Date Posted: July 16, 2026

This billing and coding article has been revised and published for notice under contract numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: August 29, 2026

Summary of Changes:

Under Excluded CPT/HCPCS Codes, added Q5164 Injection, ustekinumab-hmny (starjemza), biosimilar, 1 mg* and J3490, J3590, C9399 bimekizumab-bkzx (Bimzelx®)

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

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