| JCode | GenericName | BrandName |
|---|---|---|
| J0129 | Abatacept | Orencia/Orencia ClickJect |
| J0135 | Adalimumab | Humira |
| J0180 | Agalsidase beta | Fabrazyme |
| J0202 | Alemtuzumab | Lemtrada |
| J0221 | Alglucosidase alfa | Lumizyme |
| J0256 | Alpha-1 proteinase inhibitor | Aralast NP/Prolastin-C/Zemaira |
| J0257 | Alpha-1 proteinase inhibitor | Glassia |
| J7186 | Antihemophilic factor viii/von willebrand | Alphanate |
| J7198 | Anti-inhibitor Coagulant Complex | Feiba |
| Q2041 | Axicabtagene ciloleucel | Yescarta |
| J0490 | Belimmab | Benlysta |
| J0517 | Benralizumab | Fasenra |
| J0584 | Burosumab-twza | Crysvita |
| J0638 | Canakinumab | Ilaris |
| J0567 | Cerliponase alfa | Brineura |
| J7202 | Coagulation Factor IX (Recombinant), Albumin Fusion Protein (rlX-FP) | Idelvion |
| J7193 | Coagulation Factor IX (Human) | Alphanine SD |
| J7194 | Coagulation Factor IX (Human) | Profilnine |
| J7195 | Coagulation Factor IX (Recombinant) | BeneFIX |
| J7201 | Coagulation Factor IX (Recombinant),Fc Fusion Protein | Alprolix |
| J1299 | Eculizumab | Soliris |
| J1301 | Edaravone | Radicava |
| J3590 | Elapegademase-lvlr | Revcovi |
| J1322 | Elosulfase alfa | Vimzim |
| J7170 | Emicizumab-kxwh | Hemlibra |
| J1438 | Etanercept | Enbrel |
| J0606 | Etelcalcetide | Parsibiv |
| J7200 | Factor ix, (antihemophilic factor) | Rixubis |
| J7191 | Factor viii (antihemophilic factor, porcine) | Hyate C |
| J7192 | Factor viii (antihemophilic factor, recombinant) | Advate, Kogenate FS, Recombinate |
| J7205 | Factor viii fc fusion protein (recombinant) | Eloctate |
| J7207 | Factor viii, (antihemophilic factor) | Adynovate |
| J7210 | Factor viii, (antihemophilic factor) | Afstyla |
| J7182 | Factor viii, (antihemophilic factor) | Novoeight |
| J7209 | Factor viii, (antihemophilic factor) | Nuwiq |
| J7199, C9141 | Factor viii, (antihemophilic factor) | Jivi |
| J7175 | Factor X (human) | Coagadex |
| J7180 | Factor xiii (antihemophilic factor, human) | Corifact |
| Q5101 | Filgrastim | Zarxio |
| J1442 | Filgrastim | Neupogen |
| J1447 | Filgrastim-aafi | Nivestym |
| J1458 | Galsulfase | Naglazyme |
| J1602 | Golimumab | Simponi Aria |
| J7190 | Hemophilia clotting factor, not otherwise classified | Koate/Koate DVI/Hemofil-M |
| J7178 | Human fibrinogen concentrate | Fibryga, RiaSTAP |
| J7329 | Hyaluronan or derivative, trivisc, | TriVisc |
| J1743 | Idursulfase | Elaprase |
| J1786 | Imigulcerase | Cerezyme |
| J1556 | Immune globulin | Bivigam |
| J1555 | Immune globulin | Cuvitru |
| J1572 | Immune globulin | Flebogamma/ Flebogamma Dif |
| J1557 | immune globulin | Gammaplex |
| J1561 | Immune globulin | Gamunex-c/Gammaked |
| J1559 | Immune globulins, serum or recombinant products | Hizentra |
| J1459 | Immune globulin | Privigen |
| J1569 | Immune globulin, (gammagard liquid) | Gammagard Liquid |
| J1568 | Immune globulin, (octagam) | Octagam |
| J1599 | Immune globulin, intravenous | Carimune |
| J1576 | Immune Globulin, intravenous | Panzyga |
| J1566 | Immune globulin, intravenous, lyophilized (powdered) | Gammagard S/D |
| J1575 | Immune globulin/hyaluronidase, (hyqvia) | HyQvia |
| 90283 | Immune Globulins, Serum or Recombinant Products | Iveegam EN |
| 90284 | Immune Globulins, Serum or Recombinant Products | SCIG (used Hizentra/Hizentra 20%) |
| J1745 | Infliximab, excludes biosimilars | Remicade |
| Q5104 | Infliximab-abda (biosimilar) | Renflexis |
| Q5103 | Infliximab-dyyb (biosimilar) | Inflectra |
| J7185 | Injection, factor viii (antihemophilic factor) | Xyntha/Xyntha Solofuse |
| J7181 | Injection, factor xiii a-subunit, (recombinant) | Tretten |
| J1931 | Laronidase | Aldurazyme |
| J2182 | Mepolizumab | Nucala |
| J2350 | Ocrelizumab | Ocrevus |
| J2357 | Omalizumab | Xolair |
| J0222 | Patisiran | Onpattro |
| J2504 | Pegademase bovine | Adagen |
| J2506 | Pegfilgrastim | Neulasta |
| Q5111 | Pegfilgrastim-cbqv | Udenyca |
| Q5108 | Pegfilgrastim-jmdb | Fulphila |
| J7211 | Recombinant Human Factor VIII | Kovaltry |
| J7188 | Recombinant Porcine Factor VIII | Obizur |
| J7189 | Recominant Human Factor Vlla | NovoSeven RT |
| J0801 | Repository Corticotropin Injection | Acthar (HP Acthar Gel) |
| J2786 | Reslizumab | Cinqair |
| J2820 | Sargramostim | Leukine |
| J2840 | Sebelipase Alfa | Kanuma |
| J7331 | Sodium hyaluronate | Synojoynt |
| J7320 | Sodium hyaluronate | GenVisc 850 |
| J7321 | Sodium hyaluronate | Hyalgan |
| J7321 | Sodium hyaluronate | Supartz |
| J7321 | Sodium hyaluronate | Visco-3 |
| J7322 | Sodium hyaluronate | Hymovis |
| J7324 | Sodium hyaluronate | Orthovisc |
| J7326 | Sodium hyaluronate | Gel-One |
| J7327 | Sodium hyaluronate | Monovisc |
| J7325 | Sodium hyaluronate | Synvisc |
| J7325 | Sodium hyaluronate | Synvisc-One |
| J3060 | Taliglucerace alfa | Elelyso |
| J1447 | tbo-filgrastim | Granix |
| J3245 | Tildrakizumab | Ilumya |
| Q2042 | Tisagenlecleucel | Kymriah |
| J3262 | Tocilizumab | Actemra |
| J3380 | Vedolizumab | Entyvio |
| J3385 | Velaglucerase alfa | VPRIV |
| J3397 | Vestronidase alfa-vjbk | Mepsevii |
| J7179 | von Willebrand factor (VWF) Recombinant Human | Vonvendi |
| J7187 | von Willebrand factor complex | Humate-P |
| J7183 | von Willebrand Factor Complex (human)/Antihemophilic Factor | Wilate |
| J3398 | Voretigene neparvovec-rzyl | Luxturna |
| J1303 | Ravulizmub-cwvz | Ultomiris |
| J9210 | Emapalumab | Gamifant |
| J3490, J3590, C9399 | Immune globulin | Cutaquig |
| J0885 | Epoetin alfa | Procrit, Epogen |
| J2597 | Desmopressin Acetate | Ddavp |
| J7204 | Antihemophilic Factor | Esperoct |
| J1439 | Ferric Carboxymaltose | Injectafer |
| Q0138 | Ferumoxytol | Feraheme |
| J1554 | Immune globulin, intravenous | Asceniv |
| J9312 | Rituximab | Rituxan |
| Q5115 | Rituximab-abbs | Truxima |
| J7203 | Coagulation Factor | Rebinyn |
| J7197 | Antithrombin | Thrombate |
| J 7178 | Fibrinogen Concentrate | RiaStap |
| C9132 | Prothrombin Concentrate Complex (Human) | Kcentra |
| J0717 | Certolizumab pergol | Cimzia |
| J3358 | Ustekinumab | Stelara IV |
| Q5119 | Rituximab-pvvr | Ruxience |
| J3399 | Onasemngene abeparvoec-xioi | Zolgensma (avxs)-101 |
| J2323 | Natalizumab | Tysabri |
| J2507 | Pegloticase | Krystexxa |
| J0597 | C1 esterase Inhibitor human | Berinert |
| J0598 | C1 esterase Inhibitor human | Cinryze |
| J1290 | Ecallantide | Kalbitor |
| J0596 | C1 esterase inhibitor recombinant | Ruconest |
| J3241 | Teprotumumab-trbw | Tepezza |
| Q5122 | Pegfilgrastim-apgf | Nyvepria |
| Q2053 | KTE-X19 CAR-T Cell Therapy | Tecartus |
| 90378 | Palivizumab | Synagis |
| J1823 | Inebilizumab | Uplizna |
| J1427 | Viltolarsen | Viltepso |
| J1558 | Immune Globulin | Xembify |
| J0896 | Luspatercept | Reblozyl |
| J0791 | Ccrizanlizumab | Adakveo |
| J0223 | Givosiran | Givlaari |
| J7212 | Recombinant Human Factor Vlla | Seven Fact |
| J7352 | Afamelanotide | Scenesse |
| Q5123 | Rituximab-arrx | Riabni |
| J0224 | Oxlumo | Lumasiran |
| J1429 | Golodirsen | Vyondys 53 |
| J0219 | Avalglucosidase alfa-ngpt | Nexviazyme |
| J0491 | Anifrolumab-fnia | Saphnelo |
| C9090 | plasminogen, human tvmh | Ryplazim |
| C9075 | Casimersen | Amondys 45 |
| J3490, J3590, C9399, J9999 | idecabtagene vicleucel, Ide-cel | Abecma |
| J1305 | evinacumab-dgnb | Evkeeza |
| J1809 | fosdenopterin | Nulibry |
| Q2054 | lisocabtagene maraleucel | Breyanzi |
| J1437 | ferric derisomaltose | Monoferric |
| J0802 | repository corticotropin injection | Cortrophin Gel/Purified Corticotropin Gel |
| J2777 | Faricimab-svoa | Vabysmo |
| C9098 | Citacabtagene autoleucel | Carvykti |
| J1306 | Inclislran | Leqvio |
| J2779 | Ranibizumab Injection | Susvimo |
| J9332 | Efgartigimod alfa-fcab | Vyvgart |
| J3590, C9399 | allogenic processed thymus tissue agdc | Rethymic |
| J1302 | sutimlimab-jome | Enjaymo |
| Q5125 | filgrastim-ayow | Releuko |
| J2356 | tezepelumab-ekko | Tezspire |
| Q5130 | pegfilgrastim-pbbk | Fylnetra |
| J0879 | difelikefalin | Korsuva |
| A9607 | lutetium Lu177 vipivotide, tetraxetan | Pluvicto |
| J2327 | risankizumab-rzaa | Skyrizi IV |
| Q5121 | Infliximab-axxq | Avsola |
| J0225 | Vutrisiran | Amvuttra |
| J3387 | Elivaldogene autoemcel | Skysona |
| J9939 | Betibeglogene autoemcel | Zynteglo |
| J1411 | Entranacogene dezaparvovec | Hemgenix |
| J1449 | Eflapegrastim-xnst | Rolvedon |
| J1747 | Spesolimab-sbzo | Spevigo |
| Q5127 | Pegfilgrastim-fpgk | Stimufend |
| J0218 | Olipudase-alfa | Xenpozyme |
| J1930 | lanreotide | Lanreotide |
| J7214 | Antihemophilic factor (recombinant) Fc-VWF-XTEN fusion protein-ethl | Altuviiio |
| J2329 | Ublituximab-xiiy | Briumvi |
| J0217 | Velmanase alfa-tycv | Lamzede |
| J1304 | Toferson | Qaisody |
| J2781 | Pegcetacoplan-injection | Syfovyre |
| J3401 | Beremagene geperpavec | Vyjuvek |
| J0174 | lecanemab | Leqembi |
| J1413 | Delandistrogene moxeparvovec-roki | Elevidys |
| J2508 | Pegunigalsidase alfa | Elfabrio |
| J2782 | Avacincapted pegol | Izervay |
| J1412 | Valoctocgene roxaparvovec | Roctavian |
| J9333 | Rozanolixizumab-noli | Rystiggo |
| J9376 | Poselimab-bbfg | Veopoz |
| J9334 | Efgartigimod alfa and hyaluronidase-qvfc | Vyvgart, Hytrulo |
| J7193 | Coagulation Factor IX | Mononine |
| J7171 | ADAMTS13,recombinant krhn | Adzyma |
| J2267 | Mirikizumab-mrkz | Omvoh IV |
| J1203 | Cipaglucosidase Alfa | Pombiliti |
| J3392 | Exagamglogene autotemcel | Casgevy |
| J3392 | Exagamglogene autotemcel | Casgevy |
| J3394 | Lovotibeglogene autotemcel | Lyfgenia |
| J3490,J3590,C9399 | Donislecel-jujn | Lantidra |
| J7213 | Coagulation Factor IX (Recombinant) | Ixinity |
| J3490, J3590, C9399 | Lifileucel | Amtagvi |
| J3247 | Secukinumab | Cosentyx IV |
| J3391 | Atidarsagene autotemcel | Lenmeldy |
| J3490, J3590, C9399 | Nedosiran | Rivfloza |
| J1414 | Fidanacogene elaparvovec-dzkt | Beqvez |
| J 1747 | Spesolimab-sbzo | Spevigo SC |
| 1/1/25 J000 | Example | Example |
| J0175 | Donanemab | Kisunla |
| J2351 | Ocrelizumab and hyaluronidase-ocsq | Ocrevus Zenovo |
| Q2057 | Afamitresgene autoleucel | Tecelra |
| J1628 | Guselkumab | Tremfya IV |
| J1552 | Immune globulin intravenous, human-stwk | Alyglo |
| J0179 | Brolucizumab-dbll | Beovu |
| Q5124 | Ranibizumab-nuna | Byooviz |
| J7332 | Sodium hyaluronate | Triluron |
| Q5133 | Tocilizumab-bavi | Tofidence |
| Q5135 | Tocilizumab-aazg | Tyenne |
| Q2058 | Obecabtagene autocel | Aucatzyl |
| J1307 | Crovalimab | PiaSky |
| J7172 | Marstacimab-hncq | Hympavzi |
| J9038 | Axatilimab-csfr | Niktimvo |
| J3402 | Remestemcel-l-rknd | Ryoncil |
| Q5099 | Ustekinumab-stba | Steqeyma |
| Q5100 | Ustekinumab-kfce | Yesintek |
| Q9999 | Ustekinumab-aauz | Otulfi |
| Q9996 | Ustekinumab-ttwe | Pyzchiva (SubQ) |
| Q9997 | Ustekinumab-ttwe | Pyzchiva (IV) |
| Q9998 | Ustekinumab-aekn | Selarsdi |
| Q5137 | Ustekinumab-auub | Wezlana (SubQ) |
| Q5138 | Ustekinumab-auub | Wezlana (IV) |
| J3403 | Revakinagene taroretcel-lwey | Encelto |
| Q5148 | Filgrastim-txid | Nypozi |
| J7174 | Fitusiran | Qfitlia |
| J3389 | Prademagene Zamikeracel | Zevaskyn |
| J7173 | concizumab-mtci | Alhemo |
| J1072 | testosterone cyprionate | Azmiro |
| J0589 | daxibotulinumtoxina-lanm | Daxxify |
| J0587 | rimabotulinumtoxinB | Myobloc |
| Q5136 | denosumab-bbdz | Jubbonti |
| J3490, J3590, C9399 | eladocagene exuparvovec | Kebilidi |
| Q5152 | eculizumab-aeeb | Bkemv |
| Q5151 | eculizumab-aagh | Epysqli |
| Q5098 | Q5098 | Imuldosa |
| J3490, J3590, C9399 | ustekinumab-hmny | Starjemza |
| J2779 | ranibizumab | Susvimo |
| Q5134 | natalizumab-sztn | Tyruko |
| J1553 | immune globulin IV, human-dira | Yimmugo |
| J9029 | nadofaragene firadenovec-vcng | Adstiladrin |
| J9325 | talimogene laherparepvec | Imlygic |
| J9301 | obinutuzumab | Gazyva |
| J9256 | nipocalimab-aahu | Imaavy |
| J3404 | zopapogene imadenovec-drba | Papzimeos |
* Prior authorization required when administered by provider for the following:
J1438 Etanercept Enbrel*
J0135 Adalimumab Humira*