Product J-Code (HCPCS) Listing
Effective 10/1/2021

IVIG PRODUCTS

Asceniv

J1554
BivigamJ1556
CutaQuigJ3590
Gammagard LIQ J1569
Gamunex-C 10% J1561
Octagam 5% J1568
Octagam 10% J1568
Panzyga J1599

SPECIALTY PRODUCTS

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 500UJ0598
Dysport 300UJ0586
Dysport 500UJ0586
EntyvioJ3380
Fabrazyme J0180
Fabrazyme J0180
FasenraJ0517
Inflectra Q5103
Keytruda J9271
KrystexxaJ2507
Novoseven J7189
NucalaJ2182
OcrevusJ2350
OrenciaJ0129
Prolia J0897
Radicava (per carton)J1301
Radicava (per carton) - Direct ContractJ1301
Remicade J1745
RenflexisQ5104
Rituxan J9312
Rituxan J9312
Simponi J1602
Soliris J1300
Spinraza J2326
Stelara IV J3358
Stelara J3357
TrogarzoJ1746
Truxima Q5115
Tysabri DRPSHPJ2323
XolairJ2357

IV SOLUTIONS

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 50mLJ7030
Sodium Chloride 0.45% Freeflex Inj. Solution 100mLJ7030
Sodium Chloride 0.45% Freeflex Inj. Solution 250mLJ7030
Sodium Chloride 0.45% Freeflex Inj. Solution 500mLJ7030
Sodium Chloride 0.45% Freeflex Inj. Solution 1000mLJ7030
Sodium Chloride 0.9% Freeflex Inj. Solution 50mLJ7040
Sodium Chloride 0.9% Freeflex Inj. Solution 100mLJ7040
Sodium Chloride 0.9% Freeflex Inj. Solution 250mLJ7040
Sodium Chloride 0.9% Freeflex Inj. Solution 500mLJ7040
Sodium Chloride 0.9% Freeflex Inj. Solution 1000mLJ7040
Sodium Chloride 3.0% Injection, USP 500mL FreeflexJ7050
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 250mLJ7120
Lactated Ringer's Injection, USP 500mLJ7120
Lactated Ringer's Injection, USP 1000mLJ7120
Water Sterile Freeflex Inj, USP 1000 mL
Bio-care-sd
Fresenius-kabi
Genesis
CuraScript-SD
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