Self-Administered Drug Exclusion List (A53032) - R44 - Effective January 1, 2026

Date Posted: January 2, 2026

This billing and coding article has been revised and published for notice under contract numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), and 01312 (NV).

Effective Date: January 1, 2026

Summary of Changes:

EXCLUDED CPT/HCPCS CODES:

Deleted: J2940 Somatrem, 1 mg (Protropin); J3355 Urofollitropin, 75 IU (Metrodin, Bravelle, Ferinex); and J9212 Interferon Alfacon-1, Recombinant, 1 microgram (Infergen)

NON-EXCLUDED CPT/HCPCS CODES:

Deleted: J1562 Injection, Immune Globulin (Vivaglobin), 100 mg

Visit the Self-Administered Drugs (SADs) webpage to view the Self-Administered Drug Exclusion List.

To view the complete listing of billing and coding articles and/or access the Active, Future, or Retired articles available in the CMS MCD, visit the Billing and Coding Articles webpage.

Last Updated $dateUtil.getDate( $modifieddate , "MMM dd , yyyy" , $locale , $tzone )