Self-Administered Drug Exclusion List (A53033) - R44 - Effective November 15, 2025

Date Posted: October 2, 2025

This billing and coding article has been revised and published for notice under contract numbers: 02101 (AK), 02201 (ID), 02301(OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date: November 15, 2025

Summary of Changes:

EXCLUDED CPT/HCPCS CODES:

Added: J0490 INJECTION, BELIMUMAB, 10 MG (Benlysta)*

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.

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