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
0718   Inj, carmustine (accord)
0719   Inj cyclophos dr.reddy's 5mg
0720   Inj glofitamab gxbm, 2.5 mg
0729   Inj, motixafortide, 0.25 mg
0730   Inj melphalan (hepzato) 1 mg
0741   Inj cyclophosphamd (ingenus)
0743   Inj, cyclophosphamide, nos
0802‑1761   Oral Medications
0827   Floxuridine injection
0850   Streptozocin injection
0851   Thiotepa injection
0856   Porfimer sodium injection
1168   Inj, temsirolimus
1235   Valrubicin injection
1281‑9214   Bevacizumab injection
1466   Inj, vincristine sul lip 1mg
1471   Injection, Pertuzumab, 1 mg
1488   Injection, ramucirumab
1613   Trastuzumab injection
1822   Injection, zarxio
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
9080   Fludarabine phosphate inj
9100   Inj, bortezomib, hospira
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
9120   Injection, Fulvestrant
9123   Inj pemetrexed, hospira 10mg
9127   Inj pemetrexed (accord) 10mg
9128   Inj pemetrexed (sandoz) 10mg
9129   Inj, stimufend, 0.5 mg
9131   Inj, Ado-trastuzumab Emt 1mg
9136   Leuprolide depot cipla 7.5mg
9150   Inj mosunetuzumab-axgb, 1 mg
9151   Inj apotex/bendamustine 1 mg
9152   Paclitaxel (american regent)
9153   Inj bendamustine, baxter 1mg
9154   Inj, bendamustine, 1 mg
9156   Inj pemetrexed ditromethamin
9159   Inj, vegzelma, 10 mg
9165   Inj, decitabine (sun pharma)
9193   Nivestym
9194   Tisagenlecleucel car-pos t
9203   Inj cyclophosphamd auromedic
9204   Inj tisotu vedotin-tftv, 1mg
9205   Inj lon tesirin-lpyl 0.075mg
9207   Injection, bortezomib, 0.1mg
9213   Inj. pemetrexed nos 10mg
9235   Panitumumab injection
9241   Inj sirolimus prot part 1 mg
9244   Inj gemcitabine hcl (accord)
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
9339   Iodine i-131 iobenguane 1mci
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
9430   Piflu f-18, dia 1 millicurie
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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