|
J9000 |
 |
Injection, doxorubicin hydrochloride, 10 mg
| short | Doxorubicin hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J9010 |
|
Injection, alemtuzumab, 10 mg
| short | Alemtuzumab injection |
|
|
|
J9015 |
|
Injection, aldesleukin, per single use vial
| short | Aldesleukin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9017 |
|
Injection, arsenic trioxide, 1 mg
| short | Arsenic trioxide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 30.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9019 |
|
Injection, asparaginase (erwinaze), 1,000 iu
| short | Erwinaze injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9020 |
|
Injection, asparaginase, not otherwise specified, 10,000 units
| short | Asparaginase, nos |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J9022 |
|
Injection, atezolizumab, 10 mg
| short | Inj, atezolizumab,10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 168.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 168.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9023 |
|
Injection, avelumab, 10 mg
| short | Injection, avelumab, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 140.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 140.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9025 |
|
Injection, azacitidine, 1 mg
| short | Azacitidine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9027 |
|
Injection, clofarabine, 1 mg
| short | Clofarabine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9030 |
|
Bcg live intravesical instillation, 1 mg
| short | Bcg live intravesical 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9031 |
|
Bcg (intravesical) per instillation
| short | Bcg live intravesical vac |
|
|
|
J9032 |
|
Injection, belinostat, 10 mg
| short | Injection, belinostat, 10mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9033 |
|
Injection, bendamustine hcl (treanda), 1 mg
| short | Inj., treanda 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9034 |
|
Injection, bendamustine hcl (bendeka), 1 mg
| short | Inj., bendeka 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9035 |
|
Injection, bevacizumab, 10 mg
| short | Bevacizumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 170.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 170.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9036 |
|
Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg
| short | Inj. belrapzo/bendamustine |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 360.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9039 |
|
Injection, blinatumomab, 1 microgram
| short | Injection, blinatumomab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 210.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 210.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9040 |
|
Injection, bleomycin sulfate, 15 units
| short | Bleomycin sulfate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9041 |
|
Injection, bortezomib (velcade), 0.1 mg
| short | Inj., velcade 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 35.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 35.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9042 |
|
Injection, brentuximab vedotin, 1 mg
| short | Brentuximab vedotin inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9043 |
|
Injection, cabazitaxel, 1 mg
| short | Cabazitaxel injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9044 |
|
Injection, bortezomib, not otherwise specified, 0.1 mg
| short | Inj, bortezomib, nos, 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 35.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | OPH | 35.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9045 |
|
Injection, carboplatin, 50 mg
| short | Carboplatin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 22.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 22.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9047 |
|
Injection, carfilzomib, 1 mg
| short | Injection, carfilzomib, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9050 |
|
Injection, carmustine, 100 mg
| short | Carmustine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9055 |
|
Injection, cetuximab, 10 mg
| short | Cetuximab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9057 |
|
Injection, copanlisib, 1 mg
| short | Inj., copanlisib, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9060 |
|
Injection, cisplatin, powder or solution, 10 mg
| short | Cisplatin 10 mg injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9065 |
|
Injection, cladribine, per 1 mg
| short | Inj cladribine per 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9070 |
|
Cyclophosphamide, 100 mg
| short | Cyclophosphamide 100 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 55.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 55.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9098 |
|
Injection, cytarabine liposome, 10 mg
| short | Cytarabine liposome inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9100 |
|
Injection, cytarabine, 100 mg
| short | Cytarabine hcl 100 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J9118 |
|
Injection, calaspargase pegol-mknl, 10 units
| short | Inj. calaspargase pegol-mknl |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J9119 |
|
Injection, cemiplimab-rwlc, 1 mg
| short | Inj., cemiplimab-rwlc, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 350.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 350.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9120 |
|
Injection, dactinomycin, 0.5 mg
| short | Dactinomycin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9130 |
|
Dacarbazine, 100 mg
| short | Dacarbazine 100 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 24.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9145 |
|
Injection, daratumumab, 10 mg
| short | Injection, daratumumab 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9150 |
|
Injection, daunorubicin, 10 mg
| short | Daunorubicin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9151 |
|
Injection, daunorubicin citrate, liposomal formulation, 10 mg
| short | Daunorubicin citrate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9153 |
|
Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
| short | Inj daunorubicin, cytarabine |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 132.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 132.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9155 |
|
Injection, degarelix, 1 mg
| short | Degarelix injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9160 |
|
Injection, denileukin diftitox, 300 micrograms
| short | Denileukin diftitox inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 7.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9165 |
|
Injection, diethylstilbestrol diphosphate, 250 mg
| short | Diethylstilbestrol injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J9171 |
|
Injection, docetaxel, 1 mg
| short | Docetaxel injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 240.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9173 |
|
Injection, durvalumab, 10 mg
| short | Inj., durvalumab, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9175 |
|
Injection, elliotts' b solution, 1 ml
| short | Elliotts b solution per ml |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9176 |
|
Injection, elotuzumab, 1 mg
| short | Injection, elotuzumab, 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3000.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3000.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9178 |
|
Injection, epirubicin hcl, 2 mg
| short | Inj, epirubicin hcl, 2 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9179 |
|
Injection, eribulin mesylate, 0.1 mg
| short | Eribulin mesylate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9181 |
|
Injection, etoposide, 10 mg
| short | Etoposide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 11.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9185 |
|
Injection, fludarabine phosphate, 50 mg
| short | Fludarabine phosphate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9190 |
|
Injection, fluorouracil, 500 mg
| short | Fluorouracil injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J9199 |
|
Injection, gemcitabine hydrochloride (infugem), 200 mg
| short | Injection, infugem, 200 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J9200 |
|
Injection, floxuridine, 500 mg
| short | Floxuridine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 16.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J9201 |
|
Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
| short | In gemcitabine hcl nos 200mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9202 |
|
Goserelin acetate implant, per 3.6 mg
| short | Goserelin acetate implant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 3.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9203 |
|
Injection, gemtuzumab ozogamicin, 0.1 mg
| short | Gemtuzumab ozogamicin 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 180.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9204 |
|
Injection, mogamulizumab-kpkc, 1 mg
| short | Inj mogamulizumab-kpkc, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9205 |
|
Injection, irinotecan liposome, 1 mg
| short | Inj irinotecan liposome 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 215.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 215.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9206 |
|
Injection, irinotecan, 20 mg
| short | Irinotecan injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 42.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 42.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9207 |
|
Injection, ixabepilone, 1 mg
| short | Ixabepilone injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 90.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9208 |
|
Injection, ifosfamide, 1 gram
| short | Ifosfamide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 15.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9209 |
|
Injection, mesna, 200 mg
| short | Mesna injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 55.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 55.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9210 |
|
Injection, emapalumab-lzsg, 1 mg
| short | Inj., emapalumab-lzsg, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J9211 |
|
Injection, idarubicin hydrochloride, 5 mg
| short | Idarubicin hcl injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9212 |
|
Injection, interferon alfacon-1, recombinant, 1 microgram
| short | Interferon alfacon-1 inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J9213 |
|
Injection, interferon, alfa-2a, recombinant, 3 million units
| short | Interferon alfa-2a inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9214 |
|
Injection, interferon, alfa-2b, recombinant, 1 million units
| short | Interferon alfa-2b inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9215 |
|
Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu
| short | Interferon alfa-n3 inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J9216 |
|
Injection, interferon, gamma 1-b, 3 million units
| short | Interferon gamma 1-b inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9217 |
|
Leuprolide acetate (for depot suspension), 7.5 mg
| short | Leuprolide acetate suspnsion |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 6.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9218 |
|
Leuprolide acetate, per 1 mg
| short | Leuprolide acetate injeciton |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9219 |
|
Leuprolide acetate implant, 65 mg
| short | Leuprolide acetate implant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9225 |
|
Histrelin implant (vantas), 50 mg
| short | Vantas implant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9226 |
|
Histrelin implant (supprelin la), 50 mg
| short | Supprelin la implant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9228 |
|
Injection, ipilimumab, 1 mg
| short | Ipilimumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9229 |
|
Injection, inotuzumab ozogamicin, 0.1 mg
| short | Inj inotuzumab ozogam 0.1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 27.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 27.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9230 |
|
Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg
| short | Mechlorethamine hcl inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9245 |
|
Injection, melphalan hydrochloride, 50 mg
| short | Inj melphalan hydrochl 50 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 9.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 11.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9250 |
|
Methotrexate sodium, 5 mg
| short | Methotrexate sodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 25.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9260 |
|
Methotrexate sodium, 50 mg
| short | Methotrexate sodium inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9261 |
|
Injection, nelarabine, 50 mg
| short | Nelarabine injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 80.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 80.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9262 |
|
Injection, omacetaxine mepesuccinate, 0.01 mg
| short | Inj, omacetaxine mep, 0.01mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 700.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 700.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9263 |
|
Injection, oxaliplatin, 0.5 mg
| short | Oxaliplatin |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 700.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 700.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9264 |
|
Injection, paclitaxel protein-bound particles, 1 mg
| short | Paclitaxel protein bound |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9265 |
|
Injection, paclitaxel, 30 mg
| short | Paclitaxel injection |
|
|
|
J9266 |
|
Injection, pegaspargase, per single dose vial
| short | Pegaspargase injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 2.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9267 |
|
Injection, paclitaxel, 1 mg
| short | Paclitaxel injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 750.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 750.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9268 |
|
Injection, pentostatin, 10 mg
| short | Pentostatin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 1.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9269 |
|
Injection, tagraxofusp-erzs, 10 micrograms
| short | Inj. tagraxofusp-erzs 10 mcg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J9270 |
|
Injection, plicamycin, 2.5 mg
| short | Plicamycin (mithramycin) inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | OPH | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued | | DME | 0.0 | 3 Date of Service Edit: Clinical | Drug discontinued |
|
|
|
|
J9271 |
|
Injection, pembrolizumab, 1 mg
| short | Inj pembrolizumab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 300.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9280 |
|
Injection, mitomycin, 5 mg
| short | Mitomycin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 12.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9285 |
|
Injection, olaratumab, 10 mg
| short | Inj, olaratumab, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9293 |
|
Injection, mitoxantrone hydrochloride, per 5 mg
| short | Mitoxantrone hydrochl / 5 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 8.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9295 |
|
Injection, necitumumab, 1 mg
| short | Injection, necitumumab, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 800.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 800.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9299 |
|
Injection, nivolumab, 1 mg
| short | Injection, nivolumab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 480.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 480.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9300 |
|
Injection, gemtuzumab ozogamicin, 5 mg
| short | Gemtuzumab ozogamicin inj |
|
|
|
J9301 |
|
Injection, obinutuzumab, 10 mg
| short | Obinutuzumab inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 100.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9302 |
|
Injection, ofatumumab, 10 mg
| short | Ofatumumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 200.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9303 |
|
Injection, panitumumab, 10 mg
| short | Panitumumab injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 90.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 90.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9305 |
|
Injection, pemetrexed, 10 mg
| short | Pemetrexed injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9306 |
|
Injection, pertuzumab, 1 mg
| short | Injection, pertuzumab, 1 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 840.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 840.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9307 |
|
Injection, pralatrexate, 1 mg
| short | Pralatrexate injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 80.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9308 |
|
Injection, ramucirumab, 5 mg
| short | Injection, ramucirumab |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 280.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 280.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9309 |
|
Injection, polatuzumab vedotin-piiq, 1 mg
| short | Inj, polatuzumab vedotin 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
|
|
|
J9310 |
|
Injection, rituximab, 100 mg
|
|
|
J9311 |
|
Injection, rituximab 10 mg and hyaluronidase
| short | Inj rituximab, hyaluronidase |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 160.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9312 |
|
Injection, rituximab, 10 mg
| short | Inj., rituximab, 10 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 150.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9313 |
|
Injection, moxetumomab pasudotox-tdfk, 0.01 mg
| short | Inj., lumoxiti, 0.01 mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9315 |
|
Injection, romidepsin, 1 mg
| short | Romidepsin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 40.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 40.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9320 |
|
Injection, streptozocin, 1 gram
| short | Streptozocin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9325 |
|
Injection, talimogene laherparepvec, per 1 million plaque forming units
| short | Inj talimogene laherparepvec |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9328 |
|
Injection, temozolomide, 1 mg
| short | Temozolomide injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 400.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9330 |
|
Injection, temsirolimus, 1 mg
| short | Temsirolimus injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 50.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9340 |
|
Injection, thiotepa, 15 mg
| short | Thiotepa injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9351 |
|
Injection, topotecan, 0.1 mg
| short | Topotecan injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | OPH | 120.0 | 3 Date of Service Edit: Clinical | Clinical: Society Comment | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9352 |
|
Injection, trabectedin, 0.1 mg
| short | Injection trabectedin 0.1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 40.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 40.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9354 |
|
Injection, ado-trastuzumab emtansine, 1 mg
| short | Inj, ado-trastuzumab emt 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 600.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9355 |
|
Injection, trastuzumab, excludes biosimilar, 10 mg
| short | Inj trastuzumab excl biosimi |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 105.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 105.0 | 3 Date of Service Edit: Clinical | CMS Policy | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9356 |
|
Injection, trastuzumab, 10 mg and hyaluronidase-oysk
| short | Inj. herceptin hylecta, 10mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 60.0 | 3 Date of Service Edit: Clinical | Prescribing Information |
|
|
|
|
J9357 |
|
Injection, valrubicin, intravesical, 200 mg
| short | Valrubicin injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9360 |
|
Injection, vinblastine sulfate, 1 mg
| short | Vinblastine sulfate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 40.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 40.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 45.0 | 3 Date of Service Edit: Clinical | Clinical: CMS Workgroup |
|
|
|
|
J9370 |
|
Vincristine sulfate, 1 mg
| short | Vincristine sulfate 1 mg inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
J9371 |
|
Injection, vincristine sulfate liposome, 1 mg
| short | Inj, vincristine sul lip 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 5.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9390 |
|
Injection, vinorelbine tartrate, 10 mg
| short | Vinorelbine tartrate inj |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 36.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 36.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9395 |
|
Injection, fulvestrant, 25 mg
| short | Injection, fulvestrant |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 20.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9400 |
|
Injection, ziv-aflibercept, 1 mg
| short | Inj, ziv-aflibercept, 1mg |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 500.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9600 |
|
Injection, porfimer sodium, 75 mg
| short | Porfimer sodium injection |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Prescribing Information | | DME | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |
|
|
|
|
J9999 |
|
Not otherwise classified, antineoplastic drugs
| short | Chemotherapy drug |
| RVU | | CPT Modifier | Physician Component | Facility Practice | Nonfacility Practice | Professional Liability Insurance | Total Facility | Total Nonfacility | Global Period |
|---|
| 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | XXX |
|
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| DME | 0.0 | 3 Date of Service Edit: Clinical | Published Contractor Policy |
|
|
|