Procedure code directory

Page 13 of 14, in code order. Codes J0945 to Q5101.

• J0945Injection, brompheniramine maleate, per 10 mg$0.17
• J1000Injection, depo-estradiol cypionate, up to 5 mg$33.58
• J1010Injection, methylprednisolone acetate, 1 mg$0.13
• J1020Injection, methylprednisolone acetate, 20 mg$6.69
• J1030Injection, methylprednisolone acetate, 40 mg$6.28
• J1040Injection, methylprednisolone acetate, 80 mg$9.59
• J1071Injection, testosterone cypionate, 1 mg$0.02
• J1096Dexamethasone, lacrimal ophthalmic insert, 0.1 mg$116.54
• J1097Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml$95.35
• J1100Injection, dexamethasone sodium phosphate, 1 mg$0.11
• J1170Injection, hydromorphone, up to 4 mg$3.63
• J1171Injection, hydromorphone, 0.1 mg$0.08
• J1200Injection, diphenhydramine hcl, up to 50 mg$0.80
• J1201Injection, cetirizine hydrochloride, 0.5 mg$14.55
• J1245Injection, dipyridamole, per 10 mg$3.64
• J1250Injection, dobutamine hydrochloride, per 250 mg$8.45
• J1306Injection, inclisiran, 1 mg$11.94
• J1335Injection, ertapenem sodium, 500 mg$11.23
• J1434Injection, fosaprepitant (focinvez), 1 mg$2.91
• J1437Injection, ferric derisomaltose, 10 mg$19.81
• J1439Injection, ferric carboxymaltose, 1 mg$1.09
• J1442Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram$0.97
• J1449Injection, eflapegrastim-xnst, 0.1 mg$26.09
• J1453Injection, fosaprepitant, 1 mg$0.14
• J1454Injection, fosnetupitant 235 mg and palonosetron 0.25 mg$676.41
• J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg$47.48
• J1556Injection, immune globulin (bivigam), 500 mg$72.82
• J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg$48.15
• J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg$45.73
• J1569Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg$44.58
• J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg$66.24
• J1580Injection, garamycin, gentamicin, up to 80 mg$2.48
• J1602Injection, golimumab, 1 mg, for intravenous use$11.35
• J1610Injection, glucagon hydrochloride, per 1 mg$185.52
• J1611Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg$120.29
• J1626Injection, granisetron hydrochloride, 100 mcg$0.31
• J1627Injection, granisetron, extended-release, 0.1 mg$5.48
• J1642Injection, heparin sodium, (heparin lock flush), per 10 units$0.02
• J1644Injection, heparin sodium, per 1000 units$0.24
• J1720Injection, hydrocortisone sodium succinate, up to 100 mg$17.67
• J1740Injection, ibandronate sodium, 1 mg$27.51
• J1745Injection, infliximab, excludes biosimilar, 10 mg$31.05
• J1750Injection, iron dextran, 50 mg$17.12
• J1756Injection, iron sucrose, 1 mg$0.22
• J1885Injection, ketorolac tromethamine, per 15 mg$0.65
• J1930Injection, lanreotide, 1 mg$47.89
• J1939Injection, bumetanide, 0.5 mg$0.62
• J1940Injection, furosemide, up to 20 mg$0.51
• J1952Leuprolide injectable, camcevi, 1 mg$56.44
• J1954Injection, leuprolide acetate for depot suspension (cipla), 7.5 mg$300.04
• J1955Injection, levocarnitine, per 1 gm$27.74
• J1956Injection, levofloxacin, 250 mg$0.96
• J2001Injection, lidocaine hcl for intravenous infusion, 10 mg$0.03
• J2003Injection, lidocaine hydrochloride, 1 mg$0.57
• J2010Injection, lincomycin hcl, up to 300 mg$9.55
• J2060Injection, lorazepam, 2 mg$1.13
• J2175Injection, meperidine hydrochloride, per 100 mg$5.69
• J2182Injection, mepolizumab, 1 mg$29.61
• J2185Injection, meropenem, 100 mg$0.37
• J2250Injection, midazolam hydrochloride, per 1 mg$0.13
• J2270Injection, morphine sulfate, up to 10 mg$4.17
• J2274Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg$11.15
• J2280Injection, moxifloxacin, 100 mg$8.67
• J2323Injection, natalizumab, 1 mg$22.47
• J2350Injection, ocrelizumab, 1 mg$54.53
• J2353Injection, octreotide, depot form for intramuscular injection, 1 mg$207.19
• J2356Injection, tezepelumab-ekko, 1 mg$17.74
• J2357Injection, omalizumab, 5 mg$37.10
• J2360Injection, orphenadrine citrate, up to 60 mg$8.75
• J2403Chloroprocaine hcl ophthalmic, 3% gel, 1 mg$0.64
• J2405Injection, ondansetron hydrochloride, per 1 mg$0.09
• J2406Injection, oritavancin (kimyrsa), 10 mg$40.41
• J2468Injection, palonosetron hydrochloride (avyxa), not therapeutically equivalent to j2469, 25 micrograms$57.82
• J2469Injection, palonosetron hcl, 25 mcg$0.89
• J2506Injection, pegfilgrastim, excludes biosimilar, 0.5 mg$65.85
• J2543Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)$1.12
• J2545Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit$75.63
• J2550Injection, promethazine hcl, up to 50 mg$3.15
• J2704Injection, propofol, 10 mg$0.11
• J2720Injection, protamine sulfate, per 10 mg$1.54
• J2777Injection, faricimab-svoa, 0.1 mg$34.37
• J2778Injection, ranibizumab, 0.1 mg$159.00
• J2781Injection, pegcetacoplan, intravitreal, 1 mg$146.64
• J2782Injection, avacincaptad pegol, 0.1 mg$108.28
• J2785Injection, regadenoson, 0.1 mg$6.76
• J2795Injection, ropivacaine hydrochloride, 1 mg$0.07
• J2796Injection, romiplostim, 10 micrograms$96.86
• J2805Injection, sincalide, 5 micrograms$121.62
• J2916Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg$2.14
• J2919Injection, methylprednisolone sodium succinate, 5 mg$0.28
• J2920Injection, methylprednisolone sodium succinate, up to 40 mg$4.09
• J2930Injection, methylprednisolone sodium succinate, up to 125 mg$5.71
• J2997Injection, alteplase recombinant, 1 mg$88.19
• J3010Injection, fentanyl citrate, 0.1 mg$0.90
• J3032Injection, eptinezumab-jjmr, 1 mg$17.64
• J3111Injection, romosozumab-aqqg, 1 mg$10.70
• J3121Injection, testosterone enanthate, 1 mg$0.05
• J3145Injection, testosterone undecanoate, 1 mg$1.85
• J3245Injection, tildrakizumab, 1 mg$134.63
• J3247Injection, secukinumab, intravenous, 1 mg$17.20
• J3260Injection, tobramycin sulfate, up to 80 mg$2.38
• J3262Injection, tocilizumab, 1 mg$5.86
• J3299Injection, triamcinolone acetonide (xipere), 1 mg$47.53
• J3300Injection, triamcinolone acetonide, preservative free, 1 mg$4.35
• J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg$0.97
• J3304Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg$17.28
• J3315Injection, triptorelin pamoate, 3.75 mg$428.00
• J3360Injection, diazepam, up to 5 mg$5.64
• J3370Injection, vancomycin hcl, 500 mg$2.20
• J3380Injection, vedolizumab, intravenous, 1 mg$21.66
• J3411Injection, thiamine hcl, 100 mg$2.09
• J3415Injection, pyridoxine hcl, 100 mg$13.58
• J3420Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg$1.24
• J3475Injection, magnesium sulfate, per 500 mg$0.57
• J3480Injection, potassium chloride, per 2 meq$0.11
• J3489Injection, zoledronic acid, 1 mg$6.45
• J3490Unclassified drugs$174.57
• J3590Unclassified biologics$583.31
• J7030Infusion, normal saline solution , 1000 cc$2.58
• J7040Infusion, normal saline solution, sterile (500 ml = 1 unit)$1.28
• J70425% dextrose/normal saline (500 ml = 1 unit)$1.18
• J7050Infusion, normal saline solution, 250 cc$0.64
• J70605% dextrose/water (500 ml = 1 unit)$1.77
• J7120Ringers lactate infusion, up to 1000 cc$2.40
• J7308Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)$387.14
• J7312Injection, dexamethasone, intravitreal implant, 0.1 mg$199.53
• J7318Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg$6.47
• J7320Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg$5.37
• J7321Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose$72.31
• J7322Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg$17.14
• J7323Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose$118.58
• J7324Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose$123.96
• J7325Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg$8.81
• J7326Hyaluronan or derivative, gel-one, for intra-articular injection, per dose$509.33
• J7327Hyaluronan or derivative, monovisc, for intra-articular injection, per dose$676.13
• J7328Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg$0.52
• J7329Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg$7.16
• J7331Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg$10.27
• J7332Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg$10.15
• J7336Capsaicin 8% patch, per square centimeter$3.25
• J7345Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg$1.66
• J7351Injection, bimatoprost, intracameral implant, 1 microgram$203.27
• J7355Injection, travoprost, intracameral implant, 1 microgram$191.89
• J7611Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form,$0.16
• J7613Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg$0.05
• J7614Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 $0.05
• J7620Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered $0.18
• J7644Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dos$0.33
• J7674Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg$1.17
• J7999Compounded drug, not otherwise classified$130.30
• J9000Injection, doxorubicin hydrochloride, 10 mg$3.29
• J9022Injection, atezolizumab, 10 mg$83.41
• J9025Injection, azacitidine, 1 mg$0.37
• J9030Bcg live intravesical instillation, 1 mg$2.85
• J9035Injection, bevacizumab, 10 mg$69.31
• J9041Injection, bortezomib, 0.1 mg$1.80
• J9045Injection, carboplatin, 50 mg$3.52
• J9047Injection, carfilzomib, 1 mg$47.63
• J9060Injection, cisplatin, powder or solution, 10 mg$3.28
• J9073Injection, cyclophosphamide (ingenus), 5 mg$0.89
• J9075Injection, cyclophosphamide, not otherwise specified, 5 mg$0.99
• J9119Injection, cemiplimab-rwlc, 1 mg$27.25
• J9144Injection, daratumumab, 10 mg and hyaluronidase-fihj$48.93
• J9155Injection, degarelix, 1 mg$4.16
• J9171Injection, docetaxel, 1 mg$0.86
• J9173Injection, durvalumab, 10 mg$79.13
• J9177Injection, enfortumab vedotin-ejfv, 0.25 mg$35.42
• J9181Injection, etoposide, 10 mg$1.10
• J9190Injection, fluorouracil, 500 mg$2.88
• J9196Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg$7.02
• J9201Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg$3.29
• J9206Injection, irinotecan, 20 mg$2.55
• J9217Leuprolide acetate (for depot suspension), 7.5 mg$176.80
• J9250Methotrexate sodium, 5 mg$0.30
• J9260Injection, methotrexate sodium, 50 mg$2.26
• J9263Injection, oxaliplatin, 0.5 mg$0.07
• J9264Injection, paclitaxel protein-bound particles, 1 mg$13.41
• J9267Injection, paclitaxel, 1 mg$0.10
• J9271Injection, pembrolizumab, 1 mg$55.27
• J9280Injection, mitomycin, 5 mg$55.73
• J9299Injection, nivolumab, 1 mg$30.47
• J9304Injection, pemetrexed (pemfexy), 10 mg$55.69
• J9305Injection, pemetrexed, not otherwise specified, 10 mg$4.36
• J9312Injection, rituximab, 10 mg$75.61
• J9355Injection, trastuzumab, excludes biosimilar, 10 mg$77.94
• J9380Injection, teclistamab-cqyv, 0.5 mg$30.83
• J9394Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg$32.47
• J9395Injection, fulvestrant, 25 mg$8.03
• J9999Not otherwise classified, antineoplastic drugs$54.35
• L8606Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies$257.42
• L8607Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies$49.24
• M0010Enhancing oncology model (eom) monthly enhanced oncology services (meos) payment for eom enhanced services$71.22
• M0201Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only o$37.99
• P9016Red blood cells, leukocytes reduced, each unit$122.63
• P9047Infusion, albumin (human), 25%, 50 ml$51.86
• P9603Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or $1.08
• P9604Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or $11.14
• P9612Catheterization for collection of specimen, single patient, all places of service$8.30
• P9615Catheterization for collection of specimen(s) (multiple patients)$8.34
• Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory$43.15
• Q0092Set-up portable x-ray equipment$25.53
• Q0111Wet mounts, including preparations of vaginal, cervical or skin specimens$16.85
• Q0112All potassium hydroxide (koh) preparations$5.67
• Q0138Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)$0.35
• Q3001Radioelements for brachytherapy, any type, each$257.44
• Q3014Telehealth originating site facility fee$28.75
• Q4010Cast supplies, short arm cast, adult (11 years +), fiberglass$23.01
• Q4014Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass$31.42
• Q4021Cast supplies, short arm splint, adult (11 years +), plaster$8.05
• Q4022Cast supplies, short arm splint, adult (11 years +), fiberglass$14.44
• Q4037Cast supplies, short leg cast, adult (11 years +), plaster$19.43
• Q4038Cast supplies, short leg cast, adult (11 years +), fiberglass$47.92
• Q4046Cast supplies, short leg splint, adult (11 years +), fiberglass$21.80
• Q4049Finger splint, static$2.51
• Q4158Kerecis omega3, per square centimeter$146.69
• Q4159Affinity, per square centimeter$302.38
• Q4164Helicoll, per square centimeter$1533.07
• Q4180Revita, per square centimeter$511.91
• Q4186Epifix, per square centimeter$151.15
• Q4188Amnioarmor, per square centimeter$832.88
• Q4190Artacent ac, per square centimeter$332.58
• Q4191Restorigin, per square centimeter$1480.98
• Q4194Novachor, per square centimeter$982.49
• Q4196Puraply am, per square centimeter$102.33
• Q4197Puraply xt, per square centimeter$104.89
• Q4204Xwrap, per square centimeter$2776.15
• Q4205Membrane graft or membrane wrap, per square centimeter$1301.16
• Q4221Amniowrap2, per square centimeter$1751.50
• Q4229Cogenex amniotic membrane, per square centimeter$883.45
• Q4236Carepatch, per square centimeter$758.90
• Q4238Derm-maxx, per square centimeter$1119.08
• Q4239Amnio-maxx or amnio-maxx lite, per square centimeter$2395.07
• Q4248Dermacyte amniotic membrane allograft, per square centimeter$1068.36
• Q4250Amnioamp-mp, per square centimeter$2301.94
• Q4257Relese, per square centimeter$945.37
• Q4262Dual layer impax membrane, per square centimeter$1135.62
• Q4265Neostim tl, per square centimeter$2070.67
• Q4271Complete ft, per square centimeter$1655.29
• Q4275Esano aca, per square centimeter$2621.95
• Q4276Orion, per square centimeter$1335.32
• Q4277Woundplus membrane or e-graft, per square centimeter$1738.38
• Q4278Epieffect, per square centimeter$409.48
• Q4281Barrera sl or barrera dl, per square centimeter$1499.19
• Q4282Cygnus dual, per square centimeter$773.66
• Q4290Membrane wrap-hydro, per square centimeter$1906.94
• Q4294Amnio quad-core, per square centimeter$2211.76
• Q4295Amnio tri-core amniotic, per square centimeter$1971.26
• Q4299Amnicore pro+, per square centimeter$2369.06
• Q4303Complete aa, per square centimeter$3301.13
• Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram$0.32