CPT Code List Brand Name Generic Name HCPCS Codes Brand
CPT Code List Brand Name Generic Name HCPCS Codes Brand
CPT Code List Brand Name Generic Name HCPCS Codes Brand
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<strong>Name</strong><br />
<strong>Brand</strong><br />
<strong>CPT</strong> <strong>Code</strong> <strong>List</strong><br />
<strong>Generic</strong> <strong>Name</strong> <strong>HCPCS</strong> <strong>Code</strong>s <strong>Brand</strong> <strong>Name</strong> <strong>Generic</strong> <strong>Name</strong> <strong>HCPCS</strong> <strong>Code</strong>s<br />
Abraxane Paclitaxel J9264<br />
Factrel Vial w/<br />
Diluent<br />
Gonadorel<br />
Hydrochloride<br />
Actemra Tocilizumab J3262 Faslodex Fulvestrant J9395<br />
Actimmune<br />
Interferon gamma<br />
1B<br />
J1620<br />
J9216 Flebogamma Immune Globulin J1572<br />
Aldurazyme Laronidase J1931 Flolan Epoprostenol J1325<br />
Alferon N Interferon Alfa-N3 J9215<br />
Alimta<br />
Pemetrexed<br />
Disodium<br />
J9305<br />
Aralast Alpha 1 proteinase J0256<br />
Gamma globulin,<br />
intramuscular, 1cc<br />
Gamma globulin,<br />
intramuscular, over<br />
10cc<br />
Gammagard S/D,<br />
Gammargard Liq<br />
Immune Globulin<br />
Immune Globulin<br />
Immune Globulin<br />
J1460<br />
J1560<br />
J1569<br />
Aranesp Darbopoietin J0881, J0882 Gammaplex Immune globulin C9270<br />
Avastin Bevacizumab J9035, C9257 Gammar-P.I.V. Immune Globulin J1566<br />
Avonex Interferon beta 1-a<br />
Belimumab<br />
Benlysta<br />
J1826,<br />
Q3025,<br />
Q3026<br />
Q2044<br />
Betaseron Vial Interferon beta 1-b J1830<br />
Botox<br />
Botulinum toxin<br />
Type A<br />
Gamunex Immune Globulin J1561<br />
Genotropin<br />
Cartridge<br />
Genotropin<br />
Miniquick<br />
Somatotropin<br />
Somatotropin<br />
J2941<br />
J2941<br />
J0585 Herceptin Trastuzumab J9355<br />
Campath Alemtuzumab J9010 Hizentra Immune Globulin<br />
Carimune NF Immune Globulin J1566 Humatrope Cartridge Somatotropin J2941<br />
Ceredase Alglucerase J0205 Humatrope Vial Somatotropin J2941<br />
Cerezyme Imiglucerase J1786 Humira Pen Kit Adalimumab J0135<br />
Cimzia Kit Certolizumab pegol J0718 Humira Syringe Adalimumab J0135<br />
Copaxone Glatiramer Acetate J1595 Hyalgan Hyaluronate J7321<br />
Dysport<br />
Abobotulinum Toxin<br />
A<br />
J0586 Immune Globulin Immune Globulin<br />
J1559<br />
J1566 J1559, J1599,<br />
90281, 90283<br />
Eloxatin Oxaliplatin J9263 Increlex Mecasermin J2170<br />
Enbrel Kit Etanercept J1438 Infergen Interferon Alfacon-1 J9212<br />
Epogen or Procrit Erythropoietin J0885, J0886, Q4081 Infergen Vial Interferon Alfacon-1 J9212<br />
Erbitux Cetuximab J9055 Intron A Inj Pen Interferon alfa-2b J9214<br />
Euflexxa Hyaluronate J7323 Kineret Syr Anakinra J3490<br />
J1830<br />
Sargramostim; GM-<br />
Leukine<br />
J2820<br />
Extavia<br />
Interferon beta-1b<br />
CSF<br />
Fabrazyme Agalsidase Beta J0180 Lucentis Ranibizumab J2778<br />
Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an<br />
association of independent Blue Cross and Blue Shield Plans.<br />
Page 1 of 2
<strong>Brand</strong> <strong>Name</strong> <strong>Generic</strong> <strong>Name</strong> <strong>HCPCS</strong> <strong>Code</strong>s <strong>Brand</strong> <strong>Name</strong> <strong>Generic</strong> <strong>Name</strong> <strong>HCPCS</strong> <strong>Code</strong>s<br />
Lumizyme Alglucosidase Alfa C9257, C9277 Prokine<br />
Sargramostim<br />
Macugen PFS Pegaptanib J2503 Prolastin Alpha 1 proteinase J0256<br />
Myobloc<br />
Botulinum toxin<br />
Type A<br />
J2820<br />
J0587 Proleukin Aldesleukin, IL-2 J9015<br />
Myozyme Alglucosidase Alfa J0220 Rebif Syringe Interferon beta 1-a<br />
Q3025, Q3026,<br />
J1826, J1830<br />
Naglazyme Galsulfase J1458 Remicade Infliximab J1745<br />
Neulasta 6mg/0.6ml<br />
PFS<br />
Pegfilgrastim<br />
J2505<br />
Remodulin Treprostinil J3285<br />
Neupogen Filgrastim; G-CSF J1440, J1441 Rituxan Rituximab J9310<br />
Nordiflex<br />
Somatropin<br />
J2941<br />
Rocephin<br />
for lyme disease<br />
Ceftriaxone Sodium<br />
Norditropin Somatropin J2941 Saizen Injection Somatotropin J2941<br />
Norditropin CRTG Somatropin J2941 SCig Immune globulin 90284<br />
J0696<br />
Novantrone Mitoxantrone J9293<br />
Immune Globulin<br />
Subcutaneous<br />
SCIg<br />
[Human] 90284<br />
NuSpan Somatropin J2941 Serostim Vial Somatropin J2941<br />
Nutropin AQ<br />
Nutropin AQ Pen<br />
Cartridge<br />
Somatropin J2941 Somatrem Somatrem J2940<br />
Somatropin<br />
J2941<br />
Somatropin Somatropin J2941<br />
Nutropin AQ Vial Somatropin J2941 Stelara Ustekinumab<br />
J3357<br />
Nutropin Depot Somatropin J2941 Supartz Hyaluronic acid J7321<br />
Nutropin Vial Somatropin J2941 Synagis Palivizumab 90378<br />
Octagam Immune Globulin J1568 Synvisc Hyaluronate J7325<br />
Omnitrope Somatropin J2941 Synvisc One Hyaluronate J7325<br />
Orencia Abatacept J0129 Tev-Tropin<br />
Somatropin<br />
Orthovisc Hyaluronate J7324 Tyvaso TREPROSTINIL J7686<br />
Panglobulin Immune Globulin J1563 Vectibix Panitumumab J9303<br />
Pegasys Vial Peginteferon Alfa 2a S0145 Velcade Bortezomib J9041<br />
Peg-Intron RD Pen<br />
Peginteferon Alfa 2a S0148<br />
Kit<br />
Veletri Epoprostenol J1325<br />
Polygam S/D Immune Globulin J1563 Q4074<br />
Ventavis Lloprost<br />
Prialt Ziconotide J2278 Vidaza Azacitidine J9025<br />
J2941<br />
Privigen<br />
Immune Globulin<br />
(Human) IV Soln<br />
J1459<br />
Vpriv<br />
Velaglucerase alfa<br />
J3385<br />
Xeomin IncobotulinumtoxinA Q2040<br />
Xiaflex<br />
Collagenase,<br />
clostridium<br />
histolyticum<br />
J0775<br />
Xolair Omalizumab J2357<br />
Zemaira Alpha 1 proteinase J0256<br />
Zobtrive Somatropin J2941<br />
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