Ambulatory Payment Classifications
section notes
Cancer/Chemotherapy Drugs
section notes
0706   Inj talquetamab-tgvs 0.25 mg
0708   Inj, elranatamab-bcmm, 1 mg
0717   Instill adstiladrin, tx dose
0719   Inj cyclophos frindovyx 5 mg
0720   Inj glofitamab gxbm, 2.5 mg
0729   Inj, motixafortide, 0.25 mg
0730   Inj melphalan (hepzato) 1 mg
0741   Inj cyclophos dr reddys 5 mg
0743   Inj, cyclophosphamide, nos
0747   Inj, zolbetuximab-clzb, 2 mg
0757   Docetaxel (docivyx), 1 mg
0761   Inj, focinvez, 1mg
0767   Inj, nogapendekin pmln 1 mcg
0768   Inj, tarlatamab-dlle, 1 mg
0782   Inj, pemrydi rtu, 10 mg
0785   Inj, cyclophosphamd, sandoz
08021761   Oral Medications
0816   Inj, tislelizumab-jsgr
0827   Floxuridine injection
0831   Obecbtge autol up to 400 mil
0835   Datopotamab deruxtecan, 1 mg
0837   Inj, treosulfan, 50 mg
0841   Inj, docetaxel (beizray) 1mg
0842   Inj, melphalan (apotex) 1 mg
0847   Inj thiotepa nos 1 mg
0848   Inj nivolumab 2 mg hyaluron
0853   Inj zenocutuzumab-zbco 1 mg
0865   Inj, hercessi, 10 mg
0870   Inj. calaspargase pegol-mknl
0871   Inj pemetrexed (bluepoint)
0894   Telisotuzumab vedotin-tllv
0907   Inj, cyclophos (baxter) 5mg
0909   Inj gemcitabin (avyxa) 200mg
0915   Inj cosibelimab-ipdl, 2 mg
0916   Inj linvoseltamab-gcpt 1 mg
0917   Inj, carboplatin (avyxa)
0918   Inj, jobevne, 10 mg
0926   Gemcitabine intravesical sys
0930   Pembrolizumab 1mg berahyalur
0957   Inj belantamab mafodot blmf
1168   Inj, temsirolimus
1235   Valrubicin injection
12819214   Bevacizumab injection
1471   Injection, Pertuzumab, 1 mg
1488   Injection, ramucirumab
1613   Trastuzumab injection
1822   Injection, zarxio
2062   Inj zanidatamab-hrii, 2 mg
2066   Inj bortezomib boruzu 0.1 mg
2067   Afamitresgene autoleucel
2072   Inj, erzofri, 1 mg
9026   Inj, bortezomib, dr. reddy’s
9027   Inj, bortezomib freseniuskab
9035   Axicabtagene ciloleucel car+
9048   Inj, alymsys, 10 mg
9050   Leuprolide inj, camcevi, 1mg
9054   Lutetium lu 177 vipivotide
9057   Inj nivol relatlimab 3mg/1mg
9067   Lutetium lu 177 dotatat ther
9102   Inj, fulvestrant (teva)
9103   Inj, fulvestrant (fresenius)
9105   Inj pemetrexed (teva) 10mg
9109   Inj, elahere, 1 mg
9110   Inj, tremelimumab-actl, 1 mg
9111   Inj teclistamab cqyv 0.5 mg
9114   Inj eflapegrastim-xnst 0.1mg
9118   Inj, fylnetra, 0.5 mg
9123   Inj pemetrexed, hospira 10mg
9127   Inj pemetrexed (accord) 10mg
9129   Inj, stimufend, 0.5 mg
9131   Inj, Ado-trastuzumab Emt 1mg
9136   Inj leu acet lutr dpt 7.5 mg
9150   Inj mosunetuzumab-axgb, 1 mg
9154   Inj, vivimusta, 1 mg
9159   Inj, vegzelma, 10 mg
9193   Nivestym
9194   Tisagenlecleucel car-pos t
9203   Inj cyclophosphamd auromedic
9204   Inj tisotu vedotin-tftv, 1mg
9205   Inj lon tesirin-lpyl 0.075mg
9213   Inj. pemetrexed nos 10mg
9235   Panitumumab injection
9241   Inj sirolimus prot part 1 mg
9250   Inj epcoritamab-bysp 0.16 mg
9253   Temozolomide injection
9259   Pralatrexate injection
9260   Ofatumumab injection
9280   Inj, retifanlimab-dlwr, 1 mg
9296   Inj, ziv-aflibercept, 1mg
9390   Pertuzu, trastuzu, 10 mg
9391   Brexucabtagene car pos t
9413   lisocabtagene car pos t
9422   Idecabtagene vicleucel car
9428   Inj romidepsin non-lyo 0.1mg
9429   Inj romidepsin lyophil 0.1mg
9431   Inj, dostarlimab-gxly, 10 mg
9432   Inj, amivantamab-vmjw
9436   Inj pegfilgrast ex bio 0.5mg
9437   Inj, aspara, rylaze, 0.1 mg
9442   Inj. pemetrexed, 10 mg
9446   Inj, tebentafusp-tebn, 1 mcg
9447   Inj, releuko 1 mcg
9472   Inj talimogene laherparepvec
9480   Injection trabectedin 0.1mg
9498   Ciltacabtagene car-pos t
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