Self-Administered Drug Exclusion List (A53033) - R28 - Effective August 11, 2022

This coverage 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: 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 Fri, 12 Aug 2022 18:51:06 +0000