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: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (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.

Last Updated Oct 02 , 2025