Ambulatory Payment Classifications

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Drugs and Biologicals (Excluding Cancer/Chemotherapy)

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Injection(s)

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0703   Inj daxibotulinumtoxinA-lanm
0704   Inj, aflibercept hd, 1 mg
0705   Inj, avacincaptad peg 0.1 mg
0709   Flortaucipir inj 1 millicuri
0710   Inj velmanase alfa-tycv 1 mg
0711   Inj, artesunate, 1mg
0714   Inj delandistrogene mox rokl
0715   Pegunigalsidase alfa-iwxj
0721   Inj ronzanolixizum-noli 1 mg
0723   Inj efgart-alfa 2mg hya-qvfc
0724   Inj. olanzapine, 0.5mg
0726   Dexrazoxane HCl injection
0731   Sargramostim injection
0736   Amphotericin b liposome inj
0752   Dactinomycin injection
0759   Naltrexone, depot form
0807   Aldesleukin injection
0812   Carmustine injection
0820   Daunorubicin injection
0825   Nelarabine injection
0836   Interferon alfa-2b inj
0840   Inj melpha hydroch nos 50 mg
0843   Pegaspargase injection
0844   Pentostatin injection
0858   Inj cladribine
0875   Euflexxa inj per dose
0877   Orthovisc inj per dose
0902   Injection,onabotulinumtoxinA
0943   Octagam injection
0944   Gammagard liquid injection
0946   Hepagam b im injection
0947   Flebogamma injection
1015   Injection glatiramer acetate
1083   Adalimumab injection
1138   Hepagam b intravenous, inj
1178   Busulfan injection
1203   Verteporfin injection
1207   Octreotide injection, depot
1214   Inj IVIG privigen 500 mg
1232   Mitomycin injection
1233   Inj, vasopressin, 1 unit
1234   Inj vasopressin (am reg) 1 u
1236   Inj levoleucovorin nos 0.5mg
1237   Inj iron dextran
1263   Antithrombin iii injection
1268   Xyntha inj
1274   Edetate calcium disodium inj
1296   Degarelix injection
1311   Canakinumab injection
1312   Hizentra injection
1327   Imiglucerase injection
1340   Collagenase, clost hist inj
1341   Amobarbital 125 MG inj
1352   Wilate injection
1353   Belimumab injection
1408   Cyclophosphamide 100 MG inj
1413   Lumizyme injection
1415   Glassia injection
1420   Aflibercept injection
1421   Imported lipodox inj
1426   Eribulin mesylate injection
1433   Calcitonin salmon injection
1440   Inj desmopressin acetate
1443   Icatibant injection
1458   Phentolaine mesylate inj
1468   Inj Aripiprazole Ext Rel 1mg
1469   Inj filgrastim excl biosimil
1474   Certolizumab pegol inj 1mg
1476   Obinutuzumab inj
1478   Inj human fibrinogen con nos
1480   Elosulfase alfa, injection
1489   Injection, vedolizumab
1490   Inj pembrolizumab
1608   Etanercept injection
1658   Injection, belinostat, 10mg
1660   Injection, oritavancin
1662   Inj tedizolid phosphate
1669   Erythro lactobionate /500 mg
1694   Ziconotide injection
1696   Palifermin injection
1700   Inj secretin synthetic human
1701   Treprostinil injection
1704   Humate-P, inj
1710   Clofarabine injection
1747   Monovisc inj per dose
1748   Inj tbo filgrastim 1 microg
1809   Injection, alemtuzumab
1823   Injection, dalbavancin
1824    Ceftaroline fosamil inj
1829    Penicillin g benzathine inj
1836   Penicillin g procaine inj
1849   Foscarnet sodium injection
1861   Inj., bendeka 1 mg
1862   Gelsyn-3 injection 0.1 mg
7041   Tirofiban hcl
90029496   Injections 9000–9999
9096   Inj retacrit esrd on dialysi
9106   Inj, bupivacaine (posimir)
9107   Inj, aponvie, 1 mg
9112   Inj teplizumab mzwv 5 mcg
9113   Inj olipudase alfa-rpcp 1mg
9115   Inj, spesolimab-sbzo, 1 mg
9117   Inj, cimerli, 0.1 mg
9119   Inj sodium thiosulfate 100mg
9138   Inj, hemgenix, per tx dose
9141   Inj onase abepar-xioi treat
9144   Inj, panzyga, 500 mg
9145   Inj, invega hafyera/trinza
9146   Inj, ixinity, 1 i.u.
9149   Inj ublituximab-xiiy, 1 mg
9155   Inj, lenacapavir, 1 mg
9157   Inj, lecanemab-irmb, 1 mg
9158   Inj, pegcetacoplan, 1mg
9160   Inj, acetaminophen (b braun)
9161   Inj cefazolin sodium, baxter
9162   Inj. cefepime hcl (baxter)
9163   Inj, cefepime hcl (b braun)
9164   Inj, daptomycin (hospira)
9166   Inj, fosaprepitant (teva)
9167   Inj, linezolid (hospira)
9168   Inj, meropenem (b. braun)
9169   Inj, micafungin (par pharm)
9170   Inj midazolam (wg crit care)
9211   Inj, morphine (fresenius)
9212   Inj moxifloxacin (fres kabi)
9216   Inj, naloxone hcl (zimhi)
9218   Chloroprocaine hcl injection
9219   Procainamide hcl injection
9220   Inj. tigecycline (accord)
9221   Inj, vancomycin hcl (mylan)
9222   Inj, vancomycin hcl (xellia)
9224   Galsulfase injection
9238   Calcium glucon (wg critical)
9246   Inj, abilify asimtufii, 1 mg
9247   Inj, amisulpride, 1 mg
9249   Inj buprenorph (brixadi) 1mg
9262   Inj tofersen intrathec 1 mg
9266   Inj, uzedy, 1 mg
9267   Inj, rezafungin, 1 mg
9268   Inj. acthar gel to 40 units
9275   Inj. (ani), up to 40 units
9277   Altuviiio per factor viii iu
9279   Inj. mycophenolate mofetil
9282   Inj, acetaminophen (hikma)
9283   Inj, epinephrine (belcher)
9285   Inj allopurinol sodium 1 mg
9288   Injection, aztreonam, 100 mg
9290   Inj, bupivacaine, nos, 0.5mg
9291   Inj, clindamycin phosp 300mg
9292   Inj, clindamycin (baxter)
9321   Fosphenytoin inj pe
9325   Inj., eravacycline, 1 mg
9332   Inj lefamulin 1 mg
9334   Injection, khapzory, 0.5 mg
9338   Inj., triluron, 1 mg
9360   Inj heparin, pfizer, 1000u
9363   Inj, esmolol hcl, 10mg
9365   Inj esmolol hcl wg crit care
9369   Inj, metronidazole, 10 mg
9400   Inj, labetalol hcl, 5mg
9402   Inj labetalol hcl hikma, 5mg
9403   Methylnaltrexone injection
9404   Inj, nitroglycerin, 5 mg
9405   Inj, biorphen, 20 micrograms
9420   Eptifibatide injection
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