Chemotherapy Administration - R20

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

Effective Date: July 1, 2019
Summary of Changes: Effective 04/01/2019, changed FUSILEV® (J0641) to Khapzory™ (J3490) for Non-Outpatient Prospective Payment System (OPPS in the Infusions Chemotherapy section and asterisked section below it because FUSILEV® (J0641) is for levoleucovorin calcium instead of levoleucovorin. Effective 07/01/2019, added the following codes to the Infusions Chemotherapy section.

  • C9049 - tagraxofusp-erzs (Elzonris™)
  • Q5112 - trastuzumab-dttb, biosimilar (Ontruzant®)
  • Q5113 - trastuzumab-pkrb, biosimilar (Herzuma®)
  • Q5114 - trastuzumab-dkst, biosimilar (Ogivri™)

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Last Updated Jul 18, 2019