Self-Administered Drug Exclusion List (A53032) - R26 - Effective August 11, 2022

This coverage 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: August 11, 2022

Summary of Changes:

The article is updated to remove: Tezspire™ (tezepelumab-ekko) - C9399, J3490, J3590 effective 07/17/2022.

*Note: J2356 assigned to Tezspire™ (tezepelumab-ekko) was also not added due to the removal.

The article is updated to add an asterisk to Skyrizi™ - C9399, J3490, J3590 as this drug has multiple routes of administration and must be billed with the appropriate modifier. - Effective 06/17/2022.

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

To view the complete listing of coverage articles and/or access the Active, Future, or Retired articles available in the CMS MCD, visit the Medicare Coverage Articles webpage.

Last Updated Aug 12 , 2022