Specialty drug billing & coding references

HCPCS, NDC, modifier, ICD-10, payer policy, and Medicare ASP — sourced inline, refreshed quarterly, reviewed by the CareCost editorial team.

Abraxane
paclitaxel protein-bound (nab-paclitaxel)
J9264
Metastatic breast, NSCLC (combo), pancreatic adenocarcinoma (combo)
Actemra / biosimilars
tocilizumab + Tofidence, Tyenne, Avtozma
J3262 Q5135
RA, JIA, GCA, CRS, COVID, SSc-ILD
Acthar Gel
corticotropin (repository)
J0801 J0802
MS exacerbations, infantile spasms, multiple rheum/derm/renal indications (SC/IM)
Adcetris
brentuximab vedotin
J9042
Hodgkin lymphoma, ALCL, PTCL, CTCL (anti-CD30 ADC)
Aldurazyme
laronidase
J1931
MPS I (Hurler/Hurler-Scheie/Scheie) ERT (IV weekly)
Alyglo
immune globulin IV 10% (GC Biopharma)
J1552
PI (lowest IgA content — IgA-deficient niche)
Amvuttra
vutrisiran
J0225
hATTR-PN + ATTR-CM (SC q3mo siRNA, HELIOS-B 2025)
Aranesp
darbepoetin alfa
J0881 J0882
Long-acting ESA (CKD anemia + CIA; non-ESRD vs ESRD codes)
Avastin / biosimilars
bevacizumab + Mvasi, Zirabev, Alymsys, Vegzelma, Avzivi
J9035 Q5107 Q5118 Q5126 Q5129 Q5145
mCRC, NSCLC, GBM, RCC, cervical, ovarian, HCC
Bendeka
bendamustine HCl (premixed)
J9034
CLL, indolent NHL, MCL (10-min infusion vs Treanda J9033)
Benlysta
belimumab
J0490
SLE + lupus nephritis (anti-BAFF IV q4wk; pediatric ≥5 yr)
Beovu
brolucizumab-dbll
J0179
wAMD, DME
Berinert
C1 esterase inhibitor (human)
J0597
HAE acute attack treatment (IV on-demand)
Besponsa
inotuzumab ozogamicin
J9229
R/R B-cell precursor ALL (anti-CD22 ADC, calicheamicin payload)
Briumvi
ublituximab-xiiy
J2329
Relapsing forms of MS (RRMS, active SPMS, CIS — not PPMS)
Cerezyme
imiglucerase
J1786
Type 1 Gaucher disease ERT (IV)
Cimzia
certolizumab pegol
J0717
RA, PsA, AS, axSpA, plaque psoriasis, Crohn's
Cinqair
reslizumab
J2786
Severe eosinophilic asthma (IV, eos ≥400)
Cinryze
C1 esterase inhibitor (human)
J0598
HAE prophylaxis (IV q3-4d, plasma-derived)
Columvi
glofitamab-gxbm
J9286
R/R DLBCL (CD20×CD3 IV bispecific, fixed 12-cycle)
Cosentyx
secukinumab
J3247
PsA, AS, plaque psoriasis
Crysvita
burosumab-twza
J0584
X-linked hypophosphatemia + tumor-induced osteomalacia (anti-FGF23 SC)
Cutaquig
immune globulin SC 16.5% (Octapharma)
J1551
PI (SCIG, only 16.5% concentration)
Cuvitru
immune globulin SC 20% (Takeda)
J1555
PI (SCIG via pump)
Darzalex
daratumumab (IV)
J9145
Multiple myeloma, AL amyloidosis
Darzalex Faspro
daratumumab + hyaluronidase-fihj (SC)
J9144
Multiple myeloma, AL amyloidosis (SC formulation)
Doxil / Lipodox
doxorubicin HCl liposomal (pegylated)
Q2050
Ovarian (post-platinum), Kaposi, MM (combo with bortezomib)
Elaprase
idursulfase
J1743
MPS II (Hunter) ERT (IV weekly)
Elfabrio
pegunigalsidase alfa-iwxj
J2508
Fabry disease ERT (IV q2wk PEGylated; vs Fabrazyme J0180)
Elrexfio
elranatamab-bcmm
J1323
R/R multiple myeloma (BCMA×CD3 SC bispecific, REMS)
Empliciti
elotuzumab
J9176
Relapsed/refractory multiple myeloma
Enhertu
fam-trastuzumab deruxtecan-nxki
J9358
HER2+/low/ultralow breast, HER2+ gastric, HER2+ NSCLC, tumor-agnostic
Entyvio
vedolizumab
J3380
UC, Crohn's disease
Epkinly
epcoritamab-bysp
J9321
R/R DLBCL, FL (CD20×CD3 SC bispecific)
Epogen / Procrit
epoetin alfa
J0885
Short-acting ESA (CKD anemia, CIA, surgery, HIV)
Eylea
aflibercept
J0178
wAMD, DME, RVO, mCNV
Eylea HD
aflibercept (8 mg high-dose)
J0177
wAMD, DME, DR, RVO (high-dose formulation)
Fabrazyme
agalsidase beta
J0180
Fabry disease ERT (IV q2wk)
Fasenra
benralizumab
J0517
Severe eos asthma, EGPA (q4wk×3 → q8wk SC)
Faslodex
fulvestrant (originator + generics)
J9395
HR+/HER2- mBC (CDK4/6 combo SOC; bilateral IM)
Feraheme
ferumoxytol
Q0138 Q0139
IDA (IV, 510 mg ×2; non-ESRD vs ESRD codes; Boxed)
Firmagon
degarelix
J9155
Advanced prostate cancer (GnRH antagonist, no flare)
Gammagard Liquid
immune globulin IV 10% (Takeda)
J1569
PI, MMN, off-label CIDP / SID
Gamunex-C / Gammaked
immune globulin IV 10% (Grifols / Kedrion)
J1561
PI, ITP, CIDP (IV + SC)
Gemcitabine
gemcitabine (Gemzar + generics)
J9201
Pancreatic, NSCLC, breast, ovarian, bladder, biliary
Givlaari
givosiran
J0223
Acute hepatic porphyria attack reduction (SC monthly siRNA)
Haegarda
C1 esterase inhibitor SC (human)
J0599
HAE prophylaxis (SC q3-4d, plasma-derived)
Herceptin / biosimilars
trastuzumab + Ontruzant, Herzuma, Ogivri, Trazimera, Kanjinti, Hercessi
J9355 Q5112 Q5113 Q5114 Q5116 Q5117 Q5144
HER2+ breast cancer, HER2+ gastric
Hizentra
immune globulin SC 20% (CSL)
J1559
PI, CIDP maintenance (SCIG via pump)
Humira / biosimilars
adalimumab + Amjevita, Cyltezo, Hadlima, Hyrimoz
J0135 Q5131 Q5126
RA, PsA, AS, Crohn's, UC, plaque psoriasis
Imfinzi
durvalumab
J9173
NSCLC (PACIFIC), SCLC (ADRIATIC), HCC, biliary, urothelial, endometrial
INFeD
iron dextran
J1750
IDA (IV, requires test dose; Boxed)
Injectafer
ferric carboxymaltose
J1439
IDA (IV, 750 mg ×2; HF + pediatric expansions)
Jemperli
dostarlimab-gxly
J9272
dMMR/MSI-H endometrial (RUBY 1L), tumor-agnostic dMMR
Keytruda
pembrolizumab
J9271
Multiple solid tumor & hematologic indications
Kisunla
donanemab-azbt
J0175
Early symptomatic Alzheimer's (q4wk anti-amyloid IV)
Kyprolis
carfilzomib
J9047
R/R multiple myeloma (2nd-gen proteasome inhibitor IV)
Lemtrada
alemtuzumab
J0202
Relapsing forms of MS
Leqembi
lecanemab-irmb
J0174
Early symptomatic Alzheimer's (q2wk anti-amyloid IV)
Libtayo
cemiplimab-rwlc
J9119
Cutaneous SCC (1st FDA), BCC, NSCLC, cervical
Lucentis / biosimilars
ranibizumab + Byooviz, Cimerli
J2778 Q5124
wAMD, DME, RVO, mCNV, ROP
Lunsumio
mosunetuzumab-axgb
J9350
R/R follicular lymphoma (CD20×CD3 IV bispecific, fixed-duration)
Lupron Depot
leuprolide acetate (long-acting depot)
J1950
Prostate cancer, endometriosis, fibroids, central precocious puberty
Mircera
methoxy PEG-epoetin beta
J0888
CKD-only ESA (q4wk longest-acting; CKD-only positioning)
Monoferric
ferric derisomaltose
J1437
IDA (IV, 1,000 mg single-dose course)
Naglazyme
galsulfase
J1458
MPS VI (Maroteaux-Lamy) ERT (IV weekly)
Neulasta + biosimilars
pegfilgrastim
J2506 Q5108 Q5111 Q5120 Q5122 Q5125
Long-acting G-CSF for chemo-induced neutropenia prevention
Nucala
mepolizumab
J2182
Severe eos asthma, EGPA, HES, CRSwNP (anti-IL-5 SC)
Ocrevus
ocrelizumab (IV)
J2350
RRMS, PPMS, SPMS
Ocrevus Zunovo
ocrelizumab and hyaluronidase-ocsq (SC)
J2351
RRMS, PPMS, SPMS (subcutaneous)
Octagam
immune globulin IV 5% / 10% (Octapharma)
J1568
PI, ITP, dermatomyositis (10%)
Onivyde
irinotecan liposomal (pegylated)
J9205
Metastatic pancreatic adenocarcinoma (NALIRIFOX 1L 2024)
Onpattro
patisiran
J0222
hATTR-PN (IV q3wk siRNA)
Opdivo
nivolumab
J9299
Melanoma, NSCLC, RCC, others
Orencia
abatacept
J0129
RA, JIA, PsA, aGVHD prevention
Oxaliplatin
oxaliplatin (Eloxatin + generics)
J9263
CRC (FOLFOX), gastric (FLOT), pancreatic (FOLFIRINOX)
Padcev
enfortumab vedotin-ejfv
J9177
Locally advanced/metastatic urothelial cancer (Keytruda combo 1L + post-platinum mono)
Pemetrexed
pemetrexed (Alimta + generics)
J9305
Non-squamous NSCLC, mesothelioma (vitamin supp + CrCl)
Perjeta
pertuzumab
J9306
HER2+ breast cancer (combo with Herceptin)
Polivy
polatuzumab vedotin-piiq
J9309
DLBCL 1L (POLARIX with R-CHP) + R/R DLBCL
Privigen
immune globulin IV 10% (CSL)
J1459
PI, ITP, CIDP
Prolia / Jubbonti + biosimilars
denosumab + Jubbonti, Stoboclo
J0897 Q5136 Q5157 Q5158
Postmenopausal osteoporosis + AI/ADT-induced bone loss (60 mg SC q6mo; vs Xgeva 120 mg q4wk for cancer SREs)
Reblozyl
luspatercept-aamt
J0896
Beta-thalassemia + MDS transfusion-dependent anemia (SC)
Remicade / biosimilars
infliximab + Inflectra, Renflexis, Avsola
J1745 Q5103 Q5104 Q5121
RA, AS, PsA, psoriasis, Crohn's, UC
Retacrit
epoetin alfa-epbx (biosimilar)
Q5106 Q5105
Biosimilar ESA (Epogen/Procrit reference; non-ESRD vs ESRD)
Rituxan / biosimilars
rituximab + Ruxience, Truxima, Riabni
J9312 Q5119 Q5115
NHL, CLL, RA, GPA/MPA
Ruconest
C1 esterase inhibitor recombinant
J0596
HAE acute attack treatment (IV on-demand, recombinant)
Sandostatin / LAR Depot
octreotide acetate
J2354 J2353
Acromegaly + carcinoid + NETs (SC non-depot vs IM LAR depot)
Saphnelo
anifrolumab-fnia
J0491
Moderate-severe SLE (anti-IFN-α/β receptor IV q4wk)
Sarclisa
isatuximab-irfc
J9227
Multiple myeloma (anti-CD38, IMROZ 1L 2024)
Simponi Aria
golimumab (IV)
J1602
RA, PsA, AS, polyarticular JIA
Skyrizi (IV induction)
risankizumab-rzaa
J2327
Crohn's + UC IV induction (IL-23, → SC maintenance)
Soliris / biosimilars
eculizumab + Epysqli, Bkemv
J1299 Q5151 Q5152
PNH, aHUS, gMG, NMOSD
Stelara / biosimilars
ustekinumab + Wezlana, Selarsdi, +more
J3357 J3358 Q5137 Q5138
PsA, plaque psoriasis, Crohn's, UC
Takhzyro
lanadelumab-flyo
J0593
HAE prophylaxis (SC q2-4wk mAb)
Talvey
talquetamab-tgvs
J3055
R/R multiple myeloma (GPRC5D×CD3 SC bispecific, REMS)
Tecentriq
atezolizumab
J9022
NSCLC, SCLC, HCC, urothelial, TNBC, melanoma, sarcoma
Tecvayli
teclistamab-cqyv
J9380
R/R multiple myeloma (BCMA×CD3 SC bispecific, REMS)
Tivdak
tisotumab vedotin-tftv
J9273
Recurrent/metastatic cervical cancer (anti-tissue-factor ADC)
Tremfya (IV induction)
guselkumab
J1628
Crohn's + UC IV induction (IL-23) + psoriasis/PsA SC
Trodelvy
sacituzumab govitecan-hziy
J9317
Metastatic TNBC, HR+/HER2- metastatic breast, urothelial
Tyruko
natalizumab-sztn (biosimilar)
Q5134
RRMS, Crohn's disease
Tysabri
natalizumab
J2323
RRMS, Crohn's disease
Tzield
teplizumab-mzwv
J9381
Delay onset of stage 3 T1D (14-day IV course, anti-CD3)
Ultomiris
ravulizumab-cwvz
J1303
PNH, aHUS, gMG, NMOSD
Vabysmo
faricimab-svoa
J2777
wAMD, DME, RVO
Velcade
bortezomib + Boruzu, generic
J9041 J9054 J9049
Multiple myeloma + MCL (proteasome inhibitor SC/IV)
Venofer
iron sucrose
J1756
IDA in CKD (IV, HDD-CKD bundled into ESRD PPS)
Vimizim
elosulfase alfa
J1322
MPS IVA (Morquio A) ERT (IV weekly)
Vyepti
eptinezumab-jjmr
J3032
Migraine prevention (episodic + chronic)
Xembify
immune globulin SC 20% (Grifols)
J1558
PI (SCIG via pump)
Xenpozyme
olipudase alfa-rpcp
J0218
ASMD / Niemann-Pick type B + A/B (first-in-class IV q2wk)
Xolair
omalizumab
J2357
Allergic asthma, CSU, CRSwNP, food allergy (anti-IgE SC)
Yervoy
ipilimumab
J9228
Melanoma, RCC, MSI-H/dMMR CRC, HCC, NSCLC, esoph, mesothelioma (Opdivo combos)

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