 500mL	J7030
Sodium Chloride 0.45% Freeflex Inj. Solution 1000mL	J7030
Sodium Chloride 0.9% Freeflex Inj. Solution 50mL	J7040
Sodium Chloride 0.9% Freeflex Inj. Solution 100mL	J7040
Sodium Chloride 0.9% Freeflex Inj. Solution 250mL	J7040
Sodium Chloride 0.9% Freeflex Inj. Solution 500mL	J7040
Sodium Chloride 0.9% Freeflex Inj. Solution 1000mL	J7040
Sodium Chloride 3.0% Injection, USP 500mL Freeflex	J7050
Dextrose 5% Freeflex Inj, USP 50mL (2.5g)	J7060
Dextrose 5% Freeflex Inj, USP 100mL (5g)	J7060
Dextrose 5% Freeflex Inj, USP 250mL (12.5g)	J7060
Dextrose 5% Freeflex Inj, USP 500mL (25g)	J7060
Dextrose 5% Freeflex Inj, USP 1000mL (50g)	J7060
Dextrose 10% Freeflex Inj, USP 250mL (25g)	J7070
Dextrose 10% Freeflex Inj, USP 500mL (50g)	J7070
Dextrose 10% Freeflex Inj, USP 1000mL (100g)	J7070
Lactated Ringer's Injection, USP 250mL	J7120
Lactated Ringer's Injection, USP 500mL	J7120
Lactated Ringer's Injection, USP 1000mL	J7120
Water Sterile Freeflex Inj, USP 1000 mL